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BACKGROUND AND PURPOSE: The prevalence and duration of non-motor symptoms (NMS) in prodromal Parkinson's disease (PD) has not been extensively studied. The aim of this study was to determine the prevalence and duration of prodromal NMS (pNMS) in a cohort of patients with recently diagnosed PD. METHODS: We evaluated the prevalence and duration of pNMS in patients with early PD (n = 154). NMS were screened for using the Non-Motor Symptom Questionnaire (NMSQuest). We subtracted the duration of the presence of each individual NMS reported from the duration of the earliest motor symptom. NMS whose duration preceded the duration of motor symptoms were considered a pNMS. Individual pNMS were then grouped into relevant pNMS clusters based on the NMSQuest domains. Motor subtypes were defined as tremor dominant, postural instability gait difficulty (PIGD) and indeterminate type according to the Movement Disorder Society Unified Parkinson's Disease Rating Scale revision. RESULTS: Prodromal NMS were experienced by 90.3% of patients with PD and the median number experienced was 4 (interquartile range, 2-7). A gender difference existed in the pNMS experienced, with males reporting more sexual dysfunction, forgetfulness and dream re-enactment, whereas females reported more unexplained weight change and anxiety. There was a significant association between any prodromal gastrointestinal symptoms [odds ratio (OR), 2.30; 95% confidence interval (CI), 1.08-4.89, P = 0.03] and urinary symptoms (OR, 2.54; 95% CI, 1.19-5.35, P = 0.016) and the PIGD phenotype. Further analysis revealed that total pNMS were not significantly associated with the PIGD phenotype (OR, 1.10; 95% CI, 0.99-1.21, P = 0.068). CONCLUSIONS: Prodromal NMS are common and a gender difference in pNMS experienced in prodromal PD may exist. The PIGD phenotype had a higher prevalence of prodromal gastrointestinal and urinary tract symptoms.
Assuntos
Ansiedade/epidemiologia , Doença de Parkinson/diagnóstico , Disfunções Sexuais Fisiológicas/epidemiologia , Tremor/diagnóstico , Idoso , Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Prevalência , Sintomas Prodrômicos , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Inquéritos e Questionários , Tremor/fisiopatologiaRESUMO
OBJECTIVE: To assess reductions of cerebral glucose metabolism in Parkinson's disease (PD) with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and their associations with cognitive decline. METHODS: FDG-PET was performed on a cohort of 79 patients with newly diagnosed PD (mean disease duration 8â months) and 20 unrelated controls. PD participants were scanned while on their usual dopaminergic medication. Cognitive testing was performed at baseline, and after 18â months using the Cognitive Drug Research (CDR) and Cambridge Neuropsychological Test Automated Battery (CANTAB) computerised batteries, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). We used statistical parametric mapping (SPM V.12) software to compare groups and investigate voxelwise correlations between FDG metabolism and cognitive score at baseline. Linear regression was used to evaluate how levels of cortical FDG metabolism were predictive of subsequent cognitive decline rated with the MMSE and MoCA. RESULTS: PD participants showed reduced glucose metabolism in the occipital and inferior parietal lobes relative to controls. Low performance on memory-based tasks was associated with reduced FDG metabolism in posterior parietal and temporal regions, while attentional performance was associated with more frontal deficits. Baseline parietal to cerebellum FDG metabolism ratios predicted MMSE (ß=0.38, p=0.001) and MoCA (ß=0.3, p=0.002) at 18â months controlling for baseline score. CONCLUSIONS: Reductions in cortical FDG metabolism were present in newly diagnosed PD, and correlated with performance on neuropsychological tests. A reduced baseline parietal metabolism is associated with risk of cognitive decline and may represent a potential biomarker for this state and the development of PD dementia.
