scholarly journals Effect of Intestinal Levodopa-Carbidopa Infusion on Pharyngeal Dysphagia: Results from a Retrospective Pilot Study in Patients with Parkinson’s Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Bendix Labeit ◽  
Inga Claus ◽  
Paul Muhle ◽  
Sonja Suntrup-Krueger ◽  
Rainer Dziewas ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Common Symptom ◽  
Yahr Stage ◽  
Future Studies ◽  
Pharyngeal Dysphagia ◽  
Before And After ◽  
The Mean ◽  
Larger Sample

Background. Pharyngeal dysphagia is a common symptom of Parkinson’s disease (PD) leading to severe complications. PD-related pharyngeal dysphagia (PDrPD) may significantly improve in up to half of patients following acute oral levodopa challenge. Objective. The aim of this study was to investigate the effects of levodopa-carbidopa intestinal gel (LCIG) on PDrPD. Methods. Forty-five PD patients under LCIG treatment were available for retrospective analysis. In all patients with PDrPD who underwent flexible endoscopic evaluation of swallowing (FEES) in the clinical “on-state” both before and after implementation of LCIG treatment, FEES videos were systematically reassessed. PDrPD was characterized using a PD-specific FEES score evaluating premature bolus spillage, penetration/aspiration, and pharyngeal residue. Further, the duration of white-out was assessed, as a parameter for pharyngeal bradykinesia. Results. Eleven patients with PDrPD (mean age 74.6 ± 4.4 years; mean Hoehn and Yahr stage 3.8 ± 0.6) received FEES both before and after the onset of LCIG treatment. The mean swallowing score improved from 14.9 ± 7.3 to 13.0 ± 6.9 after implementation of LCIG; however, this difference was not significant (p=0.312). Premature bolus spillage decreased significantly (p=0.002) from 5.4 ± 1.1 to 3.6 ± 1.0, and white-out duration decreased significantly (p=0.002) from 984 ± 228 ms to 699 ± 131 ms after implementation of LCIG. Conclusions. LCIG may affect PDrPD and reduce premature bolus spillage and pharyngeal bradykinesia. Future studies with larger sample sizes are required to follow-up on these pilot results and identify which factors predict a good response of PDrPD to LCIG treatment.

scholarly journals The Experiences of Patients with Deep Brain Stimulation in Parkinson’s Disease: Challenges, Expectations, and Accomplishments

2020 ◽  
Vol 49 (1) ◽  
pp. 36
Author(s):  
Özlem İbrahimoğlu ◽  
Sevinc Mersin ◽  
Eda Akyol
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Healthcare Professionals ◽  
Focus Group Interviews ◽  
The Mean ◽  
Group Interviews ◽  
Deep Brain

<p><strong>Objectives. </strong>Deep brain stimulation (DBS) is a safe and effective alternative treatment of some movement disorders such as Parkinson's disease. Although DBS is an effective treatment for Parkinson's disease, because of the necessity of surgical intervention, follow-up and the effects on symptoms, this study was carried out to determine the challenges, expectations and accomplishments of patients with DBS in Parkinson’s disease.</p><p><strong>Materials and Methods. </strong>This qualitative study was carried out at the Neurosurgery Department of a research hospital in Turkey with seven patients who underwent DBS between 2008 and 2018. In the study, the challenges, expectations, and accomplishments of patients were investigated by using three focus group interviews in October 2018.</p><p><strong>Results. </strong>Among the participants, six patients were male, and one patient was female. The mean age of the patients was 56.85}16.48. Three main themes were revealed in the study. These were (1) Reborn; decrease in dependence, sense of accomplishment, enjoyment of life, (2) Prejudice; perceived as severely ill by others and (3) Fear; not being accustomed to the device, loss of device function.</p><p><strong>Conclusion. </strong>The results obtained from this study can be used in the process of adaptation to this process by discussing and evaluating the challenges, expectations and accomplishments of the Parkinson's patient in DBS with healthcare professionals and other patients.</p>

scholarly journals A.01 Parkinson’s disease prognosis by early motor subtypes

2018 ◽  
Vol 45 (s2) ◽  
pp. S9-S9
Author(s):  
N Hey ◽  
ML Rajput ◽  
AH Rajput ◽  
A Rajput
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Symptom Onset ◽  
Primary Outcome ◽  
Disease Duration ◽  
Motor Symptom ◽  
Future Studies ◽  
Disease Prognosis ◽  
Significant Difference

