Sexual Dysfunction Among Egyptian Idiopathic Parkinson’s Disease Patients

Background One of the non-motor features of idiopathic Parkinson’s disease (IPD) is sexual dysfunction (SD) which is under-recognized and, consequently, undertreated. This study aimed to evaluate SD in patients with IPD. Patients and methods The study was conducted on 67 IPD patients; 30 healthy subjects with age and gender matching with the patients served as the control group. All participants were subjected to sexual function assessment using the Arabic version of Arizona Sexual Experience Scale (ASEX), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI), while the severity of IPD was assessed using the modified Hoehn and Yahr scoring scale and MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Results There were no statistically significant differences between patients with IPD and the control group regarding MMSE, hypertension, diabetes mellitus, or dyslipidemia. However, BDI scores were significantly higher in patients with IPD. The rate of SD among our patients was 64% compared to 30% in the control group. The total score and subscales of ASEX were significantly higher in IPD patients than in controls. SD showed a significant correlation with the severity of the IPD irrespective of other variables, including patient age, sex, disease duration, hypertension, diabetes, dyslipidemia, smoking, and dose of L-dopa. Conclusion SD is a commonly underrated feature in patients with IPD; it should be investigated carefully as it is an important non-motor symptom that correlates with disease severity.

Comparison of 18F-DOPA and 18F-DTBZ for PET/CT Imaging of Idiopathic Parkinson’s Disease

Objective: To compare the two imaging tracers 18F-DOPA and 18F-DTBZ for PET/CT imaging in idiopathic Parkinson’s Disease (PD). Methods: 32 patients with final diagnosis of idiopathic PD and 12 healthy controls were recruited in our study. The clinical symptoms of PD patients were evaluated by using the UPDRS-III and modified H-Y stage. All subjects underwent both 18F-DOPA and 18F-DTBZ PET/CT, and the results were interpreted by visual analysis and semi-quantitative analysis. Semi-quantitative analysis was performed to calculate the specific uptake ratios (SURs) in the subregions of striatum with the occipital cortex as reference area. A one-way ANOVA test was used to compare the clinical data and the SURs among the patients at different stages. Regression analysis was performed to analyze the correlation between the SURs and the clinical data. A kappa test was used to evaluate the consistency of the visual inspection results. Results: Among the PD patients, there were 7 patients in H-Y stage I, 14 patients in stage II, and 11 patients in stage III. No statistical difference in age or gender was found among the three groups (p >0.05). The semi-quantitative analysis of 18F-DOPA and 18F-DTBZ PET images showed that PD patients in different stages had significantly lower SURs in the striatum than the healthy controls (p <0.05), and the SURs generally decreased with the progression of PD staging (p<0.05). An exponential correlation was found between the SURs of each tracer in the putamen with the UPDR-III score (p <0.05), and a linear correlation was found in striatum SURs between two tracers (p<0.05). By visual analysis, 18F-DOPA detected 29 cases with bilateral uptake decrease and the other 3 stage I cases with unilateral uptake decrease, while 18F-DTBZ detected 26 cases with bilateral uptake decrease and 6 cases with unilateral uptake decrease. The overall consistency of visual analysis between these two tracers was 90.63% (Kappa=0.62, p < 0.001).Conclusion: Both 18F-DTBZ and 18F-DOPA are reliable imaging tracers for PET/CT imaging in PD patients with good consistency, and they have the same level of striatal SURs decline percent for PD patients in early stages.

Cholinesterase inhibitor to prevent falls in Parkinson’s disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson’s disease

Background Falls are a common complication of Parkinson’s disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson’s disease. Methods This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson’s disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson’s motor and non-motor symptoms, quality of life and cost-effectiveness. Discussion This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson’s disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. Trial registration REC reference: 19/SW/0043. EudraCT: 2018–003219-23. ISCRTN: 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 Protocol at time of publication Version 7.0, 20th January 2021.