Assuntos
Glicemia/metabolismo , Encéfalo/diagnóstico por imagem , Fluordesoxiglucose F18 , Doença de Parkinson/sangue , Doença de Parkinson/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Idoso , Idoso de 80 Anos ou mais , Mapeamento Encefálico , Disfunção Cognitiva/sangue , Disfunção Cognitiva/diagnóstico por imagem , Estudos de Coortes , Inglaterra , Feminino , Humanos , Estudos Longitudinais , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Estatística como AssuntoRESUMO
BACKGROUND: The quality of life (QoL) of informal caregivers of people with Parkinson's disease (PD) (PwP) can be affected by the caring role. Because of cognitive symptoms and diminished activities of daily living, in addition to the management of motor symptoms, carers of PwP and cognitive impairment may experience increased levels of burden and poorer QoL compared with carers of PwP without cognitive impairment. This study aimed to investigate the impact of cognitive impairment in PD upon QoL of carers. METHODS: Approximately 36 months after diagnosis, 66 dyadic couples of PwP and carers completed assessments. PwP completed a schedule of neuropsychological assessments and QoL measures; carers of PwP completed demographic questionnaires and assessments of QoL. Factor scores of attention, memory/executive function and global cognition, as derived by principal component analysis, were used to evaluate cognitive domains. RESULTS: Hierarchical regression analysis found lower Montreal Cognitive Assessment was a significant independent predictor of poorer carer QoL, in addition to number of hours spent caregiving, carer depression and PD motor severity. Attentional deficits accounted for the largest proportion of variance of carer QoL. Carers of PwP and dementia (n = 9) had significantly poorer QoL scores compared with PwP and mild cognitive impairment (n = 18) or normal cognition (n = 39) carers (p < 0.01). CONCLUSIONS: Attentional deficits were the strongest predictor of carer QoL compared with other cognitive predictors. Carers for those with PD dementia reported the poorest QoL. Interventions such as respite or cognitive behavioural therapy to improve mood and self-efficacy in carers may improve carer QoL. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.
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Transtornos Cognitivos , Doença de Parkinson/psicologia , Qualidade de Vida , Atividades Cotidianas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Qualidade de Vida/psicologia , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Cross-sectional studies have identified that the prevalence of neuropsychiatric symptoms (NPS) in Parkinson's disease (PD) ranges from 70-89%. However, there are few longitudinal studies determining the impact of NPS on quality of life (QoL) in PD patients and their caregivers. We seek to determine the progression of NPS in early PD. METHODS: Newly diagnosed idiopathic PD cases (n = 212) and age-matched controls (n = 99) were recruited into a longitudinal study. NPS were assessed using the Neuropsychiatric Inventory with Caregiver Distress scale (NPI-D). Further neuropsychological and clinical assessments were completed by participants, with reassessment at 18 and 36 months. Linear mixed-effects modelling determined factors associated with NPI-D and QoL over 36 months. RESULTS: Depression, anxiety, apathy and hallucinations were more frequent in PD than controls at all time points (p < 0.05). Higher motor severity at baseline was associated with worsening NPI-D scores over time (ß = 0.1, p < 0.05), but not cognition. A higher NPI total score was associated with poorer QoL at any time point (ß = 0.3, p < 0.001), but not changed in QoL scores. CONCLUSION: NPS are significantly associated with poorer QoL, even in early PD. Screening for NPS from diagnosis may allow efficient delivery of better support and treatment to patients and their families.
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Myotonic dystrophy type 1 (DM1) is one of the most common muscular dystrophies in adults. This review summarises the current literature regarding the natural history of respiratory dysfunction in DM1, the role of central respiratory drive and peripheral respiratory muscle involvement and its significance in respiratory function, and investigates the relationship between genetics (CTG repeat length) and respiratory dysfunction. The review included all articles that reported spirometry on 10 or more myotonic dystrophy patients. The final review included 55 articles between 1964 and 2017. The major conclusions of this review were (1) confirmation of the current consensus that respiratory dysfunction, predominantly a restrictive ventilatory pattern, is common in myotonic dystrophy and is associated with alveolar hypoventilation, chronic hypercapnia, and sleep disturbance in the form of sleep apnoea and sleep related disordered breathing; (2) contrary to commonly held belief, there is no consensus in the literature regarding the relationship between CTG repeat length and severity of respiratory dysfunction and a relationship has not been established; (3) the natural history and time-course of respiratory functional decline is very poorly understood in the current literature; (4) there is a consensus that there is a significant involvement of central respiratory drive in this alveolar hypoventilation however the current literature does not identify the mechanism for this.