Background: Studies of autopsy-confirmed cases suggest that Parkinson’s disease (PD) prognosis can be predicted using motor symptom severity at first visit. We evaluated the association between motor symptom subtype at first visit and severity at eight years disease duration among clinically-diagnosed cases at the Saskatchewan Movement Disorder Program. Methods: Retrospective data review identified 374 patients with first visit within three years of symptom onset, a clinical diagnosis of idiopathic PD, and a follow-up visit eight years after symptom onset. Subtypes were grouped as tremor-dominant (TD) if tremor was greater than rigidity and bradykinesia, akinetic-rigid (AR) if rigidity or bradykinesia was greater than tremor, and mixed (MX) if patient was neither TD nor AR based on assessment of all four limbs. Primary outcome was disease severity as measured by Hoehn & Yahr score at eight years after symptom onset. Results: The most common subtype was AR (n=164) followed by MX (n=156). TD was least common (n=54). There was no significant difference between subtypes in H&Y scores at eight years disease duration. Conclusions: These findings suggest that early PD prognosis cannot be predicted based on motor symptoms in all four limbs at first visit. Earlier studies had longer follow-up and future studies will examine progression at longer periods of disease duration.

scholarly journals The Clinical Non-Motor Connectome in Early Parkinson’s Disease

2020 ◽  
Vol 10 (4) ◽  
pp. 1797-1806
Author(s):  
Nico J. Diederich ◽  
Nicolas Sauvageot ◽  
Vannina Pieri ◽  
Géraldine Hipp ◽  
Michel Vaillant
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Early Stage ◽  
Correlation Coefficients ◽  
P Value ◽  
The Mean ◽  
Disease Initiation ◽  
Non Motor Symptoms ◽  
Early Parkinson’S Disease

Background: Non-motor symptoms (NMS) of various anatomical origins are seen in early stage idiopathic Parkinson’s disease (IPD). Objective: To analyse when and how NMS are linked together at this stage of the disease. Methods: Prospective study recruiting 64 IPD patients with ≤3 years of disease duration and 71 age-matched healthy controls (HC). NMS were clustered in 7 non-motor domains (NMD): general cognition, executive function, visuospatial function, autonomic function, olfaction, mood, and sleep. Correlation coefficients ≥|0.3| were considered as significant. Bootstrapped correlation coefficients between the scores were generated in both groups. Fourteen IPD patients and 19 HC were available for a follow-up study two years later. Results: The mean age of both groups was similar. 58% of IPD patients and 37% of HC were male (p = 0.01). At baseline IPD patients performed less well than HC on all NMD (p value between 0.0001 and 0.02). Out of 91 possible correlations between NMD, 21 were significant in IPD patients and 14 in HC at the level of ≥|0.3|. The mean correlation level was higher in IPD patients than in HC, as evidenced by the higher box plot of correlation coefficients. Visuospatial scores at baseline were predictive of the motor deterioration at the follow-up exam. Conclusion: At early IPD stage various NMS are linked together, although not connected by anatomical networks. Such a clinical NMD connectome suggests almost synchronous disease initiation at different sites as also supported by fMRI findings. Alternatively, there may be compensation-driven interconnectivity of NMD.

scholarly journals Technology-Assisted Rehabilitation of Writing Skills in Parkinson’s Disease: Visual Cueing versus Intelligent Feedback

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Evelien Nackaerts ◽  
Alice Nieuwboer ◽  
Elisabetta Farella
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Visual Cues ◽  
Healthy Controls ◽  
Short Term ◽  
Future Studies ◽  
Visual Cueing ◽  
Sensory Modalities ◽  
Larger Sample

Recent research showed that visual cueing can have both beneficial and detrimental effects on handwriting of patients with Parkinson’s disease (PD) and healthy controls depending on the circumstances. Hence, using other sensory modalities to deliver cueing or feedback may be a valuable alternative. Therefore, the current study compared the effects of short-term training with either continuous visual cues or intermittent intelligent verbal feedback. Ten PD patients and nine healthy controls were randomly assigned to one of these training modes. To assess transfer of learning, writing performance was assessed in the absence of cueing and feedback on both trained and untrained writing sequences. The feedback pen and a touch-sensitive writing tablet were used for testing. Both training types resulted in improved writing amplitudes for the trained and untrained sequences. In conclusion, these results suggest that the feedback pen is a valuable tool to implement writing training in a tailor-made fashion for people with PD. Future studies should include larger sample sizes and different subgroups of PD for long-term training with the feedback pen.

scholarly journals Network-based metaanalysis identifies HNF4A and PTBP1 as longitudinally dynamic biomarkers for Parkinson’s disease

