Diabetes Mellitus and Parkinson’s Disease: A Systematic Review and Meta-Analyses

2021 ◽  
pp. 1-12
Author(s):  
Klara Komici ◽  
Grazia Daniela Femminella ◽  
Leonardo Bencivenga ◽  
Giuseppe Rengo ◽  
Gennaro Pagano
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
General Population ◽  
Disease Progression ◽  
Cochrane Library ◽  
Motor Symptoms ◽  
Yahr Stage ◽  
Meta Analyses

Background: A link between diabetes mellitus (DM) and Parkinson’s disease (PD) have been proposed but evidence are sparse and inconsistent. Objective: Perform a systematic review of all evidence that link DM and PD characterising the prevalence of DM in PD patients, the risk of developing PD in DM patients and the influence of DM on PD severity and progression. Methods: MEDLINE, Scopus, and Cochrane Library from inception to June 30, 2021 were searched. Studies reporting prevalence, incidence, severity and disease progression of DM and PD were included. Prevalence of DM in PD and incidence of PD in DM patients, and characteristics of PD. Results: A total of 21 studies (n = 11,396) included data on DM prevalence in PD patients, 12 studies (n = 17,797,221) included data on incidence of PD in DM patients, and 10 studies (n = 2,482) included data on DM impact on PD severity and disease progression. The prevalence of DM in PD patients was 10.02 %, (95%C.I. 7.88 –12.16), DM patients showed a higher risk of developing PD (OR: 1.34 95%CI 1.26–1.43 p <  0.0001) compared to non-DM, and PD patients with DM showed a greater severity of motor symptoms, with higher Hoehn and Yahr stage (SMD: 0.36 95%CI 0.12–0.60; p <  0.001) and higher UPDRS (SMD 0.60 95%CI 0.28–0.92; p <  0.001) compared with PD patients without DM. Conclusion: Although the prevalence of DM in PD patients is similar to the general population, patients with DM have a higher risk of developing PD, and the presence of DM is associated with greater PD severity and faster progression, which suggests that DM may be a facilitating factor of neurodegeneration.

Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis

2020 ◽  
Vol 34 (11) ◽  
pp. 1355-1367
Author(s):  
Zhenlan Li ◽  
Tian Wang ◽  
Haoyang Liu ◽  
Yan Jiang ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Motor Symptoms ◽  
Gait Parameters ◽  
Task Training ◽  
Dual Task Training

Objective: The aim of the present study was to systematically evaluate and quantify the effectiveness of dual-task training on gait parameters, motor symptoms and balance in individuals diagnosed with Parkinson’s disease. Data resources: A systematic review of published literature was conducted until May 2020, using PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO and CNKI databases. Methods: We included randomized controlled trials (RCTs) and non-RCTs to evaluate the effects of dual-task training compared with those of non-intervention or other forms of training. The measurements included gait parameters, motor symptoms and balance parameters. Methodological quality was assessed using the PEDro scale. Outcomes were pooled by calculating between-group mean differences using fixed- or random-effects models based on study heterogeneity. Results: A total of 11 RCTs comprising 322 subjects were included in the present meta-analysis. Results showed that dual-task training significantly improved gait speed (standardized mean difference [SMD], −0.23; 95% confidence interval [CI], −0.38 to −0.08; P = 0.002), cadence (SMD, −0.25; 95% CI, −0.48 to −0.02; P = 0.03), motor symptoms (SMD, 0.56; 95% CI, 0.18 to 0.94; P = 0.004) and balance (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03). However, no significant changes were detected in step length or stride length. Conclusion: Dual-task training was effective in improving gait performance, motor symptoms and balance in patients with Parkinson’s disease relative to other forms of training or non-intervention.

scholarly journals Effectiveness of Telerehabilitation on Motor Impairments, Non-motor Symptoms and Compliance in Patients With Parkinson's Disease: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Chiara Vellata ◽  
Stefano Belli ◽  
Francesca Balsamo ◽  
Andrea Giordano ◽  
Roberto Colombo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Patient Satisfaction ◽  
Cochrane Library ◽  
Clinical Aspects ◽  
Motor Symptoms ◽  
Non Motor Symptoms

Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a progressive alteration of the motor and non-motor function. PD influences the patient's daily living and reduces participation and quality of life in all phases of the disease. Early physical exercise can mitigate the effects of symptoms but access to specialist care is difficult. With current technological progress, telemedicine, and telerehabilitation is now a viable option for managing patients, although few studies have investigated the use of telerehabilitation in PD. In this systematic review, was investigated whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed. The usage of telerehabilitation technologies in the management of cognitive impairment was not addressed.Method: An electronic database search was performed using the following databases: PubMed/MEDLINE, COCHRANE Library, PEDro, and SCOPUS for data published between January 2005 and December 2019 on the effects of telerehabilitation systems in managing motor and non-motor symptoms. This systematic review was conducted in accordance with the PRISMA guideline and was registered in the PROSPERO database (CRD42020141300).Results: A total of 15 articles involving 421 patients affected by PD were analyzed. The articles were divided into two categories based on their topic of interest or outcome. The first category consisted of the effects of telerehabilitation on gait and balance (3), dexterity of the upper limbs (3), and bradykinesia (0); the second category regarded non-motor symptoms such as speech disorders (8) and dysphagia (0). Quality of life (7) and patient satisfaction (8) following telerehabilitation programs were also analyzed, as well as feasibility and costs.Conclusion: Telerehabilitation is feasible in people affected by PD. Our analysis of the available data highlighted that telerehabilitation systems are effective in maintaining and/or improving some clinical and non-clinical aspects of PD (balance and gait, speech and voice, quality of life, patient satisfaction).Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020141300.

scholarly journals A-084 Magnetic Resonance-Guided Focused Ultrasound for Parkinson’s Disease: A Systematic and Qualitative Review of Nonmotor Cognitive Outcomes Since FDA Approval of ExAblate, 2016–2019

2020 ◽  
Vol 35 (6) ◽  
pp. 876-877
Author(s):  
Lennon J ◽  
Hassan I
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Magnetic Resonance ◽  
Focused Ultrasound ◽  
Cognitive Outcomes ◽  
Neurocognitive Functioning ◽  
Cochrane Library ◽  
Fda Approval ◽  
Meta Analyses

Abstract Objective ExAblate received FDA approval for treatment of a range of movement disorders, including tremor-dominant Parkinson’s disease (TDPD), dyskinetic PD, and essential tremor. This incisionless device permits magnetic resonance-guided focused ultrasound (MRgFUS) for ablation of regions of interest. This systematic review sought to 1) determine the extent of literature on nonmotor cognitive outcomes of MRgFUS, 2) investigate differences in postoperative outcomes, 3) suggest future research directions. Data Selection PubMed, CINAHL, PsycINFO, Cochrane Library databases were searched January 2016 to January 2020. Guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review clinical trials comprehensively assessing pre- and postoperative neurocognitive functioning in PD patients undergoing MRgFUS. Due to limited literature, TDPD was expanded to dyskinetic PD. Data Synthesis Twenty-two abstracts were initially reviewed. After full-text review of eight articles, two studies included comprehensive neuropsychological evaluations of PD patients undergoing MRgFUS thalamotomy/pallidotomy—these occurred in different countries with different normative data, prohibiting quantitative comparison. Most excluded studies used only brief cognitive screeners with unsubstantiated cutoffs. Conclusions Few studies to-date have administered comprehensive neuropsychological batteries to ascertain MRgFUS risks to neurocognitive functioning in PD and how it compares to deep brain stimulation. Cognitive declines appear to be minimal following MRgFUS, with exceptions being verbal fluency and inhibition. These results are limited by sample size and sample diversity. Studies must extend beyond brief screeners when assessing PD populations vulnerable to decline. Further, consensus on a comprehensive battery would better serve replicability and the ability to engage in useful meta-analyses.