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Hipercapnia/fisiopatologia , Distrofia Miotônica/fisiopatologia , Transtornos Respiratórios/fisiopatologia , Músculos Respiratórios/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia , Humanos , Hipercapnia/complicações , Hipercapnia/genética , Distrofia Miotônica/genética , Transtornos Respiratórios/complicações , Transtornos do Sono-Vigília/genética , Expansão das Repetições de Trinucleotídeos/genéticaRESUMO
Cavernous transformation of the portal vein may be seen following portal vein thrombosis. Ultrasound is a useful non-invasive procedure for demonstrating many abnormalities of the portal vein and surrounding structures. Two cases of cavernous transformation of the portal vein, diagnosed by ultrasonography, are presented.
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Circulação Colateral , Veia Porta/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Hipertensão Portal/diagnóstico por imagem , Masculino , UltrassonografiaRESUMO
This is a prospective study involving seventy-two consecutive admissions of patients with fractures of the proximal femur over a period of eleven months. It reviews the incidence, pattern and clinical course of deep vein thrombosis in this group of patients. The method of detection of deep vein thrombosis was that of ascending phlebography of the injured limb. Results show that the incidence of deep vein thrombosis is low and complications of thromboembolism and local complications secondary to venous stasis are nil. It appears that prophylaxis and active treatment of deep vein thrombosis in this group of patients may not be essential.
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Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/etiologia , Tromboflebite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SingapuraRESUMO
Acute pulmonary embolism is associated with considerable morbidity and mortality. Early diagnosis and prompt treatment is essential. A number of non-invasive diagnostic tools are available for its detection. However, each one of these tests has its limitations and the invasive pulmonary angiography remains the gold standard. We describe the use of spiral volumetric computerised tomogram in the diagnosis of acute pulmonary embolism in six patients in our centre where ventilation-perfusion scan facility is not available. This safe, simple and non-invasive test has an excellent sensitivity and specificity for the detection of central and segmental pulmonary embolism and may replace the conventional invasive pulmonary angiography for the diagnosis of pulmonary embolism.
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Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIMS: To determine the diagnostic yield of Intravenous Urogram (IVU) and the values of plain radiograph of kidney, ureter and bladder (KUB) and urinalysis as screening tests, with the objective to improve the cost effectiveness, in the management of patients presenting with flank pain due to urinary lithiasis. PATIENTS AND METHODS: All Intravenous Urogram (IVU) request forms and reports for the month of February 1998 were audited. The case notes, urinalysis, KUB and IVU films were traced and reviewed. RESULTS: There were 110 patients investigated, 61.8% (68) had normal IVU, 38.2% (42) had abnormal IVU. The sensitivity and specificity of KUB alone was 79.4% and 90%. The sensitivity using urinalysis alone was 90.9% and its specificity 33.8%. The sensitivity of combined KUB and urinalysis was 100% and its specificity 26%, with a negative predictive value of 100%. All the patients with both negative KUB and urinalysis in our study were found to have negative IVU. CONCLUSION: Our study shows that in patients with both negative KUB and urinalysis, the yield of IVU is very low and may not be necessary. This is important, as an IVU examination is not without risk. A combination of KUB with urinary analysis and careful evaluation of clinical symptoms will improve the cost-effectiveness of patient management.
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Dor no Flanco/diagnóstico por imagem , Urografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Ureter/diagnóstico por imagem , Urinálise , Bexiga Urinária/diagnóstico por imagemRESUMO
Ankle arthrography was performed on 64 patients with a history of ankle injury from 21 January 1986 to 11 October 1988. There was a male predominance in the ratio of 15 to 1 and the mean age of our patients was 22 years. A total of 65 arthrograms were obtained as one patient had bilateral ankle arthrograms. Of these, 29 arthrograms were normal. A year after completing this study, we attempted to retrieve our patients' case-notes and reviewed their subsequent management. Our results showed that multiple factors influenced the further management of our patients and arthrogram did play a role in this respect.
