Patient-reported autonomic symptoms in Parkinson disease

Objective: The causes of “delayed-on” and “no-on” phenomena in Parkinson disease (PD) are thought to have some impact on the progress of L-DOPA from the time of ingestion until it reaches the brain and is converted to dopamine. Dysphagia can cause fluctuating symptom expression in L-DOPA therapy for PD. Case Description: A 69-year-old man with PD presented with “delayed-on” and “no-on” phenomena. The patient developed a gait disorder at age 60 years, and he began coughing on his food during breakfast at age 64 years. Even though he was independent in daily life, he could not eat because of dysphagia in an “off” state. Videofluoroscopic examination of swallowing in an “off” state revealed bradykinesia of the tongue and the retention of tablets in the epiglottic vallecula. We trained him to keep his tongue in strong contact with the upper incisors before swallowing. After rehabilitation of dysphagia, the frequency of “delayed-on” and “no-on” phenomena decreased, and his peak L-DOPA plasma concentration was elevated. Additionally, transdermal rotigotine (RTG) was initiated at a maintenance dose of 9.0 mg. The patient reported improvement in swallowing, and the frequency of “no-on” phenomena decreased. Conclusion: In PD patients, the “no-on” phenomenon can be caused by posterior contractile dysfunction of the tongue, and it can be improved with training of the tongue and transdermal RTG administration.

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Predictive Value of Verbatim Parkinson’s Disease Patient-Reported Symptoms of Postural Instability and Falling

Journal of Parkinson s Disease ◽

10.3233/jpd-212636 ◽

2021 ◽

pp. 1-8

Author(s):

Monica Javidnia ◽

Lakshmi Arbatti ◽

Abhishek Hosamath ◽

Shirley W. Eberly ◽

David Oakes ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Natural Language Processing ◽

Natural Language ◽

Parkinson Disease ◽

Language Processing ◽

Rating Scale ◽

Disease Patient ◽

Postural Instability ◽

Patient Reported

Background: Postural instability is an intractable sign of Parkinson’s disease, associated with poor disease prognosis, fall risk, and decreased quality of life. Objective: 1) Characterize verbatim reports of postural instability and associated symptoms (gait disorder, balance, falling, freezing, and posture), 2) compare reports with responses to three pre-specified questions from Part II of the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS), and 3) examine postural instability symptoms and MDS-UPDRS responses as predictors of future falls. Methods: Fox Insight research participants reported their problems attributed to PD in their own words using the Parkinson Disease Patient Reports of Problems (PD-PROP). Natural language processing, clinical curation, and data mining techniques were applied to classify text into problem domains and clinically-curated symptoms. Baseline postural instability symptoms were mapped to MDS-UPDRS questions 2.11–2.13. T-tests and chi-square tests were used to compare postural instability reporters and non-reporters, and Cochran-Armitage trend tests were used to evaluate associations between PD-PROP and MDS-UPDRS responses; survival methods were utilized to evaluate the predictive utility of PD-PROP and MDS-UPDRS responses in time-to-fall analyses. Results: Of participants within 10 years of PD diagnosis, 9,692 (56.0%) reported postural instability symptoms referable to gait unsteadiness, balance, falling, freezing, or posture at baseline. Postural instability symptoms were significantly associated with patient-reported measures from the MDS-UPDRS questions. Balance problems reported on PD-PROP and MDS-UPDRS 2.11–2.13 measures were predictive of future falls. Conclusion: Verbatim-reported problems captured by the PD-PROP and categorized by natural language processing and clinical curation and MDS-UPDRS responses predicted falls. The PD-PROP output was more granular than, and as informative as, the categorical responses.

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Association of autonomic symptoms with cerebrospinal fluid biomarkers in Parkinson disease and scans without evidence of dopaminergic deficit

Medicine ◽

10.1097/md.0000000000024837 ◽

2021 ◽

Vol 100 (7) ◽

pp. e24837

Author(s):

Zhenwei Yu ◽

Yang Li

Keyword(s):

Cerebrospinal Fluid ◽

Parkinson Disease ◽

Autonomic Symptoms ◽

Cerebrospinal Fluid Biomarkers

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Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease

Journal of Neurosurgery ◽

10.3171/jns.2006.104.4.502 ◽

2006 ◽

Vol 104 (4) ◽

pp. 502-505 ◽

Cited By ~ 66

Author(s):

Kelly E. Lyons ◽

Rajesh Pahwa

Keyword(s):

Parkinson Disease ◽

Subthalamic Nucleus ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Sleep Problems ◽

