scholarly journals Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)

Neurology ◽  
2006 ◽  
Vol 66 (7) ◽  
pp. 968-975 ◽  
Author(s):  
O. Suchowersky ◽  
S. Reich ◽  
J. Perlmutter ◽  
T. Zesiewicz ◽  
G. Gronseth ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Disease Progression ◽  
Clinical Features ◽  
Predictive Factors ◽  
Age At Onset ◽  
Future Research ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Parkinsonian Syndromes ◽  
Olfactory Testing

Objective: To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression?Methods: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence.Results and Conclusions: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.

scholarly journals Genetic risk of Parkinson disease and progression:

2019 ◽  
Vol 5 (4) ◽  
pp. e348 ◽  
Author(s):  
Hirotaka Iwaki ◽  
Cornelis Blauwendraat ◽  
Hampton L. Leonard ◽  
Ganqiang Liu ◽  
Jodi Maple-Grødem ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Disease Progression ◽  
Disease Risk ◽  
Age At Onset ◽  
Motor Symptom ◽  
European Ancestry ◽  
Sleep Behavior ◽  
Intronic Region ◽  
Risk Variants ◽  
Faster Development

ObjectiveTo determine if any association between previously identified alleles that confer risk for Parkinson disease and variables measuring disease progression.MethodsWe evaluated the association between 31 risk variants and variables measuring disease progression. A total of 23,423 visits by 4,307 patients of European ancestry from 13 longitudinal cohorts in Europe, North America, and Australia were analyzed.ResultsWe confirmed the importance of GBA on phenotypes. GBA variants were associated with the development of daytime sleepiness (p.N370S: hazard ratio [HR] 3.28 [1.69–6.34]) and possible REM sleep behavior (p.T408M: odds ratio 6.48 [2.04–20.60]). We also replicated previously reported associations of GBA variants with motor/cognitive declines. The other genotype-phenotype associations include an intergenic variant near LRRK2 and the faster development of motor symptom (Hoehn and Yahr scale 3.0 HR 1.33 [1.16–1.52] for the C allele of rs76904798) and an intronic variant in PMVK and the development of wearing-off effects (HR 1.66 [1.19–2.31] for the C allele of rs114138760). Age at onset was associated with TMEM175 variant p.M393T (−0.72 [−1.21 to −0.23] in years), the C allele of rs199347 (intronic region of GPNMB, 0.70 [0.27–1.14]), and G allele of rs1106180 (intronic region of CCDC62, 0.62 [0.21–1.03]).ConclusionsThis study provides evidence that alleles associated with Parkinson disease risk, in particular GBA variants, also contribute to the heterogeneity of multiple motor and nonmotor aspects. Accounting for genetic variability will be a useful factor in understanding disease course and in minimizing heterogeneity in clinical trials.

scholarly journals P056: The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S97-S97
Author(s):  
A. Carter ◽  
J. Greene ◽  
J. Cook ◽  
J. Goldstein ◽  
J. Jensen
Keyword(s):  
Evidence Based Practice ◽  
Spinal Injury ◽  
Spinal Trauma ◽  
Future Research ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Spinal Motion ◽  
Moderate Quality ◽  
Point Level

Introduction: The Canadian Prehospital Evidence-based Practice (PEP) project is an online, freely accessible, continuously updated EMS evidence repository. The summary of research evidence for EMS interventions used to care for blunt spinal trauma is described. Methods: PubMed was systematically searched. One author reviewed titles and abstracts for relevance. Included studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing results). Second party appraisal was conducted for included studies. Interventions were plotted on a 3x3 table (DOE × LOE) for the spinal injury condition based on appraisal scores. The primary outcome was identified for each study and categorized. Results: Seventy-seven studies were included. Evidence for adult and paediatric blunt spinal trauma interventions was: supportive-high quality (n=1, 7 %), supportive-moderate quality (n=3, 21.4%), supportive-low quality (n=1, 7%), neutral-high quality (n=1, 7%), neutral-moderate quality (n=5, 35.7%), neutral-low quality (n=1, 7%), opposing-high quality (n=0, 0%), opposing-moderate quality (n=0, 0%), opposing-low quality (n=1, 7%). One (7%) intervention had no evidence. Interventions with supportive evidence were: steroids, cervical-spine clearance, scoop stretcher, self-extrication and “leaving helmet in place”. The evidence weakly opposed use of short extrication devices. Leading study primary outcomes were spinal motion, diagnostic accuracy, and pressure/discomfort. Conclusion: EMS blunt spinal trauma interventions are informed by moderate quality supportive and neutral evidence. Future research should focus on high quality studies filling identified evidence gaps using patient-oriented outcomes to best inform EMS care of blunt spinal injury.

