The influence of hypertension, diabetes, lipid disorders and the presence of the APOE4 allele on the cognitive functions of patients over 65 years of age.

Diabetes mellitus (DM) and hypertension (HA) are common diseases in the population of people over 65 years of age. Many studies show the impact of the long-lasting decompensation of these chronic diseases, often diagnosed in middle age, on the cognitive functioning of elderly patients. RESULTS: There is almost 30% prevalence of cognitive impairment among patients diagnosed with arterial hypertension. Possible explanation includes intensification of inflammatory processes in the central nervous system, influence on cerebral blood flow and acceleration of atherosclerosis. Another analyzed factor is the presence of diabetes. DM impacts the development of Alzheimer's disease. The inflammatory processes are intensified by advanced glycation products promoting atherosclerotic changes in blood vessels. In addition to that, the presence of hypoglycemic episodes significantly increases the risk of dementia. Moreover, approximately 78% of adult diabetic patients are also diagnosed with arterial hypertension, resulting in the coexistence of these CNS damaging mechanisms. The effect of elevated total cholesterol concentration on cognitive performance is still under debate and more research is needed. The role of the presence of ApoE4 in the development of cognitive dysfunctions, including Alzheimer's disease is emphasized. CONCLUSIONS: In daily medical practice, extraordinary attention should be paid to control of chronic diseases of the patient, especially in the middle age. It improves cognitive functioning, possibly extending the quality-adjusted life year expectancy.

A 50-Year-Old Patient with Guillain-Barré Syndrome after COVID-19: A Case Report.

Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, causes acute respiratory disease (coronavirus disease 2019; COVID-19). However, the involvement of other mechanisms is also possible, and neurological complications are being diagnosed more frequently. Here, we would like to present a case of a Polish patient with Guillain-Barré syndrome (GBS), after a documented history of COVID-19: A 50-year-old man, 18 days after the onset of COVID-19 symptoms, had progressive quadriparesis preceded by 1-day sensory disturbances. Based on the clinical picture, the results of diagnostic work-up including a nerve conduction study (ENG) that revealed a demyelinating and axonal sensorimotor polyneuropathy, and cerebrospinal fluid (CSF) analysis that showed albumin-cytological dissociation, an acute inflammatory demyelinating polyneuropathy was confirmed, consistent with GBS. Upon a therapeutic plasma exchange (TPE), the patient's condition improved. The presented case of GBS in a patient after mild COVID-19 is the first case in Poland that has supplemented those already described in the global literature. Attention should be drawn to the possibility of GBS occurring after SARS-CoV-2 infection, even when it has a mild course.

Headache Associated with Sexual Activity-A Narrative Review of Literature.

Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.

Validation of the Polish version of the Unified Dyskinesia Rating Scale (UDysRS).

BACKGROUND: In 2008, the Movement Disorders Society published the Unified Dyskinesia Rating Scale (UDysRS). This has become the established tool for assessing the severity and disability associated with dyskinesia in patients with Parkinson's Disease (PD). We translated and validated the Polish version of the UDysRS, explored its dimensionality, and compared it to the Spanish version, which is the Reference Standard for UDysRS translations. MATERIAL AND METHODS: The UDysRS was translated into Polish by a team led by JS and GO. The back-translation, completed by colleagues fluent in both Polish and English who were not involved in the original translation, was reviewed and approved by the Executive Committee of the MDS Rating Scales Programme. Then the translated version of the UDysRS underwent cognitive pretesting, and the translation was modified based on the results. The approved version was considered to be the Official Working Document of the Polish UDysRS and was tested on 250 Polish PD patients recruited at movement disorder centres. Data was compared to the Reference Standard used for validating UDysRS translations. RESULTS: The overall factor structure of the Polish version was consistent with that of the Reference Standard version, as evidenced by the high Confirmatory Fit Index score (CFI = 0.98). The Polish UDysRS was thus confirmed to share a common factor structure with the Reference Standard. CONCLUSIONS: The Official Polish UDysRS translation is recommended for use in clinical and research settings. Worldwide use of uniform rating measures offers a common ground to study similarities and differences in disease manifestations and progression across cultures.

