Sleep disturbances in patients with Parkinson's disease

Introduction Sleep problems, common in Parkinson's disease (PD), are the consequence of the neurodegenerative process, as well as of neurochemical changes on one side, and of drug intake on the other side. Objective To estimate the frequency of sleep problems and its correlation with the disease, therapy and demographic factors in patients with idiopathic Parkinson's disease. Methods The study enrolled 65 consecutive patients who fulfilled criteria for idiopathic PD. The original questionnaire was performed to obtain demographic, disease and treatment data. The patients were tested with standardized scales: unified PD rating scale (UPDRS) and Hoehn and Yahr staging scale (HY scale). Mini mental stage examination (MMSE) was performed for the evaluation of cognitive status. Parkinson's disease sleep scale (PDSS) was applied for the assessment of sleep problems. Results There were 37 male and 28 female patients. Negative correlations (p<0.01) were found between mean total PDSS and mean total UPDRS, as well as the mean scores of each part of UPDRS and HY stage. There was no difference in PDSS scores regarding gender. Analyzing each item in the PDSS scale, the lowest score was obtained for item 8 (nocturia). We did not find any difference in total PDSS scores between the patients on d-agonist and those who did not take d-agonist. Regarding amantadin, intake there were differences between groups for items concerning nocturnal motor symptoms. Conclusion Patients in advanced stages of the disease and worse motility have more prominent sleep problems. Drug therapy has important impact on sleep quality in patients with PD. .

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The Effect of Rotigotine on Cognitive Function and Sleep Problems in Parkinson's Disease: an Open-Label Pilot Study

10.21203/rs.3.rs-138691/v1 ◽

2021 ◽

Author(s):

Keisuke Suzuki ◽

Kei Funakoshi ◽

Hiroaki Fujita ◽

Koichi Hirata

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Function ◽

Daytime Sleepiness ◽

Sleep Disturbances ◽

Rating Scale ◽

Sleep Problems ◽

Motor Symptoms ◽

Open Label ◽

Updrs Part

Abstract Background: We hypothesized that rotigotine may have a positive effect on cognitive function in patients with Parkinson’s disease (PD) by improving daytime motor function and nighttime sleep status due to its 24-hour sustained properties.Methods: We evaluated the effect of rotigotine on motor symptoms, cognitive function, daytime sleepiness, sleep disturbances, and motor symptoms in 10 PD patients with sleep disturbances, defined as a PD Sleep Scale (PDSS)-2 score of ≥ 15, in a single-center, 3-month open-label study. Participants received 24 mg/24 h (patch content: 4.5-9 mg) rotigotine for a 3-month period. At baseline and 3 months, patients were evaluated on the Movement Disorder Society Revision of the Unified PD Rating Scale (MDS-UPDRS) parts III and IV and cognitive assessments, such as the Mini-Mental State Examination (MMSE), frontal assessment battery (FAB) and Montreal Cognitive Assessment (MoCA). The Epworth Sleepiness Scale (ESS) and PDSS-2 were administered at baseline and at 1 month, 2 months and 3 months.Results: At 3 months, MDS-UPDRS part III (-10.7, p<0.001) and MDS-UPDRS part IV (-1.0, p=0.023) scores significantly decreased, MoCA scores (1.7, p=0.0095) significantly increased, and off time significantly decreased (-43.0 min; p=0.029) from baseline. PDSS-2 scores significantly decreased from baseline at 2 months (-14.5, p<0.05) and 3 months (-20.0, p<0.001). ESS, MMSE or FAB scores did not significantly change after rotigotine treatment.Conclusion: Our preliminary findings suggest that low-dose rotigotine could improve motor symptoms, sleep disturbance, and cognitive function without worsening daytime sleepiness in patients with PD.

