Cognitive Reserve in Parkinson's Disease without Dementia: ß-Amyloid and Metabolic Assessment.

BACKGROUND: Cognitive reserve (CR) is the mismatch between preserved cognition and neuropathological damage. Amyloidopathy in Parkinson's disease (PD) could be associated with faster progression to dementia, but the putative protective effect of CR is unknown. OBJECTIVES: To evaluate the effect of CR on ß-amyloid burden and brain metabolism in non-demented PD subjects. METHODS: Participants with PD (n = 53) underwent a clinical evaluation, [18 F]-fluorodeoxyglucose and [18 F]-flutemetamol positron emission tomography magnetic resonances, and were classified according to CR. The metabolic pattern of 16 controls was compared to PD subjects. RESULTS: The PD subjects showed hypometabolism mainly in the bilateral posterior cortex. Superior-CR subjects (n = 22) exhibited better cognitive performance, increased amyloid burden, and higher metabolism in several right hemisphere areas compared to low-medium-CR subjects (n = 31). CONCLUSIONS: Higher CR in non-demented PD is associated with better cognitive performance, which might reduce vulnerability to the effect of ß-amyloid. Whether superior CR leads to protection against metabolic deterioration, and predominantly right hemisphere involvement, deserves further exploration.

Levodopa-Induced Dyskinesias are Frequent and Impact Quality of Life in Parkinson's Disease: A 5-Year Follow-Up Study.

BACKGROUND: Levodopa-induced dyskinesias (LID) are frequent in Parkinson's disease (PD). OBJECTIVE: To analyze the change in the frequency of LID over time, identify LID related factors, and characterize how LID impact on patients' quality of life (QoL). PATIENTS AND METHODS: PD patients from the 5-year follow-up COPPADIS cohort were included. LID were defined as a non-zero score in the item "Time spent with dyskinesia" of the Unified Parkinson's Disease Rating Scale-part IV (UPDRS-IV). The UPDRS-IV was applied at baseline (V0) and annually for 5 years. The 39-item Parkinson's disease Questionnaire Summary Index (PQ-39SI) was used to asses QoL. RESULTS: The frequency of LID at V0 in 672 PD patients (62.4 ± 8.9 years old; 60.1% males) with a mean disease duration of 5.5 ± 4.3 years was 18.9% (127/672) and increased progressively to 42.6% (185/434) at 5-year follow-up (V5). The frequency of disabling LID, painful LID, and morning dystonia increased from 6.9%, 3.3%, and 10.6% at V0 to 17.3%, 5.5%, and 24% at V5, respectively. Significant independent factors associated with LID (P < 0.05) were a longer disease duration and time under levodopa treatment, a higher dose of levodopa, a lower weight and dose of dopamine agonist, pain severity and the presence of motor fluctuations. LID at V0 (ß = 0.073; P = 0.027; R2 = 0.62) and to develop disabling LID at V5 (ß = 0.088; P = 0.009; R2 = 0.73) were independently associated with a higher score on the PDQ-39SI. CONCLUSION: LID are frequent in PD patients. A higher dose of levodopa and lower weight were factors associated to LID. LID significantly impact QoL.

Cáncer parental: díptico de soporte para padres y madres recién diagnosticados / Parental cancer: support diptych for newly diagnosed parents and mothers

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Mitos y evidencias en el empleo de la toxina botulínica: neurofarmacología y distonías / Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia

Introducción. La toxina botulínica de tipo A (TBA) ha supuesto una verdadera revolución terapéutica en neurología, y en la actualidad es el tratamiento rutinario en las distonías focales y la espasticidad. Objetivo. Plantear, revisar y responder cuestiones controvertidas en relación con la neurofarmacología de a TBA y su uso en las distonías en la práctica clínica habitual. Desarrollo. Un grupo de expertos en trastornos del movimiento revisó una lista de temas controvertidos relacionados con la farmacología de la TBA y su uso en las distonías. Revisamos la bibliografía e incluimos artículos relevantes especialmente en inglés, pero también, si su importancia lo merece, en castellano y en francés, hasta junio de 2016. El documento se estructuró como un cuestionario que incluyó las preguntas que podrían generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. Incluimos preguntas sobre diferentes aspectos de la neurofarmacología, especialmente el mecanismo de acción, la bioequivalencia de los diferentes preparados y la inmunogenicidad. En relación con el subapartado de las distonías, se incluyeron aspectos sobre la evaluación y el tratamiento de las distonías focales. Conclusiones. Esta revisión no pretende ser una guía, sino una herramienta práctica destinada a neurólogos y médicos internos residentes interesados en esta área, dentro de diferentes ámbitos específicos del manejo de la TBA (AU)

Introduction. Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. Aim. To analyze and summarize different questions about the use of BTA in our clinical practice. Development. A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. Conclusion. This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA (AU)

