Intensive training programme improves handwriting in a community cohort of people with Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PwP) often report problems with their handwriting before they receive a formal diagnosis. Many PwP suffer from deteriorating handwriting throughout their illness, which has detrimental effects on many aspects of their quality of life. AIMS: To assess a 6-week online training programme aimed at improving handwriting of PwP. METHODS: Handwriting samples from a community-based cohort of PwP (n = 48) were analysed using systematic detection of writing problems (SOS-PD) by two independent raters, before and after a 6-week remotely monitored physiotherapy-led training programme. Inter-rater variability on multiple measures of handwriting quality was analysed. The handwriting data was analysed using pre-/post-design in the same individuals. Multiple aspects of the handwriting samples were assessed, including writing fluency, transitions between letters, regularity in letter size, word spacing, and straightness of lines. RESULTS: Analysis of inter-rater reliability showed high agreement for total handwriting scores and letter size, as well as speed and legibility scores, whereas there were mixed levels of inter-rater reliability for other handwriting measures. Overall handwriting quality (p = 0.001) and legibility (p = 0.009) significantly improved, while letter size (p = 0.012), fluency (p = 0.001), regularity of letter size (p = 0.009), and straightness of lines (p = 0.036) were also enhanced. CONCLUSIONS: The results of this study show that this 6-week intensive remotely-monitored physiotherapy-led handwriting programme improved handwriting in PwP. This is the first study of its kind to use this tool remotely, and it demonstrated that the SOS-PD is reliable for measuring handwriting in PwP.

Mental Effects of Excess Parathyroid Hormone in Hemodialysis Patients: A Possible Role for Parathyroid 2 Hormone Receptor?

Depression as measured by the kidney disease quality of life (KDQOL) form is known to be an independent risk factor for mortality dialysis patients. Excess parathyroid hormone (PTH) has long been associated with neuropsychiatric disturbances. Those psychiatric complications are currently attributed to hypercalcemia with very little evidence; however, with the discovery of the parathyroid hormone 2 receptor (PTH2R) in the brain which can be activated by PTH, PTH2R might indicate a direct effect of PTH. As secondary and tertiary hyperparathyroidism is common in dialysis patients where the serum calcium is low or normal, we chose to investigate a possible relationship between PTH levels and depression in dialysis patients. This was a matched pair observational study with 10 patients with intact PTH values above 1000 pg/mL who were matched with 10 patients who had PTH values less than 400 pg/mL for the presence of diabetes, years on dialysis, duration of dialysis time, Kt/V, hemoglobin, and 25 OH vitamin D levels, as well as intravenous iron and erythropoietin administration. The Kidney Disease Quality of Life questionnaire (KDQOL-36) scores and patient Health Questionnaire scores were analyzed during that time. All variables underwent tests for normality and matched pair t-test. All subscales of the KDQOL-36 were worse in the high PTH group with the effect on daily life reaching P = 0.01 and the burden of disease and symptoms both reaching P = 0.02. PTH and PTH2R may be appropriate targets for investigations to improve the quality of life in hemodialysis patients.

Use of the Fractional Excretion of Urea in an Azotemic Nonoliguric State: Type 1 Cardiorenal Syndrome.

The fractional excretion of urea is a useful tool to evaluate renal function in oliguric states; however, it remains unexplored in nonoliguric states. We evaluated its use to predict responses in patients with type 1 cardiorenal syndrome. This was a prospective observational study of 116 patients with type 1 cardiorenal syndrome referred over a 4-year period. Fractional excretion of urea and sodium, ejection fraction, mean arterial pressure, age, sex, diabetes, brain natriuretic peptide (BNP), serum sodium and blood urea nitrogen were analyzed for effects upon serum creatinine and survival. Improvement of renal function correlated most significantly with FeUrea (P = 0.00001) followed by the FeNa (P = 0.005) but no other variable studied reached significance. Survival was best predicted by improvement of the serum creatinine at 24 h (P = 0.005) and 7 days after all inotropes were stopped (P = 0.001). A limitation of this study is that it cannot be extrapolated to all cardiorenal syndrome patients other than type 1. Also, the study was not randomized and those with potentially worse disease have had worse outcomes due merely to worse underlying disease. The success of the FeUrea may possibly be related to interference of dobutamine on creatinine levels. Despite being a nonoliguric state, the FeUrea appears to provide insight to those patients with type 1 cardiorenal syndrome whose renal function (as measured by serum creatinine) and survival might improve.