A Rare Mutation in The APOB Gene Associated with Neurological Manifestations in Familial Hypobetalipoproteinemia.

Clinical phenotypes of familial hypobetalipoproteinemia (FHBL) are related to a number of defective apolipoprotein B (APOB) alleles. Fatty liver disease is a typical manifestation, but serious neurological symptoms can appear. In this study, genetic analysis of the APOB gene and ophthalmological diagnostics were performed for family members with FHBL. Five relatives with FHBL, including a proband who developed neurological disorders, were examined. A sequencing analysis of the whole coding region of the APOB gene, including flanking intronic regions, was performed using the next-generation sequencing (NGS) method. Electrophysiological ophthalmological examinations were also done. In the proband and his affected relatives, NGS identified the presence of the pathogenic, rare heterozygous splicing variant c.3696+1G>T. Two known heterozygous missense variants-c.2188G>A, p.(Val730Ile) and c.8353A>C, p.(Asn2785His)-in the APOB gene were also detected. In all patients, many ophthalmologic abnormalities in electrophysiological tests were also found. The identified splicing variant c.3696+1G>T can be associated with observed autosomal, dominant FHBL with coexisting neurological symptoms, and both identified missense variants could be excluded as the main cause of observed clinical signs, according to mutation databases and the literature. Electroretinography examination is a sensitive method for the detection of early neuropathy and should therefore be recommended for the care of patients with FHBL.

Effectiveness of 6-Week Nordic Walking Training on Functional Performance, Gait Quality, and Quality of Life in Parkinson's Disease.

Background and objectives: Motor rehabilitation improves physical mobility and quality of life in Parkinson's disease (PD). As specialized rehabilitation is expensive and resource-consuming, there is a need for simpler, cost-effective methods. The purpose of the study was to determine whether Nordic Walking (NW) training may support the management of motor disability in PD. Materials and Methods: Forty patients (median age 64.0 years, range 50-75 years) with idiopathic PD, Hoehn and Yahr stages II-III, were randomly assigned to NW or standard rehabilitation (SR) programs, comprising twelve rehabilitation sessions conducted bi-weekly throughout the 6-week study period. Results: Median Unified Parkinson's Disease Rating Scale part III scores were significantly reduced with NW, by 8.5, and with SR, by 6.0 points (both p < 0.001), with significantly greater improvement with NW than with SR (p = 0.047). Gait quality and balance control, measured using the Dynamic Gait Index, improved with NW by a median of 8.0 and with SR by 5.5 points (both p < 0.001), with slightly greater improvement with NW, compared to the SR group (p = 0.064). Quality of life, assessed using the Parkinson's Disease Questionnaire (PDQ-39), improved with NW by a median of 15 and with SR by 12 points, p = 0.001 and p = 0.008, respectively. Conclusions: The 6-week Nordic Walking program improves functional performance, quality of gait, and quality of life in patients with PD and has comparable effectiveness to standard rehabilitation.

Validation of the Polish version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

BACKGROUND: In 2008, the Movement Disorders Society (MDS) published a new Unified Parkinson's Disease Rating Scale (MDS-UPDRS) as the official benchmark scale for Parkinson's Disease (PD). We have translated and validated the Polish version of the MDS-UPDRS, explored its dimensionality, and compared it to the original English one. METHODS: The MDS-UPDRS was translated into Polish by a team of Polish investigators led by JS and GO. The back-translation was completed by colleagues fluent in both languages (Polish and English) who were not involved in the original translation, and was reviewed by members of the MDS Rating Scales Programme. Then the translated version of the MDS-UPDRS underwent cognitive pretesting, and the translation was modified based on the results. The final translation was approved as the Official Working Document of the MDS-UPDRS Polish version, and was tested on 355 Polish PD patients recruited at movement disorders centres all over Poland (at Katowice, Gdansk, Lódz, Warsaw, Wroclaw, and Kraków). Confirmatory and explanatory factor analyses were applied to determine whether the factor structure of the English version could be confirmed in the Polish version. RESULTS: The Polish version of the MDS-UPDRS showed satisfactory clinimetric properties. The internal consistency of the Polish version was satisfactory. In the confirmatory factor analysis, all four parts had greater than 0.90 comparative fit index (CFI) compared to the original English MDS-UPDRS. Explanatory factor analysis suggested that the Polish version differed from the English version only within an acceptable range. CONCLUSIONS AND CLINICAL IMPLICATIONS: The Polish version of the MDS-UPDRS meets the requirements to be designated as the Official Polish Version of the MDS-UPDRS, and is available on the MDS web page. We strongly recommend using the MDS-UPDRS instead of the UPDRS for research purposes and in everyday clinical practice.