Total Sleep Time ◽

Sleep Time ◽

Early Morning ◽

Patient Reported ◽

Stn Dbs

Object The aim of this study was to assess the long-term effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) on sleep, daytime sleepiness, and early morning dystonia and to evaluate the relationship between total sleep time and motor function. Methods Patients who had undergone bilateral STN DBS and a follow-up evaluation of 6 months (89 patients), 12 months (83 patients), and 24 months (43 patients) were included in this study. The patients were preoperatively assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) in the medication-on and -off conditions, and they completed patient diaries. A subset of patients also completed the Epworth Sleepiness Scale. These assessments were repeated postoperatively with stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as total sleep hours were significantly improved at 6, 12, and 24 months poststimulation and with no medication compared with baseline values. Increased sleep time was significantly correlated with improvements in bradykinesia but not with tremor or rigidity. Patient-reported sleep problems and early morning dystonia were reduced after STN DBS. Antiparkinsonian medications were significantly reduced after STN DBS; however, there were no changes in excessive daytime sleepiness 6, 12, or 24 months after surgery. Conclusions Bilateral STN DBS increased total sleep time and reduced patient-reported sleep problems and early morning dystonia for up to 24 months posttreatment. These changes in sleep were related to improvements in functioning, specifically those affected by bradykinesia. Despite significant reductions in antiparkinsonian medications, STN DBS did not reduce excessive daytime sleepiness.

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Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988717710335 ◽

2017 ◽

Vol 30 (4) ◽

pp. 191-195 ◽

Cited By ~ 5

Author(s):

Christian Lachner ◽

Melissa J. Armstrong ◽

Ann L. Gruber-Baldini ◽

Zahra Rezvani ◽

Stephen G. Reich ◽

...

Keyword(s):

Depressive Symptoms ◽

Parkinson Disease ◽

Physician Assessment ◽

Patient Reported

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Prevalence and clinical correlates of patient-reported autonomic symptoms among subjects with COPD

10.1183/13993003.congress-2016.pa4618 ◽

2016 ◽

Author(s):

Jibril Mohammed ◽

Eric Derom ◽

Jessica Van Oosterwijck ◽

Hellen Da Silva ◽

Patrick Calders

Keyword(s):

Autonomic Symptoms ◽

Clinical Correlates ◽

Patient Reported

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Baseline symptoms and basal forebrain volume predict future psychosis in early Parkinson disease

Neurology ◽

10.1212/wnl.0000000000005421 ◽

2018 ◽

Vol 90 (18) ◽

pp. e1618-e1626 ◽

Cited By ~ 19

Author(s):

Matthew J. Barrett ◽

Jamie C. Blair ◽

Scott A. Sperling ◽

Mark E. Smolkin ◽

T. Jason Druzgal

Keyword(s):

Logistic Regression ◽

Parkinson Disease ◽

Rating Scale ◽

Rem Sleep Behavior Disorder ◽

Symptom Burden ◽

Psychotic Symptoms ◽

Sleep Behavior ◽

Autonomic Symptoms ◽

Increased Risk ◽

Age And Sex

ObjectiveDetermining baseline predictors of future psychosis in Parkinson disease (PD) may identify those at risk for more rapidly progressive disease, i.e., a more malignant PD subtype.MethodsThis cohort study evaluated 423 patients with newly diagnosed PD collected as part of the Parkinson's Progression Markers Initiative. Psychotic symptoms were assessed with the Movement Disorders Society–Unified Parkinson Disease Rating Scale item 1.2, which assesses hallucinations and psychosis over the past week. At baseline, participants completed the Scales for Outcomes in Parkinson's Disease–Autonomic, the REM Sleep Behavior Disorder (RBD) Screening Questionnaire, and the Epworth Sleepiness Scale. Cholinergic nucleus 4 (Ch4) density was calculated for 228 participants with PD and 101 healthy controls.ResultsMultivariate logistic regression adjusted for age and sex found that greater autonomic symptoms (p = 0.002), RBD (p = 0.021), and excessive daytime sleepiness (EDS) (p = 0.003) at baseline were associated with increased risk of reporting psychotic symptoms on ≥2 occasions. Having 2 or 3 of these baseline symptoms was associated with lower Ch4 density (p = 0.007). In a logistic regression model adjusted for age and sex, higher Ch4 gray matter density was associated with lower risk of reporting psychotic symptoms on ≥2 occasions (odds ratio 0.96 [for an increase in density of 1 unit], p = 0.03).ConclusionsThis study confirms that RBD, EDS, and greater autonomic symptom burden are associated with greater risk of future psychotic symptoms in PD. Reduced Ch4 density at baseline is associated with future psychotic symptoms and a greater burden of RBD, EDS, and autonomic symptoms.

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Patient reported benefit of the efficacy of speech therapy in dysphonia

Clinical Otolaryngology ◽

10.1046/j.1365-2273.1998.0138n.x ◽

1998 ◽

Vol 23 (3) ◽

pp. 284-285 ◽

Cited By ~ 2

Author(s):

Mackenzie ◽

Deary ◽

Sellars ◽

Wilson

Keyword(s):

Speech Therapy ◽

Patient Reported

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