scholarly journals Functional MRI of disease progression in Parkinson disease and atypical parkinsonian syndromes

Neurology ◽  
2016 ◽  
Vol 87 (7) ◽  
pp. 709-717 ◽  
Author(s):  
Roxana G. Burciu ◽  
Jae Woo Chung ◽  
Priyank Shukla ◽  
Edward Ofori ◽  
Hong Li ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Disease Progression ◽  
Functional Mri ◽  
Parkinsonian Syndromes

scholarly journals Predicting onset, progression, and clinical subtypes of Parkinson disease using machine learning

2018 ◽  
Author(s):  
Faraz Faghri ◽  
Sayed Hadi Hashemi ◽  
Hampton Leonard ◽  
Sonja W. Scholz ◽  
Roy H. Campbell ◽  
...  
Keyword(s):  
Machine Learning ◽  
Parkinson Disease ◽  
Disease Progression ◽  
Clinical Care ◽  
Age At Onset ◽  
Unmet Need ◽  
Clinical Manifestations ◽  
Supervised Machine Learning ◽  
Distinct Disease ◽  
Disease Subtypes

AbstractBackgroundThe clinical manifestations of Parkinson disease are characterized by heterogeneity in age at onset, disease duration, rate of progression, and constellation of motor versus nonmotor features. Due to these variable presentations, counseling of patients about their individual risks and prognosis is limited. There is an unmet need for predictive tests that facilitate early detection and characterization of distinct disease subtypes as well as improved, individualized predictions of the disease course. The emergence of machine learning to detect hidden patterns in complex, multi-dimensional datasets provides unparalleled opportunities to address this critical need.Methods and FindingsWe used unsupervised and supervised machine learning approaches for subtype identification and prediction. We used machine learning methods on comprehensive, longitudinal clinical data from the Parkinson Disease Progression Marker Initiative (PPMI) (n=328 cases) to identify patient subtypes and to predict disease progression. The resulting models were validated in an independent, clinically well-characterized cohort from the Parkinson Disease Biomarker Program (PDBP) (n=112 cases). Our analysis distinguished three distinct disease subtypes with highly predictable progression rates, corresponding to slow, moderate and fast disease progressors. We achieved highly accurate projections of disease progression four years after initial diagnosis with an average Area Under the Curve of 0.93 (95% CI: 0.96 ± 0.01 for PDvec1, 0.87 ± 0.03 for PDvec2, and 0.96 ± 0.02 for PDvec3). We have demonstrated robust replication of these findings in the independent validation cohort.ConclusionsThese data-driven results enable clinicians to deconstruct the heterogeneity within their patient cohorts. This knowledge could have immediate implications for clinical trials by improving the detection of significant clinical outcomes that might have been masked by cohort heterogeneity. We anticipate that machine learning models will improve patient counseling, clinical trial design, allocation of healthcare resources and ultimately individualized clinical care.

Atypical Parkinsonian Syndromes

2021 ◽  
pp. 583-592
Author(s):  
Shannon Y. Chiu ◽  
Jeremy K. Cutsforth-Gregory
Keyword(s):  
Parkinson Disease ◽  
Disease Progression ◽  
Initial Response ◽  
Parkinsonian Syndrome ◽  
Dopaminergic Therapy ◽  
Rapid Disease Progression ◽  
Parkinsonian Syndromes ◽  
Cardinal Characteristics ◽  
Atypical Parkinsonian Syndrome

The cardinal characteristics of parkinsonism are represented in the mnemonic TRAP: tremor at rest, rigidity, akinesia and bradykinesia, and postural instability. The parkinsonian phenotype encompasses a broad range of clinical and pathologic disorders; the most common (about 55% of cases) is idiopathic (sporadic) Parkinson disease. Rapid disease progression, poor initial response to dopaminergic therapy, or the early presence of certain other signs may suggest an atypical parkinsonian syndrome, sometimes called parkinsonism-plus syndrome.

scholarly journals Nonpharmacological interventions for cognitive impairments following primary progressive aphasia: A systematic review of the literature

2013 ◽  
Vol 7 (1) ◽  
pp. 122-131 ◽  
Author(s):  
Maria Teresa Carthery-Goulart ◽  
Amanda da Costa da Silveira ◽  
Thais Helena Machado ◽  
Leticia Lessa Mansur ◽  
Maria Alice de Mattos Pimenta Parente ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Rehabilitation ◽  
Primary Progressive Aphasia ◽  
Future Research ◽  
Single Subject ◽  
Evidence Based ◽  
Research Committee ◽  
Level Of Evidence ◽  
Progressive Aphasia ◽  
Primary Progressive