Case report on novel mutation in SPAST gene in Polish family with spastic paraplegia.

BACKGROUND: Hereditary spastic paraplegia is a large group of degenerative, neurological disorders characterized by progressive lower limb spasticity and weakness. The disease was investigated precisely but still clinicians often make incorrect or late diagnosis. Our aim was to investigate the genetic background and clinical phenotype of spastic paraplegia in large Polish family. CASE PRESENTATION: A 37 years old woman presented with 4-year history of walking difficulties. On neurological examination, she had signs of upper motor lesion in lower extremities. She denied sphincter dysfunction and her cognition was normal. Her family history was positive for individuals with gait problems. The initial diagnosis was familial spastic paraplegia. Genetic testing identified a novel mutation in SPAST gene. All available family members were examined and had genetic testing. The same mutation in SPAST gene was identified in other affected family members. All patients caring the mutation presented with different phenotypes. CONCLUSION: This study presents a family with spastic paraplegia due to a novel mutation c.1390G>T(p.Glu464Term) in SPAST gene. Affected individuals showed a range of phenotypes that varied in their severity. This case report demonstrates, the signs of hereditary spastic paraplegia can be often misdiagnosed with other diseases. Therefore genetic testing should always be considered in patients with lower limb spasticity and positive family history in order to help to establish the correct diagnosis.

[Quality of life of people with Parkinson's disease in the context of professional work and physiotherapy]. / Jakosc zycia osób z choroba Parkinsona w kontekscie pracy zawodowej i rehabilitacji ruchowej.

BACKGROUND: Of many diseases and disorders of the nervous system Parkinson's disease (PD) deserves a particular attention for its specific effects having an impact on the ability to undertake different forms of professional and economic activities. Due to the constantly growing incidence rate and the lowering age of patients, PD is becoming more and more serious social problem. The aim of this study was to determine the effects of professional work and physiotherapy on the quality of live in people with Parkinson's disease. MATERIAL AND METHODS: The research was carried out on 109 people with diagnosed PD of stage II according to the Hoehn and Yahr classification. They were divided into professionally working and non-working subjects and those participating and not participating in physiotherapy programs. The Unified Parkinson's Disease Rating Scale (UPDRS), was used to estimate the patients' clinical status. The Parkinson's Disease Questionnaire (PDQ-39), the Quality of Life Short Form (SF-36) Questionnaire and the Parkinson's Disease Quality of Life Questionnaire (PDQL) were used to estimate the quality of life. RESULTS: In all groups statistically significant differences were observed in each of the used scale. The PDQ-39 (F = 5.278, p = 0.04), SF physical component (F = 4.24, p = 0.005), SF mental component (F = 3.45, p = 0.021), PDQL (F = 6.57, p = 0.003). The highest quality of life was noticed in people working professionally and participating in physiotherapy programs. CONCLUSIONS: Professional activity and participation in properly planned physiotherapy help reduce the symptoms and improve the quality of life of people with Parkinson's disease. The study showed that the quality of life of people with PD is determined by professional work and participation in the process of rehabilitation. Med Pr 2017;68(6):725-734.

[Gait disturbances and falls in various types of dementias].

Dementia is a group of symptoms of damage of higher cortical functions. The causes of dementia include brain diseases, most often chronic and progressive, leading to cognitive impairment typical of these disorders. Apart from progressive cognitive deficits, dementias may coexist with mental disorders, sleep disorders, epileptic seizures, parkinsonism and other motor disorders. Motor disorders, including gait disturbances and falls, represent a serious challenge to the health of older adults and contribute to loss of mobility and independence. Analysis of motor disturbances in the population of healthy older adults and those with progressive cognitive impairment is likely to support effective planning of pharmacological therapies and rehabilitation for this group of patients.