2015 ◽  
Vol 112 (7) ◽  
pp. 2257-2262 ◽  
Author(s):  
Jose A. Santiago ◽  
Judith A. Potashkin
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Relative Abundance ◽  
Mrna Translation ◽  
The Elderly ◽  
Yahr Stage ◽  
Polypyrimidine Tract Binding Protein ◽  
Hepatocyte Nuclear Factor 4 ◽  
Microarray Studies

Environmental and genetic factors are likely to be involved in the pathogenesis of Parkinson’s disease (PD), the second most prevalent neurodegenerative disease among the elderly. Network-based metaanalysis of four independent microarray studies identified the hepatocyte nuclear factor 4 alpha (HNF4A), a transcription factor associated with gluconeogenesis and diabetes, as a central regulatory hub gene up-regulated in blood of PD patients. In parallel, the polypyrimidine tract binding protein 1 (PTBP1), involved in the stabilization and mRNA translation of insulin, was identified as the most down-regulated gene. Quantitative PCR assays revealed that HNF4A and PTBP1 mRNAs were up- and down-regulated, respectively, in blood of 51 PD patients and 45 controls nested in the Diagnostic and Prognostic Biomarkers for Parkinson’s Disease. These results were confirmed in blood of 50 PD patients compared with 46 healthy controls nested in the Harvard Biomarker Study. Relative abundance of HNF4A mRNA correlated with the Hoehn and Yahr stage at baseline, suggesting its clinical utility to monitor disease severity. Using both markers, PD patients were classified with 90% sensitivity and 80% specificity. Longitudinal performance analysis demonstrated that relative abundance of HNF4A and PTBP1 mRNAs significantly decreased and increased, respectively, in PD patients during the 3-y follow-up period. The inverse regulation of HNF4A and PTBP1 provides a molecular rationale for the altered insulin signaling observed in PD patients. The longitudinally dynamic biomarkers identified in this study may be useful for monitoring disease-modifying therapies for PD.

scholarly journals Risk factors and functional outcomes of surgical treatment of fall-related hip fractures in patients with Parkinson’s disease

2020 ◽  
Vol 10 (2) ◽  
pp. 70-76
Author(s):  
Bougiouklis Dimitrios ◽  
Psichogyios N Vasileios, ◽  
Plessas Spyridon ◽  
Konstas Athanasios ◽  
Louverdis ionysios
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Hip Fracture ◽  
Functional Outcome ◽  
Barthel Index ◽  
Functional Result ◽  
The Mean ◽  
Risk Of Fall

urpose: One of the cardinal symptoms of Parkinson’s disease (PD) is represented by postural instability and disturbed balance which can cause frequent falls in these patients. Indeed, the increased risk of falling in combination with osteoporosis puts PD patients at high risk for hip osteoporotic fractures. This study was aimed to evaluate the potential risk factors associated with fall-related hip fracture in individual with PD and 2) to determine the impact of the disease on the perioperative course and functional outcome of these fractures. Materials and methods: From 2005 to 2016, 209 patients (98 males and 111 females, aged >65 years) with a definitive diagnosis of idiopathic parkinsonism were enrolled in this multicenter retrospective study. From these patients, 123 sustained falling, while 86 did not. From the patients who sustained a fall, 41 patients sustained a hip fracture and were surgically treated with either internal fixation or hip hemiarthroplasty. The recorded clinical features were age, disease duration, falls, and type fracture. The risk of fall was assessed by Morse fall scale. According to the scores of the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Hoehn and Yahr staging(H&Y) we graded the PD severity. Osteoporosis was diagnosed using bone mineral density (BMD). The pre-fracture Barthel Index (BI) and Timed Up and Go test (TUG) were used to assess the functional status. In order to compare parameters that determine the functional result, was included a reference group of 40, sex- and age-matched, patients. This group comprised of individuals without intake of anti-parkinson medication. The perioperative complications and the in-hospital mortality were both reported. Results: The mean follow-up was 24-months. In this study, the percentage of falls was 58.8%, while the percentage of osteoporosis between patients with and without falls were respectively 33.3% (42/123) and 15.4% (13/86). 74 patients had fall-related fractures. Statistical analysis of the clinical manifestations and functional score findings between the PD patients with fall-related fractures and PD patients without fracture, revealed that sex (p = 0.001), mean Morse fall scale (p < 0.0001) and Hoehn and Yahr stage (p = 0.009) were significant variables. Regarding the functional outcome, no significant differences were observed between the groups [BI (p = 0.21) and TUG (p = 0.89)]. At the final follow-up, in patients with PD who were surgically treated for a fall-related hip fracture compare to patients without PD, the functional outcome was reduced according to Barthel Index (p = 0.001). Urinary tract infection was the more frequent perioperative complication. Post-operative pneumonia is another frequent complication, occurred in 5.5% of our series. 8 of 41 patients developed a pressure sore, while 1 patient with femoral neck fracture suffered a dislocation and underwent revision surgery. The mean length of hospital stay for Parkinson’s disease patients was 14 days, while patients without PD were staying 9 days.The in-hospital mortality rate for all patients was 4.3 %. Conclusions: Female sex, and advanced stage of PD and a higher mean Morse fall scale are associated with higher risk of fall-related hip fractures. Patients with PD who suffered a hip fracture are inclined to a longer hospital stay and a higher risk of complications. However, Parkinson’s disease does not represent a risk factor for a higher mortality or an inferior functional result, but in these patients, after 2-years follow-up, the functional outcome was reduced according to Barthel Index.