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Alvászavarok Parkinson-kórban: megjelenés, kivizsgálás, terápiás lehetőségek

Orvosi Hetilap ◽

10.1556/650.2015.30191 ◽

2015 ◽

Vol 156 (27) ◽

pp. 1091-1099 ◽

Cited By ~ 6

Author(s):

Béla Faludi ◽

József Janszky ◽

Sámuel Komoly ◽

Norbert Kovács

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disorders ◽

Sleep Disturbances ◽

Sleep Problems ◽

Therapeutic Interventions ◽

Neurodegenerative Process ◽

Pubmed Database ◽

Parkinson's Desease ◽

Specific Symptoms

Introduction: Parkinson’s disease is a well known representant of the movement disorder group of neurological disorders. The diagnosis of Parkinson’s disease is based on specific symptoms and signs of movement abnormalities. In addition to classic motor symptoms, Parkinson’s disease has characteristic non-motor features, and some of these emerges the classic signs. Aim: The authors discuss characteristics and therapeutic interventions in Parkinson’s disease related sleep disturbances. Method: The authors reviewed and summarised literature data on sleep disorders in Parkinson’s disease published in the PubMed database up to January 2015. Results: Sleep problems are important non-motor complains (insomnia, hypersomnia, REM behaviour disorder, sleep apnea and restless legs syndrome). The neurodegenerative process of the brain-stem, the effect of symptoms of Parkinson’s desease on sleep and concomitant sleep disorders constitute the background of the patient’s complains. Conclusions: Appropriate diagnosis and therapy of the consequential or concomitant sleep disorders in Parkinson’s disease will help to improve the patient’s quality of life. Orv. Hetil., 2015, 156(27), 1091–1099.

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Relationships among Depression, Anxiety, Sleep, and Quality of Life in Patients with Parkinson’s Disease in Taiwan

Parkinson s Disease ◽

10.1155/2016/4040185 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Jun-Yu Fan ◽

Bao-Luen Chang ◽

Yih-Ru Wu

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Rating Scales ◽

Rating Scale ◽

Cognitive Status ◽

Health Related Qol ◽

Health Related

The aim of this study was to examine the relationships among depression, anxiety, sleep disturbances, Parkinson’s disease (PD) symptoms, PD medications, and health-related quality of life (QOL) and to identify the predictors of health-related QOL in PD patients. To do this, we administered a battery of questionnaires and rating scales (validated Chinese versions), including the Unified Parkinson’s Disease Rating Scale, 39-item Parkinson’s Disease Questionnaire, Parkinson’s Disease Sleep Scale-2, Beck Depression Inventory, and Beck Anxiety Inventory, to 134 patients with PD whose Minimental State Examination scores were ≥24. We found that patients who reported having poorer QOL had longer disease durations, more severe PD symptoms, higher Hoehn and Yahr stages, and higher levodopa dosages, as well as higher levels of anxiety and depression, more sleep disturbances, and poorer overall cognitive statuses. Among these variables, the cognitive status, dependency of activities of daily living, depression, and anxiety were identified as predictors of QOL in PD patients and were all significant and independent factors of poor QOL in PD patients. The clinicians should be aware of the effects of these factors on QOL and attempt to treat comorbid psychiatric conditions to improve the PD patients’ QOL.

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Sleep Quality and Levodopa Intestinal Gel Infusion in Parkinson’s Disease: A Pilot Study

Parkinson s Disease ◽

10.1155/2018/8691495 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Oriol De Fabregues ◽

Alex Ferré ◽

Odile Romero ◽

Manuel Quintana ◽

José Álvarez-Sabin

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pilot Study ◽

Sleep Quality ◽

Rem Sleep ◽

Rating Scale ◽

Sleep Problems ◽

Periodic Leg Movements ◽

Before And After ◽

Hamilton Anxiety Rating Scale

Background. Sleep problems in patients with advanced Parkinson’s disease (PD) have a deleterious impact on quality of life. Objective. To assess the effect of levodopa-carbidopa intestinal gel (LCIG) infusion on sleep quality in advanced PD patients. Methods. Seven patients participated in a prospective pilot study. Before and after 6 months of LCIG infusion, an overnight polysomnography was performed and the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale were administered. Results. PSG showed low sleep efficiency. REM sleep without atony was found in 5 patients. After 6 months of LCIG infusion, the percentage of REM sleep decreased as well as the number of arousals especially due to reduction of spontaneous arousals and periodic leg movements during REM sleep, but differences were not statistically significant. Also, scores of all study questionnaires showed a tendency to improve. Conclusion. The results show a trend toward an improvement of sleep quality after 6 months of LCIG infusion, although differences as compared to pretreatment values were not statistically significant. The sleep architecture was not modified by LCIG. Further studies with larger study samples are needed to confirm these preliminary findings.