Influence of functional movement rehabilitation on quality of life in people with Parkinson's disease.

[Purpose] Parkinson's disease is one of the most frequent diseases of the central nervous system. Thorough knowledge of reasons for movement defects may contribute to the ability to quality of life at a good level as far as motor abilities are concerned. The aim of the study was to evaluate the influence of functional movement rehabilitation on the degree of intensity of movement symptoms in Parkinson's disease. [Subjects] The research was carried out in people diagnosed with stage III Parkinson's disease, according to the Hoehn and Yahr scale classification. [Methods] In order to establish the clinical state of patients, parts I, II, and III of the Unified Parkinson's Disease Rating Scale, the Schwab and England Activities of Daily Living scale, and the quality of life in Parkinson's disease questionnaire were applied. The intervention group took part in 60 minutes of functional movement rehabilitation twice a week for a period of 15 weeks. The main emphasis was placed on the ability to cope with everyday activities. [Results] A significant difference in scores for the given scales between before and after research the intervention period was observed in the intervention group. [Conclusion] The obtained results revealed positive that the influence of applied rehabilitation program had a positive influence on the degree of intensity of movement symptoms in people with Parkinson's disease.

The impact of MRI white matter hyperintensities on dementia in Parkinson's disease in relation to the homocysteine level and other vascular risk factors.

BACKGROUND: The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear. OBJECTIVE: The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD. METHODS: A total of 192 patients with PD and 184 age- and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined. RESULTS: Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH. CONCLUSIONS: WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.

Diagnosis of cognitive disorders in primary health care in Poland. / Diagnostyka zaburzen poznawczych w ramach podstawowej opieki zdrowotnej w Polsce.

OBJECTIVES: The aim of this study was to assess the knowledge, attitudes and the rules of proceeding concerning primary health care (PHC) doctors in the field of screening diagnostics for cognitive disorders in elderly people in Poland. METHODS: The study included 175 PHC doctors. A validated anonymous questionnaire was used. The survey was conducted using the PAPI (Paper and Pencil Interviews) and CAWI (Computer Assisted Web Interviews) methods. RESULTS: The vast majority of the respondents (n=159; 91.4%) saw the advisability of screening for cognitive disorders in the age group >65 years of age, but only 53 subjects (30.29%) believed that these tests should be conducted by general practitioners (GPs). According to the surveyed doctors, the main obstacle in the diagnostics of cognitive functions is the lack of time - this was the opinion of 142 (81.14%) respondents. When dementia was suspected, the respondents usually ordered laboratory tests and referred patients to a neurologist (n=111; 63.4%). The Mini Mental Status Examination (MMSE) and the Clock Drawing Test (CDT) were the most popular scales assessing cognitive functions, known by 120 doctors (68.57%), and 122 respondents (69.71%), respectively. CONCLUSIONS: Polish GPs are aware of the necessity of screening for cognitive disorders in seniors. Currently, there are no mechanisms within primary health care system that would enable proper early screening for dementia in people at the high risk (i.e.> 65 years of age). The development of standards for the early detection of cognitive disorders within primary health care system in Poland seems to be an urgent need.

The Increase of Theta Power and Decrease of Alpha/Theta Ratio as a Manifestation of Cognitive Impairment in Parkinson's Disease.