scholarly journals Predictive Factors of Concerns about Falling in People with Parkinson’s Disease: A 3-Year Longitudinal Study

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Magnus Lindh-Rengifo ◽  
Stina B. Jonasson ◽  
Niklas Mattsson ◽  
Susann Ullén ◽  
Maria H. Nilsson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Predictive Factors ◽  
Fear Of Falling ◽  
Daily Activities ◽  
Negative Consequences ◽  
Dual Tasking ◽  
Future Studies ◽  
Female Sex ◽  
The Mean

Introduction. Fear of falling (FOF) is more common in people with Parkinson’s disease (PD) than in healthy controls. It can lead to several negative consequences such as restrictions in everyday life. Moreover, FOF is a risk factor for future falls. Aim. This study aimed to identify predictive factors of FOF (conceptualized as concerns about falling) after three years, with and without adjusting for concerns about falling at baseline, in people with PD. Methods. This study included 151 participants (35% women) with PD. At baseline, their mean (SD) age and PD duration were 68 (±9.0) and 9 (±6.1) years, respectively. The Falls Efficacy Scale-International (FES-I) was used as the dependent variable in multivariable linear regression analyses. Results. The mean (SD) FES-I score increased from 28.1 (11.9) to 33.1 (14.0) three years later (p<0.001). The strongest (according to the standardized regression coefficient, β) predictor of concerns about falling was walking difficulties (β = 0.378), followed by age (0.227), problems maintaining balance while dual tasking (0.172), and needing help in daily activities (0.171). When adjusting for baseline FES-I scores, the strongest predictive factor was problems maintaining balance while dual tasking (β = 0.161), which was followed by age (0.131) and female sex (0.105). Conclusions. This study pinpoints several predictive factors of concerns about falling that are modifiable and which could be addressed in rehabilitation: perceived walking difficulties, having problems maintaining balance while dual tasking, and dependence on others in daily activities. The importance of dual tasking is a novel finding, which future studies need to confirm or refute. One should be aware of the fact that an increased age predicts concerns about falling with and without adjusting for baseline FES-I scores, whereas female sex predicts concerns about falling only when adjusting for baseline FES-I scores.

Efficacy of Intranasal Apomorphine in Parkinson's Disease

1995 ◽  
Vol 11 (5) ◽  
pp. 226-228 ◽  
Author(s):  
Jacinto Duarte ◽  
Maria Dolores Ruiz ◽  
Angel L Mataix ◽  
Angel P Sempere ◽  
Francisco M García ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Performance ◽  
Yahr Stage ◽  
Peak Dose ◽  
Metered Dose ◽  
Subcutaneous Apomorphine ◽  
Duration Of Response ◽  
Optimal Adjustment ◽  
The Mean