Estado emocional en mujeres con cáncer de mama: variación experimentada después de una sesión psico-oncológica basada en el counselling y la psicología positiva / No dEmotional status in women with breast cancer: variation experienced after a psycho-oncological session based on counseling and positive psychology

Objetivo: La mayoría de estudios sobre los beneficios de la intervención psicológica en pacientes de cáncer de mama se han centrado en los efectos acumulados después de varias sesiones terapéuticas. El objetivo de la presente investigación ha sido describir el estado emocional de las pacientes antes de la sesión y constatar el posible efecto emocional inmediato de la misma. Método: Se evaluó el estado emocional de 30 mujeres diagnosticadas de cáncer de mama, mediante un instrumento ad hoc que incluía ítems del Distress Thermometer for Patients, antes y después de una sesión de apoyo psicológico. Durante la sesión se abordaban aquellos aspectos que preocupaban a las pacientes desde un enfoque terapéutico basado en el counselling y la psicología positiva. Resultados: La media de malestar emocional experimentado durante la semana previa a la sesión era de 6,4 puntos (sobre 10) en el termómetro emocional y más de la mitad de las mujeres habían experimentado varios problemas emocionales durante ese período. Después de la sesión se redujo significativamente la intensidad de las emociones negativas con respecto al inicio de la visita y, también, el malestar emocional en comparación con la última semana. Así mismo, más de la mitad de la muestra experimentaban estados emocionales positivos. Las mejoras no se relacionaron con la situación médica ni con el número de visitas psico-oncológicas previas. Conclusiones: Ante la constatación de alivio inmediato del malestar emocional, se concluye que es adecuado derivar a todos los pacientes al servicio de psico-oncología al menos para una vista de control

Objective: Most studies on psychological intervention benefits have focused on the effects after several therapeutic sessions. The objective of this research was to describe the patients’ emotional state, and establish the possible immediate emotional effects of an individual psycho-oncological session. Method: The emotional state of 30 women with breast cancer was assessed with an ad- hoc tool that included items from the Distress Thermometer for Patients at the beginning and at the end of a psychological support session. During the session, issues that worried patients were addressed through an approach based on counselling and positive psychology. Results: The mean of emotional distress experienced during the previous week was 6.4 on the emotional thermometer, and more than half of the women had experienced multiple emotional problems during this period. After the session, the intensity of certain emotions decreased significantly in relation to the beginning of it, and the emotional distress compared to the previous week also decreased. In addition, more than half the sample experienced positive emotional states. Improvements were related to neither medical condition nor the number of previous psycho-oncological sessions. Conclusions: In light of the immediate distress relief, it is concluded that it is appropriate to refer all patients to the psych-oncology service, at least for a psychological assessment visit

Levodopa en el tratamiento de la enfermedad de Parkinson: mitos y realidades / Levodopa in the treatment of Parkinson’s disease: myths and realties

Durante los últimos años hemos sido testigos de una utilización preferente de agonistas dopaminérgicos (AD) como tratamiento de la enfermedad de Parkinson (EP), con la intención de retrasar en lo posible el desarrollo de fluctuaciones y discinesias. Sin embargo, la levodopa continúa siendo el fármaco antiparkinsoniano más eficaz y, probablemente, el que mejora un mayor número de síntomas de la enfermedad. En este artículo se ha realizado una revisión exhaustiva de la literatura por parte de un grupo de neurólogos expertos y miembros del Grupo de Trastornos del Movimiento de la Sociedad Española de Neurología sobre los beneficios y riesgos del tratamiento con levodopa en pacientes con EP. La principal conclusión de este artículo es que la levodopa continúa siendo el tratamiento más eficaz para la EP. Aunque el riesgo y la incidencia de desarrollar discinesias se mantiene en un nivel menor en el grupo tratado inicialmente con AD, el número de pacientes que desarrollan discinesias incapacitantes es muy bajo en todos los estudios y similar para los AD y la levodopa, y las escalas de calidad de vida son también similares en ambos grupos, lo que cuestiona el impacto que estas complicaciones motoras tienen sobre la calidad de vida de los pacientes con EP. A la vista de estos resultados, deberíamos plantearnos si está justificado privar a los pacientes del buen control de los síntomas que proporciona la levodopa por el temor a que desarrollen discinesias o fluctuaciones motoras leves que no van a mermar su calidad de vida. A ello hay que añadir la posibilidad de que desarrollen efectos secundarios graves, que son más frecuentes con el uso de AD (AU)