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Stereopsis Deficits in Parkinson’s Disease and Their Clinical Implications

10.21203/rs.3.rs-106032/v1 ◽

2020 ◽

Author(s):

Fang Ba ◽

Tina T. Sang ◽

Jaleh Fatehi ◽

Wenjing He ◽

Emanuel Mostofi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Disease Severity ◽

Rating Scale ◽

Disease Status ◽

Cognitive Status ◽

Control Group ◽

Motor Disorder ◽

Healthy Control ◽

Stereo Acuity

Abstract Background: Parkinson's disease (PD) is not exclusively a motor disorder. Among non-motor features, PD patients possess sensory visual dysfunctions. Stereopsis deficit can significantly impact patients' motor performance. However, it is not routinely tested, and its significance is under-investigated. Studying stereopsis using reliable 3D stimuli may help determine its implications in disease status in PD.The objective of the study is to investigate stereopsis abnormalities in PD with reliable and more physiological tools, and their correlation with indicators of PD severity. Methods: Twenty-four healthy control and 20 PD participants were first evaluated for visual acuity, visual field, contrast acuity, and stereoperception with 2D and Titmus stereotests, followed by the assessment with the 3D active shutter system. The correlation between stereopsis and disease severity, Unified Parkinson’s disease rating scale motor scores (UPDRS-III), levodopa equivalent daily dose (LEDD), course of disease and cognitive status were evaluated using univariate regression models. Results: Screening visual tests did not reveal any differences between PD and control group. With the 3D active shutter system, PD patients demonstrated significantly worse stereopsis (i.e p=0.002, 26 seconds of arc). There was a trend that UPDRS-III and LEDD negatively correlate with the stereo acuity, suggesting poorer stereoperception is related to disease severity. Preserved cognitive function correlated with more intact stereo acuity. Conclusion: With more reliable and physiological tools, PD patients exhibit poorer stereopsis. These deficits reflected PD motor and cognitive status. How stereopsis relates to gait, fall risks and navigation warrants more investigations in the future.

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Is the MDS-UPDRS a Good Screening Tool for Detecting Sleep Problems and Daytime Sleepiness in Parkinson’s Disease?

Parkinson s Disease ◽

10.1155/2014/806169 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Krisztina Horváth ◽

Zsuzsanna Aschermann ◽

Péter Ács ◽

Edit Bosnyák ◽

Gabriella Deli ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Daytime Sleepiness ◽

Screening Tool ◽

Rating Scale ◽

Sleep Problems ◽

Rank Correlation ◽

Correlation Coefficients ◽

Moderate Correlation ◽

Cross Sectional

Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) has separate items for measuring sleep problems (item 1.7) and daytime sleepiness (1.8). The aim of our study was to evaluate the screening sensitivity and specificity of these items to the PD Sleep Scale 2nd version (PDSS-2) and Epworth Sleepiness Scale (ESS). In this nationwide, cross-sectional study 460 PD patients were enrolled. Spearman’s rank correlation coefficients were calculated between the individual items, domains, and the total score of PDSS-2 and item 1.7 of MDS-UPDRS. Similarly, the items and the total score of ESS were contrasted to item 1.8 of MDS-UPDRS. After developing generalized ordinal logistic regression models, the transformed and observed scores were compared by Lin’s Concordance Correlation Coefficient. Only item 3 difficulties staying asleep and the “disturbed sleep” domain of PDSS-2 showed high correlation with “sleep problems” item 1.7 of the MDS-UPDRS. Total score of PDSS-2 had moderate correlation with this MDS-UPRDS item. The total score of ESS showed the strongest, but still moderate, correlation with “daytime sleepiness” item 1.8 of MDS-UPDRS. As intended, the MDS-UPDRS serves as an effective screening tool for both sleep problems and daytime sleepiness and identifies subjects whose disabilities need further investigation.