Objective: To suggest that intranasal delivery may offer an effective alternative to subcutaneous injection of apomorphine. Methods: Four patients (3 men, 1 woman) with idiopathic Parkinson's disease, with disabling “on-off” fluctuations in motor performance, despite optimal adjustment in the levodopa regimen and use of dopamine agonists, were included in this study. Their mean age was 61.5 years (range 58–65) and the mean duration of the disease was 13.5 years (range 5–18). The mean duration of levodopa treatment was 12.2 years (range 5–16). Disabling fluctuations had been present in these patients for more than 1 year. The Hoehn and Yahr stage was III-IV during the off periods. All four patients had dyskinesia when receiving the peak dose. Levodopa and dopamine agonist medications were unchanged for 1 month before the study. All four patients had already received intermittent subcutaneous apomorphine injections for a mean of 12.25 months (range 7–16). Apomorphine solution 10 mg/mL was administered with the use of a metered-dose nebulizer that delivered 1 mg of solution with each puff. Results: All patients showed a clear clinical response, with a mean reduction in daily off period of 94.5% with respect to the basal off period. No loss of therapeutic effect or increase in dyskinesia was observed compared with subcutaneous apomorphine. The speed, quality, and duration of response were comparable with that found with injection of apomorphine. One patient showed a slight vestibulitis, but it did not interfere with the efficacy of apomorphine. Conclusions: Intranasal apomorphine is a comfortable and easy alternative to subcutaneous apomorphine in the treatment of off phases in patients with Parkinson's disease and severe refractory motor fluctuations.

Management of visual hallucinations in dementia and Parkinson’s disease

2018 ◽  
Vol 31 (06) ◽  
pp. 815-836 ◽  
Author(s):  
Peter Swann ◽  
John T. O’Brien
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scales ◽  
Neuropsychiatric Symptoms ◽  
Functional Decline ◽  
Evidence Base ◽  
Psychotic Symptoms ◽  
Common Symptom ◽  
Visual Hallucinations

ABSTRACTObjectives:Visual hallucinations are a common symptom in dementia and Parkinson’s disease and have been associated with greater cognitive and functional decline, but optimal management strategies are unclear. We review the frequency and pathogenesis of visual hallucinations in dementia and Parkinson’s disease and examine the evidence base for their management.Design:We undertook a systematic review of the visual hallucinations in dementia, searching studies published between January 1980 and July 2017 using PubMed with the search terms visual hallucinations AND review AND (dementia OR parkinson*).Results:We found 645 articles and screened them for relevance, finally including 89 papers (11 meta-analyses, 34 randomized controlled trials, six other trials and a number of relevant review articles). Only six of the trials reported visual hallucination outcomes separately from other neuropsychiatric symptoms.Conclusions:Atypical antipsychotics were frequently studied, but with the exception of clozapine in Parkinson’s disease dementia, results were equivocal. There was some evidence that acetylcholinesterase inhibitors may help visual hallucinations. Overall, effect sizes for most treatments were small and there were few studies with long term follow up. Treatments need to be carefully weighed up with the risks and reviewed often, and many patients improved without treatment. There is a lack of data regarding visual hallucinations due to the grouping of psychotic symptoms together in commonly used rating scales. The lack of a specific rating scales, or analyzable items within other scales, for visual hallucinations, limited efficacy of current and small evidence base with short follow up are important areas for future studies to address.

Ventilatory Impairments Associated with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Laura López-López ◽  
Janet Remedios Rodríguez-Torres ◽  
Lawrence Patrick Cahalin ◽  
Irene Cabrera-Martos ◽  
Irene Torres Sánchez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Vital Capacity ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Cochrane Library ◽  
Respiratory Impairment ◽  
Future Studies

<b><i>Background:</i></b> The peripheral and central repercussions of Parkinson’s disease (PD) affect the neuromuscular system producing a loss of muscle strength that can influence the respiratory system. Although several studies have examined various respiratory aspects of PD, to the best of our knowledge no study to date has systematically reviewed the existing data. <b><i>Objectives:</i></b> To examine the available literature related to the respiratory impairment in PD patients. <b><i>Methods:</i></b> We used PRISMA guidelines when reporting this review. We searched Pubmed, Cinhal, SciELO, and Cochrane Library, from inception until August 2018. Main variables assessed were forced vital capacity percent predicted (FVC%) and forced expiratory volume in 1 s percent predicted (FEV<sub>1</sub>%) for PD patients. <b><i>Results:</i></b> Six studies were included in this systematic review and meta-analysis. The obtained results concluded that PD patients present poorer pulmonary function when compared to healthy controls. When PD patients were compared between ON and OFF states, the results reviewed are in favour of the ON state. In the meta-analysis performed for FVC% and FEV<sub>1</sub>%, the results fail to find significant differences between PD patients and controls (<i>p</i> = 0.336 and <i>p</i> = 0.281, respectively), and between PD ON and OFF states (<i>p</i> = 0.109 and <i>p</i> = 0.059, respectively). <b><i>Conclusions:</i></b> We conclude that PD patients have impaired respiratory capacities that are related to the PD severity, time since diagnosis, and OFF state. Adequate follow-up of the respiratory function and studies focused on PD phenotypes have to be considered in future studies.

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