In this study, we aim to assess and examine cognitive functions in Parkinson's Disease patients using EEG recordings, with a central focus on characteristics associated with a cognitive decline. Based on neuropsychological evaluation using Mini-Mental State Examination, Montreal Cognitive Assessment, and Addenbrooke's Cognitive Examination-III, 98 participants were divided into three cognitive groups. All the particpants of the study underwent EEG recordings with spectral analysis. The results revealed an increase in the absolute theta power in patients with Parkinson's disease dementia (PD-D) compared to cognitively normal status (PD-CogN, p=0.00997) and a decrease in global relative beta power in PD-D compared to PD-CogN (p=0.0413). An increase in theta relative power in the left temporal region (p=0.0262), left occipital region (p=0.0109), and right occipital region (p=0.0221) were observed in PD-D compared to PD-N. The global alpha/theta ratio and global power spectral ratio significantly decreased in PD-D compared to PD-N (p = 0.001). In conclusion, the increase in relative theta power and the decrease in relative beta power are characteristic changes in EEG recordings in PD patients with cognitive impairment. Identifying these changes can be a useful biomarker and a complementary tool in the neuropsychological diagnosis of cognitive impairment in Parkinson's Disease.

Specific patterns of coherence and phase lag index in particular regions as biomarkers of cognitive impairment in Parkinson's disease.

INTRODUCTION: Cognitive impairment is a persistent and increasingly reported symptom of patients with Parkinson's disease (PD), significantly affecting daily functioning quality. This study aims to evaluate the functional connectivity of the brain network in patients with Parkinson's disease with various severities of cognitive decline using quantitative electroencephalography (EEG) analysis. METHODS: Based on the EEG recorded in the resting state, the coherence and phase lag index were calculated to evaluate functional connectivity in 108 patients with Parkinson's disease divided into three groups according to their cognitive condition: dementia due to PD (PD-D), PD and mild cognitive impairment (PD-MCI) and cognitively normal patients (PD-CogN). RESULTS: It was found that there were significantly different coherence values in the PD-D group compared to PD-CogN in different frequency bands. In most cases, there was a decrease in coherence in PD-D compared to PD-CogN. The most specific changes were revealed in the theta frequency band in the temporal right-frontal left and temporal right-frontal right regions. In the alpha frequency band, the most significant decreases were shown in the occipital right-frontal left and occipital left-frontal right areas. There were also statistically significant differences in phase lag index between many areas, especially in the theta frequency range. CONCLUSIONS: These findings indicate that the functional connectivity patterns of coherence and phase lag index - found in a particular frequency band and region - could become a reliable biomarker for identifying cognitive impairment and differentiating its severity in PD patients.

Association of COMT, MTHFR, and SLC19A1(RFC-1) polymorphisms with homocysteine blood levels and cognitive impairment in Parkinson's disease.

INTRODUCTION: Elevated plasma homocysteine (Hcy) concentration is an independent risk factor for cardiovascular disease, and its involvement in endothelial cell dysfunction is well established. However, the role of Hcy and folate in the pathogenesis of Parkinson's disease (PD) remains controversial. OBJECTIVES: The study was aimed at evaluating the relationships between Hcy, vitamin B12, and folic acid levels in the blood and cognitive status in PD patients with the genetic polymorphisms of MTHFR (rs1801133: C>T-677C>T, rs1801131: A>C-1298A>C), COMT (rs4680: A>G-Val158Met, rs6269: A>G, rs4633: C>T, rs4818: C>G), or SLC19A1 (rs1051266: G>A-80G>A). METHODS: A total of 502 participants (248 with PD and 254 age-matched and sex-matched controls) were included in the study. The Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging, and the Schwab-England scale were used to assess motor abilities and activity during daily life. Complex psychological examination with a battery of tests was used to classify patients into groups with (PDD) and without (nPDD) dementia. Blood samples were examined for Hcy, vitamin B12, and folic acid levels, as well as polymorphisms in genes related to Hcy metabolism, such as COMT, MTHFR, and SLC19A1(RFC-1). RESULTS: The frequency of homozygous COMT rs4680G and rs4633C allele carriers was significantly decreased in PD patients in comparison with the controls (P=0.015; odds ratio=0.60; 95% confidence interval 0.41-0.90 and P=0.020; odds ratio=0.619; 95% confidence interval 0.42-0.92, respectively). No significant differences in the distribution of MTHFR 677C>T, 1298A>C, and SLC19A1 80G>A alleles and genotypes between PD patients and the controls were found. Hcy levels were significantly increased in PD patients (18±7.8 µmol/l) as compared with the controls (14.0±9.6 µmol/l, P=10(-8)) and were significantly associated with the MTHFR 677C>T polymorphism both in PD patients and controls, in which T allele carriers were characterized by markedly elevated Hcy plasma concentrations. No association was observed between Hcy plasma level and COMT and SLC19A polymorphisms. The results of multivariate logistic regression analysis revealed age (P=0.0003) and Hcy plasma levels (P=0.07) as independent risk factors predisposing individuals to PD dementia. The studied polymorphisms were not associated with cognitive status in PD patients. CONCLUSION: The genetic factors studied were not associated with cognitive status in PD patients. Only age and Hcy plasma levels were found to be independent risk factors predisposing individuals to PD dementia. However, COMT: rs4680: A>G and rs4633: C>T polymorphisms were found to significantly affect PD risk, and the MTHFR 677C>T polymorphism helped determine plasma Hcy concentrations.