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Traumatismos do Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Artrografia/métodos , Adolescente , Adulto , Feminino , Fluoroscopia/métodos , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Vasculogenic causes of impotence and especially venous leakage are now considered to be significantly worthwhile to be evaluated in the light of new developments and changes in the treatment of erectile dysfunction. The investigations of cavernosography and penile arteriography are gaining importance. In 32 months, from August 1990 to March 1993, 126 cavernosograms and 11 bilateral internal pudendal arteriograms have been performed on patients from Toa Payoh Hospital. Smooth muscle relaxants are helpful in both procedures. Nearly three-quarters of the cavernosograms showed deep venous leakage. The use of arteriograms is still very restricted. The many variations of the arterial supply to the penis pose problems in the interpretation of the arteriograms and hence, recognition of the numerous variations besides the knowledge of the normal basic vascular anatomy is of paramount importance.
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Angiografia , Disfunção Erétil/diagnóstico por imagem , Pênis/irrigação sanguínea , Adulto , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Ereção Peniana , Pênis/diagnóstico por imagemRESUMO
INTRODUCTION: Most patients with active pulmonary tuberculosis (PTB) are treated with a 6-month short course regimen. The purpose of the present study was to assess the efficacy of using 4 months of chemotherapy to treat patients with smear-negative PTB. METHODS: A total of 314 patients were randomised to a daily or combined (daily and intermittent) regimen as follows: (1) 2HRZ/2HR--2 months of isoniazid (H), rifampicin (R) and pyrazinamide (Z), followed by 2 months of H and R or (2) 2HRZ/2H3R3--2 months of HRZ as in regimen 1, followed by H and R given 3 times weekly for 2 months or 4 months if initial sputum specimens were culture positive. RESULTS: One hundred and fifty-eight patients were assigned to the daily regimen and 156 to the combined regimen. Of the 158 patients, 99 had negative cultures and 59 had positive cultures. There was no relapse among 96 culture-negative patients assessed at 30 months and 68 patients at 60 months. However, 6 patients had no radiological response while 1 was considered on review to have non-tuberculous disease. There was no relapse among 57 culture-positive patients assessed at 30 months and 41 at 60 months. In the combined regimen group, 102 had negative cultures and 54 had positive cultures. There was 1 relapse in the culture-negative group of 100 patients assessed at 30 months and 74 at 60 months. There was no radiological response in 5 patients. One patient in the culture-positive group failed therapy but there were no relapses during follow-up to 60 months. CONCLUSION: A 4-month daily or combined regimen appears to be highly effective in the treatment of non-immunocompromised patients with smear- and culture-negative PTB.
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Antituberculosos/administração & dosagem , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escarro/microbiologia , Resultado do Tratamento , Tuberculose Pulmonar/diagnósticoRESUMO
INTRODUCTION: A rare case of adrenal myelolipoma presenting with spontaneous rupture and retroperitoneal haemorrhage is described. CLINICAL PICTURE: A 51-year-old Caucasian male presented with acute onset of right loin pain. Preliminary diagnosis of haemorrhagic adrenal tumour was made on computed tomography (CT) and angiography. TREATMENT: Vascular embolisation was performed to stabilise the patient prior to definitive surgery. Tumour resection was subsequently performed. Histology confirmed ruptured adrenal myelolipoma. OUTCOME: The patient made an uneventful recovery. CONCLUSION: Ruptured adrenal myelolipoma should be considered in cases of spontaneous retroperitoneal haemorrhage. Vascular embolisation may be useful in stabilising the patient prior to definitive surgery.
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Neoplasias das Glândulas Suprarrenais/diagnóstico , Hemorragia/etiologia , Mielolipoma/diagnóstico , Tomografia Computadorizada por Raios X , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mielolipoma/complicações , Mielolipoma/diagnóstico por imagem , Mielolipoma/cirurgia , Artéria Renal/diagnóstico por imagem , Espaço Retroperitoneal , Ruptura EspontâneaRESUMO
INTRODUCTION: The objective of this study was to establish the normal bone mineral density (BMD) reference curve for the Asian Singapore male. MATERIALS AND METHODS: Three hundred and eighty-three male subjects were enrolled; comprising of 309 Chinese, 44 Malays and 30 Indians resident in Singapore. Bone mineral density was measured at the lumbar spine and left hip using a Hologic QDR 4500 Elite dual-energy X-ray absorptiometry (DXA) scanner. RESULTS: The mean peak BMD for the average lumbar spine and the neck of femur was 1.006 g/cm2 and 0.97 g/cm2, respectively. The mean peak BMD was taken at the 20 to 24 years age group at both the hip and spine based on data distribution for the various age groups. The BMD corresponding to -2.5 standard deviations from the peak adult value was 0.719 g/cm2 for the average lumbar spine and 0.655 g/cm2 for the neck of femur. CONCLUSION: This Asian male BMD reference database, which is 10% and 5% lower than corresponding values from the Caucasian reference database, allows for more accurate diagnosis of osteoporosis in Asian males.