ABSTRACT This study provided a systematic review on nonpharmacological interventions applied to patients diagnosed with Primary Progressive Aphasia (PPA) and its variants: Semantic (SPPA), Nonfluent (NFPPA) and Logopenic (LPPA) to establish evidence-based recommendations for the clinical practice of cognitive rehabilitation for these patients. Methods: A PubMed and LILACS literature search with no time restriction was conducted with the keywords PPA (and its variants) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. To develop its evidence-based recommendations, a research committee identified questions to be addressed and determined the level of evidence for each study according to published criteria (Cicerone et al., 2000). Overall evidence for treatments was summarized and recommendations were derived. Results: Our search retrieved articles published from 1995 to 2013: 21 for SPPA, 8 for NFPPA, 3 for LPPA and 8 for PPA with no specification. Thirty-five studies were rated as Class III, consisting of studies with results obtained from one or more single-cases and that used appropriate single-subject methods with adequate quantification and analysis of results. The level of evidence of three functional interventions could not be established. One study was rated as Class II and consisted of a nonrandomized case-control investigation. Conclusion: Positive results were reported in all reviewed studies. However, in order to be recommended, some investigation regarding the intervention efficacy was required. Results of the present review allows for recommendation of some nonpharmacological interventions for cognitive deficits following PPA as Practice Options. Suggestions for further studies on PPA interventions and future research are discussed.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

An Evidence-Based Review of Antitussive Herbs Containing Essential Oils in Traditional Persian Medicine

2020 ◽  
Vol 17 ◽  
Author(s):  
Ayda Hosseinkhani ◽  
Bijan Ziaeian ◽  
Kamran Hessami ◽  
Mohammad Mehdi Zarshenas ◽  
Ali Kashkooe ◽  
...  
Keyword(s):  
Medicinal Plants ◽  
Essential Oils ◽  
Scientific Evidence ◽  
Herbal Remedies ◽  
Future Research ◽  
Evidence Based ◽  
Online Databases ◽  
Persian Medicine ◽  
Troublesome Symptom ◽  
Traditional Persian Medicine

Background: Cough is one of the most common medical symptoms for which medical advice is sought. Although cough is a protective reflex responsible for clearing the airways from secretions and foreign bodies, it can be a troublesome symptom that causes discomfort to patients. Due to the increasing interest in herbal remedies in the both developed and developing countries, in the current study, we aimed to overview medicinal herbs containing essential oils used as antitussive agents according to the Traditional Persian Medicine [TPM] textbooks. We summarized the relevant scientific evidence on their possible pharmacological actions. Methods: To collect the evidence for treatment of cough or “seaal” [cough in ancient books] from TPM sources, five main medicinal Persian manuscripts were studied. The antitussive herbs were listed and their scientific names were identified and authenticated in accordance with botanical reference books. ScienceDirect and PubMed online databases were searched for related mechanisms of action of the reported medicinal plants. Results: The number of 49 herbs containing essential oils were recommended in TPM for the treatment of cough; 21 of them had at least one known mechanism of action for cough suppression in the scientific literature. According to this review, most of the cited medicinal plants were assessed for either nitric oxide inhibitory or antitussive/expectorant activities. Conclusion: In addition to advantageous effects of antitussive herbs noted by TPM, the present review highlighted some recent evidence-based data on these promising candidates that could be used as an outline for future research on their medicinal use.

Ketamine Treatment in Depression: A Systematic Review of Clinical Characteristics Predicting Symptom Improvement

2020 ◽  
Vol 20 (15) ◽  
pp. 1398-1414 ◽  
Author(s):  
Darby J.E. Lowe ◽  
Daniel J. Müller ◽  
Tony P. George
Keyword(s):  
Clinical Features ◽  
Clinical Characteristics ◽  
Bipolar Depression ◽  
Antidepressant Effect ◽  
Future Research ◽  
Symptom Improvement ◽  
Randomized Controlled ◽  
Treatment Of Depression ◽  
Future Direction

Ketamine has been shown to be efficacious for the treatment of depression, specifically among individuals who do not respond to first-line treatments. There is still, however, a lack of clarity surrounding the clinical features and response periods across samples that respond to ketamine. This paper systematically reviews published randomized controlled trials that investigate ketamine as an antidepressant intervention in both unipolar and bipolar depression to determine the specific clinical features of the samples across different efficacy periods. Moreover, similarities and differences in clinical characteristics associated with acute versus longer-term drug response are discussed. Similarities across all samples suggest that the population that responds to ketamine’s antidepressant effect has experienced chronic, long-term depression, approaching ketamine treatment as a “last resort”. Moreover, differences between these groups suggest future research to investigate the potential of stronger efficacy towards depression in the context of bipolar disorder compared to major depression, and in participants who undergo antidepressant washout before ketamine administration. From these findings, suggestions for the future direction of ketamine research for depression are formed.

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