Update on the Management of Parkinson’s Disease for General Neurologists

Management of Parkinson’s disease (PD) is complicated due to its progressive nature, the individual patient heterogeneity, and the wide range of signs, symptoms, and daily activities that are increasingly affected over its course. The last 10–15 years have seen great progress in the identification, evaluation, and management of PD, particularly in the advanced stages. Highly specialized information can be found in the scientific literature, but updates do not always reach general neurologists in a practical and useful way, potentially creating gaps in knowledge of PD between them and neurologists subspecialized in movement disorders, resulting in several unmet patient needs. However, general neurologists remain instrumental in diagnosis and routine management of PD. This review provides updated practical information to identify problems and resolve common issues, particularly when the advanced stage is suspected. Some tips are provided for efficient communication with the members of a healthcare team specialized in movement disorders, in order to find support at any stage of the disease in a given patient, and especially for a well-timed decision on referral.

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Analysis of Nucleotide Variations in Genes of Iron Management in Patients of Parkinson's Disease and Other Movement Disorders

Parkinson s Disease ◽

10.4061/2011/827693 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6

Author(s):

Emanuela Castiglioni ◽

Dario Finazzi ◽

Stefano Goldwurm ◽

Gianni Pezzoli ◽

Gianluca Forni ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Movement Disorders ◽

Regulatory Protein ◽

The Body ◽

Motor Dysfunction ◽

Sequence Variations ◽

Donor And Acceptor ◽

Electron Donor And Acceptor ◽

The Individual

The capacity to act as an electron donor and acceptor makes iron an essential cofactor of many vital processes. Its balance in the body has to be tightly regulated since its excess can be harmful by favouring oxidative damage, while its deficiency can impair fundamental activities like erythropoiesis. In the brain, an accumulation of iron or an increase in its availability has been associated with the development and/or progression of different degenerative processes, including Parkinson's disease, while iron paucity seems to be associated with cognitive deficits, motor dysfunction, and restless legs syndrome. In the search of DNA sequence variations affecting the individual predisposition to develop movement disorders, we scanned by DHPLC the exons and intronic boundary regions of ceruloplasmin, iron regulatory protein 2, hemopexin, hepcidin and hemojuvelin genes in cohorts of subjects affected by Parkinson's disease and idiopathic neurodegeneration with brain iron accumulation (NBIA). Both novel and known sequence variations were identified in most of the genes, but none of them seemed to be significantly associated to the movement diseases of interest.

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Population-based Studies on the Clinical Progression of Motor and Non-motor Features in Parkinson’s Disease

European Neurological Review ◽

10.17925/enr.2009.04.01.36 ◽

2009 ◽

Vol 4 (1) ◽

pp. 36

Author(s):

Guido Alves ◽

Jan Petter Larsen ◽

◽

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scales ◽

Clinical Course ◽

Current Knowledge ◽

Population Based ◽

Cross Sectional ◽

Wide Range ◽

Advanced Stages ◽

Non Motor Symptoms

Although Parkinson’s disease (PD) is a movement disorder in which tremor, rigidity and bradykinesia constitute the cardinal signs of the disease, it is increasingly recognised to be associated with a wide range of motor and non-motor features. Population-based studies demonstrate that the motor course in PD is generally slowly progressive, with average annual progression rates of ≤3%. However, there is remarkable inter-individual variation in the clinical course of PD, with advanced age and predominant postural instability and gait difficulties being major risk factors for more rapid motor and cognitive decline. Around 20–40% of patients exhibit subtle cognitive deficits at diagnosis. These usually worsen over time and progress into dementia, which approximately 80% of PD subjects develop during the course of their disease. Population-based studies indicate rather high frequencies of other non-motor symptoms in moderate to advanced stages, such as depression, fatigue, apathy, sleep disorders and autonomic dysfunction, although prevalence rates often are lower than those observed in clinic-based studies. However, as several population-based studies were cross-sectional, uncontrolled and did not use currently accepted rating scales or diagnostic criteria, the relative risk and clinical course of many disease-related features remain unclear in the general PD population. Further population-based studies are warranted in order to extend current knowledge on the clinical course in representative PD cohorts.

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The East European Journal of Parkinson’s Disease and Movement Disorders

East European Journal of Parkinson`s Disease and Movement Disorders ◽

10.33444/2414-0007.6.1-2 ◽

2020 ◽

Vol 6 (1-2) ◽

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Movement Disorders ◽

East European

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Current Therapeutic Strategies and Perspectives for Neuroprotection in Parkinson’s Disease

Current Pharmaceutical Design ◽

10.2174/1381612826666200217114658 ◽

2020 ◽

Vol 26 (37) ◽

pp. 4738-4746

Author(s):

Mohan K. Ghanta ◽

P. Elango ◽

Bhaskar L. V. K. S.

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Early Diagnosis ◽

Neurodegenerative Disorder ◽

Therapeutic Strategies ◽

Neuroprotective Agents ◽

Striatal Neurons ◽

The Status ◽

Advanced Stages ◽

Dopaminergic Pathways

Parkinson’s disease is a progressive neurodegenerative disorder of dopaminergic striatal neurons in basal ganglia. Treatment of Parkinson’s disease (PD) through dopamine replacement strategies may provide improvement in early stages and this treatment response is related to dopaminergic neuronal mass which decreases in advanced stages. This treatment failure was revealed by many studies and levodopa treatment became ineffective or toxic in chronic stages of PD. Early diagnosis and neuroprotective agents may be a suitable approach for the treatment of PD. The essentials required for early diagnosis are biomarkers. Characterising the striatal neurons, understanding the status of dopaminergic pathways in different PD stages may reveal the effects of the drugs used in the treatment. This review updates on characterisation of striatal neurons, electrophysiology of dopaminergic pathways in PD, biomarkers of PD, approaches for success of neuroprotective agents in clinical trials. The literature was collected from the articles in database of PubMed, MedLine and other available literature resources.

