Understanding and Assessing Occupational Performance for Individuals With Parkinson's Disease

Date Presented 04/200/21 OT has a valuable role in promoting quality of life for individuals with PD in all aspects of daily life. The Canadian Occupational Performance Measure (COPM) enables practitioners to address the holistic needs of clients, rather than exclusively focusing on predetermined areas of disability. This study has shown that the full breadth of clients' needs are vast and varied and exist beyond those included in standardized assessment tools because only one-third of the items identified by the COPM were included in the Movement Disorder Society—Unified Parkinson's Disease Rating Scale. Primary Author and Speaker: Abdullah Alsaeed Additional Authors and Speakers: Kristen A. Pickett Contributing Authors: Maria Widmer

Randomized double-blind placebo-controlled trial of hydrogen inhalation for Parkinson’s disease: a pilot study

Background Oxidative stress is involved in the progression of Parkinson’s disease (PD). Recent studies have confirmed that molecular hydrogen (H2) functions as a highly effective antioxidant in animal models of PD. A placebo-controlled, randomized, double-blind, parallel-group clinical pilot study was conducted to assess the efficacy of hydrogen gas inhalation in Japanese patients with PD on treatment with levodopa. Methods Twenty participants fulfilling the Movement Disorder Society criteria were enrolled. Participants inhaled 6.5 (0.1) vol% hydrogen gas in 2 L/min of mixed air or placebo air for 16 weeks, twice a day for 1 h. Results Five participants were excluded due to deviation from the protocol of the total duration of inhalation < 112 h. No significant differences were seen in the change in the total Movement Disorder Society Unified Parkinson’s Disease Rating Scale score from baseline to the 16th week between the group that inhaled hydrogen gas and the group that inhaled placebo air (Mann–Whitney U test, p > 0.05). No adverse events were seen. The compliance to the protocol-based duration of inhalation time in all participants decreased with the elderly participants, the higher daily dose of levodopa, and the higher PDQ-39 items on emotions (n = 20, p < 0.05). Conclusion This pilot study revealed that the inhalation of molecular hydrogen gas was safe, but did not show any beneficial effects in patients with PD. Trial registration: UMIN ID: 000,039,217 (October 6, 2018)

Clinical Presentation of Parkinson’s Disease: Experience of using Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s Disease

Aims: Parkinson’s disease (PD) is a common neurodegenerative disorder. As no definite diagnostic tests are available, diagnosis is done mostly clinically. UK Brain Bank criteria is commonly used globally for that purpose. In this study we used Movement Disorder Society (MDS) Clinical Diagnostic Criteria to diagnose PD and document the clinical presentations. Study design: Descriptive cross-sectional study. Methodology: This study was carried out in the department of neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from May 2018 to April 2019. Total 42 patients (4 clinically established and 38 clinically probable PD) were enrolled as study population according to Movement Disorder Society (MDS) Clinical Diagnostic Criteria - 2015 for PD. Their patterns of clinical presentation were recorded. Results: Among the PD patients, 31 were male and 11 were female. Mean age of all patients was 59.43 ± 11.34 years. The most common presenting feature was tremulous movement (90.5%) followed by slowness of movement (40.5%). Only 9% patients had early onset PD. All patients had history of positive response to dopaminergic therapy with documented resting tremor in 95.2%, and end-of-dose wearing off in 75.6%. Constipation was the commonest (69%) non motor symptom followed by sleep dysfunction (64.3%) & depression (50%). On examination- 100% patients had bradykinesia, 97.6% rest tremor, 95.2% rigidity, 21.4% mild dementia and 4.8% moderate dementia. Also 26.2% patients were found to have postural hypotension. 4 patients had red flag features- urinary retention was found in three patients and one patient suffered from recurrent early fall. Conclusion: MDS Clinical Diagnostic Criteria help in accurate diagnosis of PD and include more clinical features which will help in formulating management plan.

Correction to the article “Translation, Adaptation and Validation of the European Portuguese Version of the NMS-Quest for Parkinson’s Disease”, Published on Acta Med Port 2021 Jan;34(1):6-11.

On the title of Appendix 1, where it reads:“Appendix 1: Validated European Portuguese version of the “Non-Motor Symptoms Questionnaire”It should read:“Appendix 1: Validated European Portuguese version of the “Non-Motor Symptoms Questionnaire. Copyright© [2021]International Parkinson and Movement Disorder Society (MDS). All rights reserved. Provisional translation used with permissionof MDS.”Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13160

Salivary caffeine in Parkinson’s disease

We aimed to investigate salivary caffeine content, caffeine absorption and metabolism in Parkinson’s disease (PD) and verify whether salivary caffeine can be used as a biomarker of PD. We enrolled 98 PD patients and 92 healthy subjects. Caffeine and its major metabolite, paraxanthine, were measured in saliva samples collected before and 4 h after the oral intake of caffeine (100 mg). We measured caffeine absorption as the normalized increase in caffeine levels, and caffeine metabolism as the paraxanthine/caffeine ratio. The Movement Disorder Society Unified Parkinson's Disease Rating Scale part III, the Hoehn & Yahr, the presence of motor complications, and levodopa equivalent dose (LED) were assessed and correlated with caffeine levels, absorption, and metabolism. The effects of demographic and environmental features possibly influencing caffeine levels were also investigated. Caffeine levels were decreased in patients with moderate/advanced PD, while caffeine levels were normal in patients with early and de-novo PD, unrelated to caffeine intake. Caffeine absorption and metabolism were normal in PD. Decreased salivary caffeine levels in PD were associated with higher disease severity, longer duration, and the presence of motor complications, no significant association was found with LED. Salivary caffeine decrease correlates with PD progression.

Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism

X-linked dystonia-parkinsonism (XDP) is a neurodegenerative condition found among males with maternal ancestry from Panay Island, Philippines. The treatment options are limited. We report on our experience of three XDP patients who underwent transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) pallidothalamic tractotomy. The three patients were all genetically confirmed XDP, with a mean XDP-Movement Disorder Society of the Philippines (MDSP) Scale score of 68.7/200. All patients were on stable doses of their oral medications and their last botulinum toxin injection was 12 months prior to study. Two patients complained of moderate to severe arm pain 2–7 months after the procedure. There was an overall improvement in the XDP-MDSP Scale score of 36.2% (18.7 vs. 15) at 6 months and 30.1% (68.7 vs. 45.5) at 1 year. Notably, there was worsening of the nonmotor subscale (part IIIB, nonbehavioral aspect) by 350% at 1 year. While these numbers are encouraging, there is a need to do a larger study on the safety and efficacy of tcMRgFUS on XDP.

Co-occurrence of apathy and impulsivity in progressive supranuclear palsy

BackgroundApathy and impulsivity are common problems in progressive supranuclear palsy (PSP) and can worsen its prognosis. They can co-exist in the same patients although their concomitant prevalence remains unclear. Their relationship to emotional lability is also unknown.ObjectivesTo estimate the co-occurrence of apathy and impulsivity and their relationship to emotional lability in PSP. To characterize the demographic, clinical, and cognitive features of PSP patients with apathy and impulsivity.MethodsIn a retrospective study of a long-term clinical cohort, we assessed the prevalence of apathy, impulsivity, and emotional lability from clinical interviews, medical records, and contemporary carer questionnaires. N=154 patients with a diagnosis of probable or possible PSP (according to the 2017 Movement Disorder Society criteria) were identified. N=64 of these patients had neuropathological confirmation of PSP. PSP patients with both apathy and impulsivity were compared in terms of demographic, clinical, and cognitive characteristics to PSP patients with either one or neither of these neuropsychiatric features.ResultsApathy and impulsivity co-existed in two-thirds of people with PSP. A fifth displayed emotional lability in addition to apathy and impulsivity. Apathy and impulsivity were more commonly co-expressed than by chance. There was no single demographic, clinical or cognitive feature that distinguished between PSP patients with versus patients without apathy and impulsivity.ConclusionsThe co-existence of apathy and impulsivity in PSP suggests that these neuropsychiatric features may share similar risk factors and etio-pathogenetic mechanisms. Apathy and impulsivity should be jointly assessed when planning symptomatic treatments for behavioural problems in PSP.

16 Pharmacological Interventions for Sialorrhoea in Parkinson’s Disease: A Systematic Review

Introduction We looked at patients with Idiopathic Parkinson’s disease and reviewed articles that used any pharmacological therapy to attempt to reduce the volume or burden of sialorrhoea. The control was patients on placebo or receiving usual best care. The primary outcome was symptom burden of sialorrhoea. Method The review was registered on Prospero (CRD42016042470.) 7 electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS) were searched until April 2019 using search terms for sialorrhoea and Parkinson’s disease. We additional searched through the last 6 years of abstracts from the International Movement Disorder Conference, Movement Disorder Society International Congress and World Parkinson’s Congress. Hand searching was performed of published journals from the Movement Disorder Journal of the Movement Disorder Society and Neurology. Inclusion criteria included patients aged over 18; patients with a diagnosis of Idiopathic Parkinson’s disease; patients with the complication of sialorrhoea and any pharmacological therapy aimed at reducing sialorrhoea. All articles were assessed for risk of bias independently by two assessors using the Cochrane risk of bias tool. Results 7 articles were included from the 1,015 screened citations. 3 studies used Botox B as an intervention with clear objective measures and low risk of bias. These studies did show a significant reduction in sialorrhoea however the largest study showed some reporting bias and the others had small numbers and a short follow up period. 1 study looked at Botox A which showed significant improvement in sialorrhoea but had short follow-up. Conclusion Most studies have very small numbers and were followed up for only 1 month. There was significant heterogeneity in outcome measures but little evidence of significant harm from from the treatments studied. Overall, more robust evidence is required in order to achieve a gold standard in the treatment of sialorrhoea.