scholarly journals Effectiveness of Long-Term Physiotherapy in Parkinson’s Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Yohei Okada ◽  
Hiroyuki Ohtsuka ◽  
Noriyuki Kamata ◽  
Satoshi Yamamoto ◽  
Makoto Sawada ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Aerobic Exercise ◽  
Meta Analysis ◽  
Motor Symptoms ◽  
Yahr Stage ◽  
Multidisciplinary Rehabilitation ◽  
Medication Dose

Background: Long-term physiotherapy is acknowledged to be crucial to manage motor symptoms for Parkinson’s disease (PD) patients, but its effectiveness is not well understood. Objective: This systematic review and meta-analysis aimed to assess the evidence regarding the effectiveness of long-term physiotherapy to improve motor symptoms and reduce antiparkinsonian medication dose in PD patients. Methods: Pubmed, Cochrane, PEDro, and CINAHL were searched for randomized controlled trials before August 31, 2020 that investigated the effectiveness of physiotherapy for 6 months or longer on motor symptoms and levodopa-equivalent dose (LED) in PD patients with Hoehn and Yahr stage 1– 3. We performed random effects meta-analyses for long-term physiotherapy versus no/control intervention and estimated standard mean differences with 95% confidence intervals (CIs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation approach. Results: From 2,940 studies, 10 studies involving 663 PD patients were assessed. Long-term physiotherapy had favorable effects on motor symptoms in off medication state [– 0.65, 95% CI – 1.04 to – 0.26, p = 0.001] and LED [– 0.49, 95% CI – 0.89 to – 0.09, p = 0.02]. Subgroup analyses demonstrated favorable effects on motor symptoms in off medication state by aerobic exercise [– 0.42, 95% CI – 0.64 to – 0.20, p <  0.001] and LED by multidisciplinary rehabilitation of primarily physiotherapy [– 1.00, 95% CI – 1.44 to – 0.56, p <  0.001]. Quality of evidence for aerobic exercise and multidisciplinary rehabilitation were low and very low. Conclusion: This review provided evidence that long-term physiotherapy has beneficial impact on motor symptoms and antiparkinsonian medication dose in PD patients and could motivate implementation of long-term physiotherapy.

scholarly journals Cognitive and Behavior Deficits in Parkinson’s Disease with Alteration of FDG-PET Irrespective of Age

Geriatrics ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 110
Author(s):  
Fulvio Lauretani ◽  
Livia Ruffini ◽  
Crescenzo Testa ◽  
Marco Salvi ◽  
Mara Scarlattei ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Disease Progression ◽  
Metabolic Activity ◽  
Fdg Pet ◽  
Surrogate Marker ◽  
Metabolic Imaging ◽  
Clinical Aspects ◽  
Histopathological Diagnosis ◽  
Motor Symptoms

Significant progress has been made in our understanding of the neurobiology of Parkinson’s disease (PD). Post-mortem studies are an important step and could help to comprehend not only the progression of motor symptoms, but also the involvement of other clinical domains, including cognition, behavior and impulse control disorders (ICDs). The correlation of neuropathological extension of the disease with the clinical stages remains challenging. Molecular imaging, including positron emission tomography (PET) and single photon computed tomography (SPECT), could allow for bridging the gap by providing in vivo evidence of disease extension. In the last decade, we have observed a plethora of reports describing improvements in the sensitivity of neuroimaging techniques. These data contribute to increasing the accuracy of PD diagnosis, differentiating PD from other causes of parkinsonism and also obtaining a surrogate marker of disease progression. FDG-PET has been used to measure cerebral metabolic rates of glucose, a proxy for neuronal activity, in PD. Many studies have shown that this technique could be used in early PD, where reduced metabolic activity correlates with disease progression and could predict histopathological diagnosis. The aim of this work is to report two particular cases of PD in which the assessment of brain metabolic activity (from FDG-PET) has been combined with clinical aspects of non-motor symptoms. Integration of information on neuropsychological and metabolic imaging allows us to improve the treatment of PD patients irrespective of age.