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Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530319666190311104247 ◽

2019 ◽

Vol 19 (7) ◽

pp. 1022-1031 ◽

Cited By ~ 2

Author(s):

Paula D. Cebrián ◽

Omar Cauli

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Cognitive Performance ◽

Functional Impairment ◽

Movement Disorders ◽

Neurological Disorders ◽

Daily Living ◽

Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

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Present and Future of Parkinson’s Disease in Spain: PARKINSON-2030 Delphi Project

Brain Sciences ◽

10.3390/brainsci11081027 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1027

Author(s):

Diego Santos García ◽

Marta Blázquez-Estrada ◽

Matilde Calopa ◽

Francisco Escamilla-Sevilla ◽

Eric Freire ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

New Technologies ◽

Management Strategies ◽

Multidisciplinary Teams ◽

Modified Delphi ◽

Advanced Stages ◽

Diagnostic Capacity ◽

Socio Economic Impact

Parkinson’s disease (PD) is a chronic progressive and irreversible disease and the second most common neurodegenerative disease worldwide. In Spain, it affects around 120.000–150.000 individuals, and its prevalence is estimated to increase in the future. PD has a great impact on patients’ and caregivers’ lives and also entails a substantial socioeconomic burden. The aim of the present study was to examine the current situation and the 10-year PD forecast for Spain in order to optimize and design future management strategies. This study was performed using the modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it will include multidisciplinary teams, and innovative treatments will be developed. The expansion of new technologies and studies on biomarkers will have an impact on future PD management, leading to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic impact of the disease will continue to be significant by 2030, especially for patients in advanced stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to establish recommendations for future diagnostic and therapeutic management of PD.

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Will Artificial Intelligence Replace the Movement Disorders Specialist for Diagnosing and Managing Parkinson’s Disease?

Journal of Parkinson s Disease ◽

10.3233/jpd-212545 ◽

2021 ◽

pp. 1-6

Author(s):

Matt Landers ◽

Suchi Saria ◽

Alberto J. Espay

Keyword(s):

Artificial Intelligence ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Precision Medicine ◽

Movement Disorders ◽

Living Environment ◽

Patient Status ◽

Patient Symptom ◽

Molecular Therapies ◽

Improve Patient

The use of artificial intelligence (AI) to help diagnose and manage disease is of increasing interest to researchers and clinicians. Volumes of health data are generated from smartphones and ubiquitous inexpensive sensors. By using these data, AI can offer otherwise unobtainable insights about disease burden and patient status in a free-living environment. Moreover, from clinical datasets AI can improve patient symptom monitoring and global epidemiologic efforts. While these applications are exciting, it is necessary to examine both the utility and limitations of these novel analytic methods. The most promising uses of AI remain aspirational. For example, defining the molecular subtypes of Parkinson’s disease will be assisted by future applications of AI to relevant datasets. This will allow clinicians to match patients to molecular therapies and will thus help launch precision medicine. Until AI proves its potential in pushing the frontier of precision medicine, its utility will primarily remain in individualized monitoring, complementing but not replacing movement disorders specialists.

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Hispanic Perspectives on Parkinson’s Disease Care and Research Participation

Journal of Alzheimer s Disease ◽

10.3233/jad-210231 ◽

2021 ◽

pp. 1-11

Author(s):

Lisa Damron ◽

Irene Litvan ◽

Ece Bayram ◽

Sarah Berk ◽

Bernadette Siddiqi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Native Language ◽

Research Participation ◽

Ongoing Research ◽

Research Recruitment ◽

Research Opportunities ◽

Research Engagement ◽

Wide Range ◽

Tertiary Center

Background: Hispanics are under-represented in Parkinson’s disease (PD) research despite the importance of diversity for results to apply to a wide range of patients. Objective: To investigate the perspective of Hispanic persons with Parkinson disease (PWP) regarding awareness, interest, and barriers to participation in research. Methods: We developed and administered a survey and qualitative interview in English and Spanish. For the survey, 62 Hispanic and 38 non-Hispanic PWP linked to a tertiary center were recruited in Arizona. For interviews, 20 Hispanic PWP, 20 caregivers, and six physicians providing service to Hispanic PWP in the community were recruited in California. Survey responses of Hispanic and non-Hispanic PWP were compared. Major survey themes were identified by applying grounded theory and open coding. Results: The survey found roughly half (Q1 54%, Q2 55%) of Hispanic PWP linked to a tertiary center knew about research; there was unawareness among community Hispanic PWP. Most preferred having physician recommendations for research participation and were willing to participate. Hispanics preferred teams who speak their native language and include family. Research engagement, PD knowledge, role of family, living with PD, PD care, pre-diagnosis/diagnosis emerged as themes from the interview. Conclusion: Barriers exist for participation of Hispanic PWP in research, primarily lack of awareness of PD research opportunities. Educating physicians of the need to encourage research participation of Hispanic PWP can address this. Physicians need to be aware of ongoing research and should not assume PWP disinterest. Including family members and providing research opportunities in their native language can increase research recruitment.

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