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Influence of Hypertension on Neurocognitive Domains in Nondemented Parkinson’s Disease Patients

Parkinson s Disease ◽

10.1155/2014/507529 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Jacob D. Jones ◽

Charles Jacobson ◽

Martina Murphy ◽

Catherine Price ◽

Michael S. Okun ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Executive Function ◽

Cognitive Decline ◽

Verbal Memory ◽

Rating Scale ◽

Cognitive Status ◽

Cross Sectional ◽

The Impact ◽

Health Comorbidities

Objective. Health comorbidities, particularly cardiovascular risk factors, are well known to pose risks for cognitive decline in older adults. To date, little attention has focused on the impact of these comorbidities on Parkinson’s disease (PD). This study examined the prevalence and contribution of comorbidities on cognitive status in PD patients, above and beyond the effects of disease severity.Methods. A cross sectional design was used, including neuropsychological data on 341 PD patients without severe cognitive decline. Comorbidity data were collected via medical chart review. Data were analyzed using a series of multiple hierarchical regressions, controlling for PD-related disease variables.Results. Overall sample characteristics are 69% male, disease duration 9.7 years, Unified Parkinson’s Disease Rating Scale 26.4, and age 64.7 years. Hypercholesterolemia (41.6%), hypertension (38.1%), and hypotension (30.2%) were the most reported comorbidities. The presence of hypertension significantly contributed to domains of executive function and verbal memory. The cooccurrence of orthostatic hypotension moderated the relationship between hypertension and executive function.Conclusions. This study on a large cohort of PD patients provides evidence for a detrimental influence of health comorbidities, particularly hypertension, on cognitive domains that have traditionally been conceptualized as being frontally and/or temporally mediated.

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Foveal Remodeling of Retinal Microvasculature in Parkinson’s Disease

Frontiers in Neuroscience ◽

10.3389/fnins.2021.708700 ◽

2021 ◽

Vol 15 ◽

Author(s):

Ane Murueta-Goyena ◽

Maitane Barrenechea ◽

Asier Erramuzpe ◽

Sara Teijeira-Portas ◽

Marta Pengo ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Diagnostic Accuracy ◽

Rating Scale ◽

Cognitive Status ◽

Retinal Layer ◽

Inner Plexiform Layer ◽

Retinal Microvasculature ◽

Microvascular Alterations ◽

Perfusion Density

BackgroundRetinal microvascular alterations have been previously described in Parkinson’s disease (PD) patients using optical coherence tomography angiography (OCT-A). However, an extensive description of retinal vascular morphological features, their association with PD-related clinical variables and their potential use as diagnostic biomarkers has not been explored.MethodsWe performed a cross-sectional study including 49 PD patients (87 eyes) and 40 controls (73 eyes). Retinal microvasculature was evaluated with Spectralis OCT-A and cognitive status with Montreal Cognitive Assessment. Unified PD Rating Scale and disease duration were recorded in patients. We extracted microvascular parameters from superficial and deep vascular plexuses of the macula, including the area and circularity of foveal avascular zone (FAZ), skeleton density, perfusion density, vessel perimeter index, vessel mean diameter, fractal dimension (FD) and lacunarity using Python and MATLAB. We compared the microvascular parameters between groups and explored their association with thickness of macular layers and clinical outcomes. Data were analyzed with General Estimating Equations (GEE) and adjusted for age, sex, and hypertension. Logistic regression GEE models were fitted to predict diagnosis of PD versus controls from microvascular, demographic, and clinical data. The discrimination ability of models was tested with receiver operating characteristic curves.ResultsFAZ area was significantly smaller in patients compared to controls in superficial and deep plexuses, whereas perfusion density, skeleton density, FD and lacunarity of capillaries were increased in the foveal zone of PD. In the parafovea, microvascular parameters of superficial plexus were associated with ganglion cell-inner plexiform layer thickness, but this was mainly driven by PD with mild cognitive impairment. No such associations were observed in controls. FAZ area was negatively associated with cognition in PD (non-adjusted models). Foveal lacunarity, combined with demographic and clinical confounding factors, yielded an outstanding diagnostic accuracy for discriminating PD patients from controls.ConclusionParkinson’s disease patients displayed foveal microvascular alterations causing an enlargement of the vascular bed surrounding FAZ. Parafoveal microvascular alterations were less pronounced but were related to inner retinal layer thinning. Retinal microvascular abnormalities helped discriminating PD from controls. All this supports OCT-A as a potential non-invasive biomarker to reveal vascular pathophysiology and improve diagnostic accuracy in PD.