scholarly journals Writers Are Common among Parkinson’s Disease Patients: A Longitudinal Study

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Anna Aasly ◽  
Jan O. Aasly
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Longitudinal Study ◽  
General Population ◽  
Personality Disorders ◽  
Disease Progression ◽  
Medical Record ◽  
Disease Onset ◽  
Psychological Characteristics ◽  
Personality Profile

Parkinson’s disease (PD) patients may have a specific personality profile, which includes being introvert, cautious and devoted to hard work. The evaluation of psychological characteristics must be evaluated according to methods for assessments of personality disorders. Such evaluations are often time-consuming and available only in research settings. The “parkinsonian trait” may be established early in life but may change with disease progression. To overcome this long interval before onset of PD questions on literary activities were included in the medical record. Three percent of PD patients could be defined as writers, significantly higher than observed in the general population. PD writers published their first books long before onset of disease. Being a writer is an extrovert trait meaning that the patient is prepared for criticism and publicity. We suggest that questions regarding personal activities prior to disease onset add valuable information on personality which differs significantly from traits observed later in the disease period.

scholarly journals Acupuncture-Related Therapies for Parkinson's Disease: A Meta-Analysis and Qualitative Review

2021 ◽  
Vol 13 ◽  
Author(s):  
Xiaopeng Wen ◽  
Kunbin Li ◽  
Hao Wen ◽  
Qian Wang ◽  
Zhiyuan Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rating Scale ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Hamilton Depression Scale ◽  
High Quality ◽  
Conventional Medication

Objective: This systematic review and meta-analysis aimed to assess the effects of the combination of acupuncture-related therapies with conventional medication compared with conventional medication in patients with Parkinson's disease (PD).Methods: A literature search within eight databases [including Medline, Embase, the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang Database] was performed covering a time frame from their inception to August 2020. Randomized controlled trials (RCTs) comparing acupuncture-related therapies combined with conventional medication vs. conventional medication in patients with PD were eligible. Two authors independently assessed the risk of bias. Assessments were performed with the total and subscales scores of the Unified Parkinson's Disease Rating Scale (UPDRS), 39-item Parkinson's Disease Questionnaire (PDQ-39), the dosage of Madopar, Mini-Mental State Examination (MMSE), and 17-item Hamilton Depression Scale (HAMD). Data were analyzed by adopting the Cochrane Collaboration's RevMan 5.4 (Review Man, Copenhagen, Denmark); and mean effect sizes and 95% confidence intervals were estimated. Tests for heterogeneity were used to assess differences in treatment effects across different types of acupuncture used.Results: Sixty-six trials met the inclusion criteria, of which 61 trials provided data for the meta-analysis. We defined high-quality articles as those with a low risk of bias in four or more domains; and only 10 (15.15%) articles were of high quality. Compared with the controls, acupuncture-related therapies with conventional medication achieved a benefit in the primary outcomes of UPDRS (motor subscore: −3.90, −4.33 to −3.49, P &lt; 0.01; total score: −7.37 points, −8.91 to −5.82, P &lt; 0.001; activities of daily living subscore: −3.96, −4.96 to −2.95, P &lt; 0.01). For the subgroup difference test among the effects of different acupuncture methods, significant differences existed in outcomes with the UPDRS-III, UPDRS-I, UPDRS-IV, and PDQ-39 scores and Madopar dosage, while non-significant differences existed with the UPDRS-total, UPDRS-II, HAMD, and MMSE scores.Conclusions: Acupuncture-related therapies combined with conventional medication may benefit individuals with PD. Our review findings should be considered with caution because of the methodological weaknesses in the included trials. Future, large randomized trials of acupuncture-related therapies for PD with high methodological quality are warranted.Systematic Review Registration: Identifier CRD42021228110.