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Densidade Óssea/fisiologia , Osteoporose/diagnóstico , Padrões de Referência , Absorciometria de Fóton/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , SingapuraRESUMO
INTRODUCTION: Vasculogenic impotence is one of the major causes of erectile dysfunction. Cavernosometry and cavernosography is traditionally the gold standard for evaluation of venogenic impotence. However, it is invasive and there are potentially significant complications. Penile colour flow Doppler imaging (PCDI) is non-invasive and can be used to assess venous incompetence. MATERIALS AND METHODS: One hundred and sixty-eight patients were referred for PCDI assessment from March 1998 to February 2001. Forty-three of these also had cavernosogram and cavernosometry done and were included in the study. RESULTS: The sensitivity was 93.9%, the specificity was 90.0%, the accuracy was 93.0% with a negative predictive value of 81.8% and a positive predictive value of 96.9%. Kappa value of 0.81 was obtained, indicating excellent agreement between PCDI and cavernosogram and cavernometry. CONCLUSIONS: Penile colour flow Doppler imaging is accurate in the assessment of venogenic erectile dysfunction. It can replace cavernometry and cavernosogram as a screening tool. Cavernometry and cavernosogram should only be done in cases when PCDI suggests venogenic impotence, and when surgery is contemplated.
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Impotência Vasculogênica/diagnóstico por imagem , Pênis/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Dupla , Adulto , Idoso , Disfunção Erétil/diagnóstico por imagem , Disfunção Erétil/etiologia , Humanos , Impotência Vasculogênica/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Lithium has neuroprotective effects in cell and animal models of amyotrophic lateral sclerosis (ALS), and a small pilot study in patients with ALS showed a significant effect of lithium on survival. We aimed to assess whether lithium improves survival in patients with ALS. METHODS: The lithium carbonate in amyotrophic lateral sclerosis (LiCALS) trial is a randomised, double-blind, placebo-controlled trial of oral lithium taken daily for 18 months in patients with ALS. Patients aged at least 18 years who had ALS according to the revised El Escorial criteria, had disease duration between 6 and 36 months, and were taking riluzole were recruited from ten centres in the UK. Patients were randomly assigned (1:1) to receive either lithium or matched placebo tablets. Randomisation was via an online system done at the level of the individual by block randomisation with randomly varying block sizes, stratified by study centre and site of disease onset (limb or bulbar). All patients and assessing study personnel were masked to treatment assignment. The primary endpoint was the rate of survival at 18 months and was analysed by intention to treat. This study is registered with Eudract, number 2008-006891-31. FINDINGS: Between May 26, 2009, and Nov 10, 2011, 243 patients were screened, 214 of whom were randomly assigned to receive lithium (107 patients) or placebo (107 patients). Two patients discontinued treatment and one died before the target therapeutic lithium concentration could be achieved. 63 (59%) of 107 patients in the placebo group and 54 (50%) of 107 patients in the lithium group were alive at 18 months. The survival functions did not differ significantly between groups (Mantel-Cox log-rank χ(2) on 1 df=1·64; p=0·20). After adjusting for study centre and site of onset using logistic regression, the relative odds of survival at 18 months (lithium vs placebo) was 0·71 (95% CI 0·40-1·24). 56 patients in the placebo group and 61 in the lithium group had at least one serious adverse event. INTERPRETATION: We found no evidence of benefit of lithium on survival in patients with ALS, but nor were there safety concerns, which had been identified in previous studies with less conventional designs. This finding emphasises the importance of pursuing adequately powered trials with clear endpoints when testing new treatments. FUNDING: The Motor Neurone Disease Association of Great Britain and Northern Ireland.