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INFLUENCE OF SLEEP DISTURBANCES ON COGNITIVE DECLINE IN PATIENTS WITH PARKINSON’S DISEASE

Ukrainian Scientific Medical Youth Journal ◽

10.32345/usmyj.3(117).2020.58-67 ◽

2020 ◽

Vol 117 (3) ◽

pp. 58-67

Author(s):

Anastasiia Shkodina ◽

Kateryna Tarianyk ◽

Dmytro Boiko

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Sleep Disorders ◽

Sleep Disturbances ◽

Rating Scale ◽

Early Stages ◽

The Impact

The article summarizes the arguments and counter-arguments within the scientific discussion on the impact of sleep disorders on the development of cognitive decline in patients with Parkinson's disease. The main purpose of the study is to study the possibility of predicting the development of cognitive decline by assessing the severity of sleep disorders and their differences in the presence of cognitive impairment. Systematization of literature sources and approaches to solving the problem showed that sleep disorders develop in the early stages of Parkinson's disease and are often accompanied by cognitive impairment. Cognitive decline is manifested throughout Parkinson's disease and ranges from moderate in the early stages to dementia in the late stages. The relevance of the study of the relationship between sleep disorders and cognitive functions lies in the possibility of further improving the prediction of the development of cognitive decline in order to effectively correct it. Treatment of sleep disorders can be accompanied by improved memory and even morphological changes in the brain. Therefore, the question arises about the possibility of correcting cognitive decline by influencing sleep disorders. The methodology of the study included assessment of the overall status of patients on a unified scale of Parkinson's disease, Montreal cognitive rating scale and sleep scale in Parkinson's disease. The duration of the study was 8 months. Patients with Parkinson's disease were selected as the study. The article presents the results of a survey of patients who show that patients with Parkinson's disease and cognitive decline showed a predominance of motor disorders, sleep disorders and the overall score on the sleep scale in Parkinson's disease. In the presence of cognitive decline more pronounced disorders of motor functions in everyday life, which can lead to sleep disorders and its quality. The study empirically confirms and theoretically proves that the assessment of sleep disorders can be used to predict the risk of developing cognitive impairment in patients with Parkinson's disease. The results of this study may be useful for improving the early diagnosis and prevention of cognitive impairment in patients with Parkinson's disease, which, in turn, leads to improved quality of treatment of these patients. Such changes can directly affect the choice of therapeutic tactics and improve the quality of life of patients with Parkinson's disease. The question of the features of various sleep disorders and their prognostic value in relation to cognitive decline in patients with various forms of Parkinson's disease remains open.

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The use of vortioxetine for the correction of depression in Parkinson's disease: an example of clinical cases

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2019-3-78-82 ◽

2019 ◽

Vol 11 (3) ◽

pp. 78-82 ◽

Cited By ~ 1

Author(s):

I. V. Miliukhina

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Depressive Disorder ◽

Cognitive Status ◽

Dopaminergic Drugs ◽

Insufficient Response ◽

Advanced Stages ◽

Clinical Cases

The prevalence of depression in Parkinson's disease (PD) amounts to as much as 90%. The paper describes patients at different ages and with different durations of PD in its early and advanced stages and with various types of depressive disorder.The described clinical cases show that depression substantially worsens quality of life in a patient with PD and makes it difficult to choose antiparkinsonian therapy. Depression remains unrecognized on average in half of patients, while only a quarter of patients with identified depression receive timely treatment with antidepressants. PD complicated by depression is characterized by a faster progression and more significantly impaired quality of life and cognitive status than PD without affective disorders. Patients with PD and depressive disorder are characterized by an insufficient response to standard doses of antiparkinsonian drugs, which often leads to an irrational increase in the dose of dopaminergic drugs and to the development of complications.Difficulties in choosing an antidepressant for PD are associated with the development of a complex multicomponent neurotransmitter imbalance in this disease. The prescription of multimodal antidepressants can solve this problem.It is necessary to timely detect and correct depression in patients with PD using the currently available drugs and nonpharmacological methods (psychotherapy and physical rehabilitation).

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