scholarly journals Association Between Irritable Bowel Syndrome and Risk of Parkinson's Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
XinYue Zhang ◽  
Zhen Svn ◽  
MengSi Liv ◽  
Yan Yang ◽  
Rui Zeng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Irritable Bowel Syndrome ◽  
Meta Analysis ◽  
Underlying Mechanism ◽  
Cochrane Library ◽  
Bowel Diseases ◽  
Newcastle Ottawa Scale ◽  
Irritable Bowel

Background: Parkinson's disease (PD) and irritable bowel syndrome (IBS) are respectively one of the most common neurodegenerative diseases and functional bowel diseases in the world. Recent studies suggest that patients with IBS seem to have a higher risk of PD, which conflicts with the result of previous meta-analysis. Therefore, the purpose of this systematic review is to evaluate all available evidence, in order to clarify the association between PD and IBS.Methods: Two reviewers independently searched the PubMed, Embase, Web of Science, and Cochrane library on April 25, 2021 to identify all records that explore the association between IBS and PD. All reports that clearly define PD and IBS and analyze the relationship between the two were included. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies.Results: Five studies from four articles involving 2,044,110 subjects were included in this analysis. The pooled results demonstrated a significant association between PD and IBS (1.48; 95% CI: 1.35–1.62, P &lt; 0.001), with subtle heterogeneity (I2 = 0.0%, p = 0.585). The association was observed across genders and increased with age. However, the available evidence cannot allow a reliable analysis of the causal relationship between IBS and PD.Conclusion: This study demonstrates a higher risk of PD among subjects with IBS. Future studies are required to further clarify the causation and underlying mechanism of the association.

scholarly journals The impact of Type 2 diabetes in Parkinson's disease

2021 ◽  
Author(s):  
Dilan Athauda ◽  
James Evans ◽  
Anna Wernick ◽  
Gurvir Virdi ◽  
Minee Liane-Choi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Disease Progression ◽  
Independent Predictor ◽  
Motor Symptoms ◽  
Severity Scores ◽  
The Impact ◽  
Over Time

Importance: Type 2 diabetes (T2DM) is an established risk factor for developing Parkinson's disease (PD) but its effect on disease progression is not well understood. Objective: To examine the effects of co-morbid T2DM on Parkinson's disease progression and quality of life. Design: We analysed data from the Tracking Parkinson's study, a large multi-centre prospective study in the UK. Participants: The study included 1930 adults with recent onset PD, recruited between February 2012 and May 2014, and followed up regularly thereafter. Exposure: A diagnosis of pre-existing T2DM was based on self-report at baseline. After controlling for confounders, an evaluation of how T2DM affects PD was performed by comparing symptom severity scores; and analyses using multivariable mixed models was used to determine the effects of T2DM on Parkinson's disease progression. Main Outcomes and Measures: The impact of T2DM on Parkinsons disease severity was derived from scores collected using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Questionnaire for impulsive-compulsive disorders in PD (QUIP), Leeds Anxiety and Depression Scale (LADS), and Schwab and England ADL scale. Results: We identified 167 (8.7%) patients with PD and T2DM (PD+T2DM) and 1763 (91.3%) with PD without T2DM (PD). Patients with T2DM had more severe motor symptoms, as assessed by MDS-UPDS III 25.8 (0.9) vs 22.5 (0.3) p=0.002, had significantly faster motor symptom progression over time (p=0.012), and T2DM was an independent predictor for the development of substantial gait impairment (HR 1.55, CI 1.07-2.23, p=0.020). Patients were more likely to have loss of independence (OR 2.08, CI 1.34-3.25, p=0.001); and depression (OR 1.62, CI 1.10-2.39, p=0.015), and developed worsening mood (p=0.041) over time compared to the PD group. T2DM was also an independent predictor for the development mild cognitive impairment (HR 1.7, CI 1.24-2.51, p=0.002) over time Conclusions and relevance: T2DM is associated with faster disease progression in PD, highlighting an interaction between these two diseases. As it is a potentially modifiable, metabolic state, with multiple peripheral and central targets for intervention, it may represent a target for ameliorating parkinsonian symptoms, and progression to disability and dementia.

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