A Dual Centre Study of Pain in Parkinson's Disease and Its Relationship with Other Non-Motor Symptoms.

BACKGROUND: Pain is a disabling and often underestimated non-motor symptom (NMS) detrimentally affecting the quality of life of patients with Parkinson's disease (PD). OBJECTIVE: Here, we conducted a cross-sectional, observational international study on 167 patients with idiopathic PD in order to analyze the potential relationship between pain and other NMS. METHODS: Subjects were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS) part III, Hoehn and Yahr (H&Y) stage, King's Parkinson's Disease Pain Scale (KPPS), Brief Pain Inventory (BPI), Non-Motor Symptoms Scale (NMSS), and Beck Depression Inventory (BDI). Spearman's rank correlation coefficient, multiple regression and multiple index-based clustering algorithms were used for data analysis. RESULTS: The prevalence of pain was 88.6%, was not correlated with age, motor severity (UPDRS part III) or disease duration, whereas a weak correlation with female gender and H&Y stage >2.5 was found. Multiple NMS correlated significantly with pain. Specifically, sleep disturbance had the strongest correlation with pain, followed by depression, gastrointestinal and cardiovascular disturbances. Further analyses showed that sleep and cardiovascular disturbance were independently associated with pain, and that these symptoms clustered together in a subset of PD patients. The relationship between pain, sleep and dysautonomia persisted independently from dopamine replacement therapy. CONCLUSION: Our study suggests that sleep disruption and cardiovascular disturbance are associated with pain in PD, and possibly identifies a specific subtype within PD patients with pain. Our data also indicate that sleep disruption, pain and dysautonomia may have a common pathophysiology, possibly involving non-dopaminergic pathways.

Thomas Mann's depiction of neurosyphilis and other diseases.

Thomas Mann (1875-1955), a Nobel Prize recipient rightly considered one of the great novelists of the twentieth century, was one of the most medically perceptive writers of recent times. His novels take place against the background of the different plagues (tuberculosis, cholera) that characterized the eighteenth and nineteenth centuries. One of Mann's later novels, Doctor Faustus, is set against a background of syphilis. In the 500-page book, which is subtitled The Life of the German Composer Adrian Leverkühn as told by a Friend, we see the theologian turned composer make a pact with the devil. He "voluntarily" contracts syphilis and, as a result of the pact and despite (or because of) the disease, Leverkühn starts a brilliant 24-year career, becoming the greatest German composer of his time. While it is widely thought that Arnold Schoenberg (1874-1951) is the model for Leverkühn, we will show that other composers of the time also inspired the fictitious musician's life and works. We will also illustrate the parallel between Leverkühn's disease progression and political events in Germany in the 1930s and 1940s and their similarity with current political events.

Charles Bonnet Syndrome and Other Hallucinatory Phenomena.

Descriptions of hallucinatory phenomena have figured prominently since the beginning of recorded history. Jean Etienne Esquirol (1772-1840) is usually credited for having introduced the term in 1817, differentiating between hallucinations and illusions. Both are wrong perceptions, but in illusions, an external stimulus is always present whereas hallucinations are perceptions that occur in the absence of corresponding sensory stimuli. They occur in a variety of conditions but more often in the mentally ill, especially in schizophrenia where hallucinations, particularly auditory hallucinations represent for many, such as Henri Ey one of the cardinal features. This chapter, however, deals with visual hallucinations as found in individuals who are not necessarily mentally ill: the Charles Bonnet syndrome and autoscopy.

Thomas Mann and Neurology.

Thomas Mann (1875-1955) is considered one of the most influential writers of the late nineteenth and early twentieth century. In addition to his novels and essays, he was well known for his criticisms of the Nazi party, and particularly against the racial nationalism promoted by Adolf Hitler after the First World War, as well as for his depiction of diseases. Here, we provide a quick sketch of Mann's life and his relationship with nineteenth to twentieth century German society. We then proceed to describe how Mann became interested in diseases, how he used the diseases as metaphors, and his specific contribution to the field of neurology. We describe some of the neurological cases portrayed in Mann's work, and particularly epilepsy described in The Buddenbrooks, Felix Krull and The Magic Mountain, meningitis, neurosyphilis and migraines depicted in Doctor Faustus, and essential tremor described in The Magic Mountain and Doctor Faustus. We conclude with reflections about Mann's interest in diseases and particularly in neurology.

Deterioration of semantic associative relationships in mild cognitive impairment and Alzheimer Disease.

The aim of this research was to study semantic abilities and their loss in mild cognitive impairment (MCI) and in dementia, while analyzing efficiency in the use of associative relations, within verbal and visuoperceptual modalities. Participants were split into 4 groups: 19 participants with amnestic MCI, 16 patients with mild Alzheimer disease (AD), 20 patients with moderate AD, and 20 healthy controls (HCs). All participants performed standardized neuropsychological tests and experimental (naming and semantic associations) tasks to evaluate verbal and visuoperceptual semantic abilities. We analyzed 4 associative relations (part/whole, function, superordinate, and contiguity) in both verbal and visuoperceptual code. Our results suggest a progressive impairment in semantic categorization knowledge, with worse performance in the AD groups relative to the MCI and HC groups. Our data show a different pattern in the 4 associative relations and the involvement of associative semantic relations already in the early stage of disease, as well as a different pattern of deterioration between verbal and visuoperceptual modalities. Our data indicate that the visuoperceptual semantic network appears to be less deteriorated than the verbal network in AD. The verbal semantic network may be more sensitive in detecting patients at an early stage of the disease.

The Semantic Associative Ability in Preschoolers with Different Language Onset Time.

Aim of the study is to verify the semantic associative abilities in children with different language onset times: early, typical, and delayed talkers. The study was conducted on the sample of 74 preschool children who performed a Perceptual Associative Task, in order to evaluate the ability to link concepts by four associative strategies (function, part/whole, contiguity, and superordinate strategies). The results evidenced that the children with delayed language onset performed significantly better than the children with early language production. No difference was found between typical and delayed language groups. Our results showed that the children with early language onset presented weakness in the flexibility of elaboration of the concepts. The typical and delayed language onset groups overlapped performance in the associative abilities. The time of language onset appeared to be a predictive factor in the use of semantic associative strategies; the early talkers might present a slow pattern of conceptual processing, whereas the typical and late talkers may have protective factors.