In recent years we have witnessed a growing tendency to opt for the use of dopamine agonists (DA) as treatment for Parkinson’s disease (PD), with the aim of delaying as far as possible the development of fluctuations and dyskinesias. Yet, levodopa continues to be the most effective antiparkinson drug and is probably the one that improves the greatest number of symptoms of the disease. This article reports on the results of a comprehensive review of the literature dealing with the benefits and risks of levodopa treatment in patients with PD which was conducted by a group of expert neurologists and members of the Spanish Neurology Society’s Movement Disorder Group. The main conclusion reached in this article is that levodopa continues to be the most effective treatment for PD. Although the risk and incidence of developing dyskinesias remains at a lower level in the group initially treated with DA, the number of patients who develop disabling dyskinesias is very low in all the studies and is similar for DA and for levodopa. Scores on the quality of life scales are also similar in the two groups, which casts some doubt on the impact that these motor complications have on the quality of life of patients with PD. In view of these findings, we should consider whether there is any real justification for depriving patients of the good control of their symptoms offered by levodopa owing to the fear of developing dyskinesias or mild motor fluctuations that are not really going to have any negative effect on their quality of life. There is also the possibility of their developing severe side effects, which are more frequent with the use of DA (AU)

Manejo perioperatorio de la enfermedad de Parkinson / Perioperative management of Parkinson’s disease

Una de las características singulares de la enfermedad de Parkinson (EP) es la gran variabilidad clínica en relación con el tratamiento que puede acontecer en un mismo paciente. Esto sucede tanto con el tratamiento específico para la EP como con otra serie de fármacos que pueden empeorar la función motora. Por esta razón, el manejo perioperatorio de la EP requiere experiencia y sobre todo una planificación adecuada. En este artículo se revisan las peculiaridades de la EP y su tratamiento, y se plantea una estrategia para el perioperatorio de estos pacientes (AU)

One of the particular characteristics of Parkinson’s disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and astrategy is set out for the perioperative management of these patients (AU)

Tratamiento de la enfermedad de Parkinson. ¿Con qué empezar? ¿Es realmente importante? / Treatment of Parkinson's disease. Where to start? Is it really important?

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Valoración cuantitativa de la rigidez axial, estado funcional y calidad de vida relacionada con la salud en pacientes con enfermedad de Parkinson / Quantitative measurement of axial rigidity, functional status and health-related quality of life in patients with Parkinson’s disease

Introducción. La rigidez es uno de los síntomas motores característicos de la enfermedad de Parkinson (EP). Escasos estudios han valorado la rigidez axial mediante métodos objetivos en dicha enfermedad. Objetivos. Realizar una valoración objetiva de la rigidez del tronco en pacientes con EP y examinar su correlación con la gravedad de la enfermedad, los años desde su diagnóstico, la funcionalidad y la calidad de vida relacionada con la salud. Pacientes y métodos. Se empleó un dinamómetro isocinético tipo Biodex System 3 para valorar la rigidez de tronco en 36 pacientes. Se realizaron movilizaciones pasivas hacia la flexoextensión a tres velocidades angulares: 30º/s, 45º/s y 60º/s. Se administraron el estadio de Hoehn-Yahr, la Unified Parkinson’s Disease Rating Scale III (UPDRS-III), la escala de actividades de la vida diaria de Schwab y England, el European Quality of Life-5 Dimensions y la versión española del Parkinson’s Disease Questionnaire-39 items (PDQ-39). Resultados. Se encontraron correlaciones significativas entre la rigidez hallada en la musculatura extensora y flexora del tronco y el estadio de Hoehn-Yahr, la UPDRS-III, los años desde el diagnóstico, el estado funcional a 30°/s, 45°/s y 60°/s, así como diversos dominios del PDQ-39. Conclusiones. Las velocidades angulares utilizadas con esta metodología objetiva de valoración fueron válidas para evaluar la rigidez axial y se correlacionaron con la gravedad de la enfermedad, los años desde el diagnóstico, el estado funcional y la calidad de vida relacionada con la salud en los pacientes con EP (AU)

Introduction. Rigidity is a cardinal symptom of Parkinson’s disease (PD). Clinically, rigidity is usually assessed by passively flexing and extending a patient’s limb. Few studies have assessed rigidity in trunk muscles in PD patients. Aims. To develop an objective measurement to quantify trunk rigidity in PD patients, and to examine its relationship with disease severity using the Hoehn and Yahr staging score (H&Y) and the Unified Parkinson’s Disease Rating Scale III (UPDRS-III), disease duration, functional status with the Schwab & England activities of daily living scale and health related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions and Parkinson’s Disease Questionnaire-39 items (PDQ-39). Patients and methods. An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30°/s, 45°/s and 60°/s were applied and resistive torques were recorded as trunk flexor and extensors rigidity. Results. Significant correlations between trunk flexors-extensors tone and H&Y staging score, UPDRS-III, disease duration and functional status at 30°/s, 45°/s and 60°/s were obtained. Trunk rigidity was correlated with the HRQoL assessed with the PDQ-39. Conclusions. Our results suggest that the 30°/s, 45°/s and 60°/s angular velocities of this objective method was valid to assess trunk rigidity and was correlated with disease severity, disease duration, functional status and HRQoL in PD patients (AU)

I Encuentro Nacional de Expertos en Enfermedad de Parkinson: Madrid 28-29 de Marzo de 2008 / 1st National Parkinson's Disease Expert Meeting

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