Smartphones, the Epidemic of the 21st Century: A Possible Source of Addictions and Neuropsychiatric Consequences.

BACKGROUND AND OBJECTIVES: Phonoholism is the excessive and harmful use of a smartphone. We are now observing this phenomenon among adults more often. Using a smartphone for several hours may lead to somatic and psychological symptoms, such as headaches and depression. The aim of this study is to assess the prevalence of phonoholism and to assess the association between smartphone overuse and neuropsychiatric disorders. MATERIALS AND METHODS: A total of 368 people (70.1% were woman), aged between 19 and 82 years (average age 26.1), took part in an anonymous questionnaire consisting of the following elements: Hospital Anxiety and Depression Scale (HADS), Mobile Phone Problem Use Scale (MPPUS-9), and original questions regarding headaches and sleep quality, along with a subjective assessment of the use of smartphones and an objective evaluation based on data from the applications "Stay Free" and "Screen Time". RESULTS: A total of 61 respondents (16.6%) obtained a score on the MPPUS-9 scale, which revealed their problematic use of mobile devices. Patients with phonoholism had significantly more headaches (85% vs. 58.7%, p = 0.027). Subjects with phonoholism had significantly shorter mean sleep duration (7.14 h vs. 7.42 h, p = 0.0475) and were less likely to feel sleepy during the day (43.33% vs. 59.73%, p = 0.0271). The group with phonoholism had significantly higher scores on the HADS-A anxiety scale (8.29 vs. 10.9, p = 0.015), but a statistical significance was not confirmed for depressive symptoms. CONCLUSIONS: The excessive use of the telephone negatively affects both somatic and mental health and can pose a significant clinical problem.

If Not Insulin Resistance so What? - Comparison of Fasting Glycemia in Idiopathic Parkinson's Disease and Atypical Parkinsonism.

Background: Parkinson's disease (PD) is a synucleinopathy, which presents dysautonomia, as its common non-motor symptom. Some research suggests the existing interplay between the autonomic nervous system dysfunction and glucose metabolism dysregulation in PD. Objective: To determine the prevalence of metabolic disorders with particular emphasis on glucose metabolism in patients with PD and atypical parkinsonism (AP). Patients and Methods: A retrospective study was performed by analyzing 461 clinical data of consecutive patients diagnosed with PD, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) hospitalized from 2019 to 2021 in the authors' institution. The study group included 350 patients (303 PD, 14 MSA, 33 PSP), aged 65.8 ± 9.7 years (42% were female). Laboratory results (fasting glycemia, lipid parameters, TSH, homocysteine and vitamin D3 levels) were collected. The patient's clinical condition was assessed in III part of Unified Parkinson's Disease Rating Scale (UPDRS p. III), Hoehn-Yahr scale, Mini Mental State Examination (MMSE) and Beck Depression Inventory (BDI). Results: Impaired fasting glycemia (IGF) was more prevalent in PD than in the PSP (43.43% vs 18.18%; p = 0.043). Similarly, PD presented a higher level of fasting glycemia (102.4 ± 16.7 mg/dl vs 92.2 ± 16.1mg/dl; p = 0.042). According to lipid parameters, patients with PD showed lower LDL cholesterol (92.3 ± 44.3mg/dl vs 119 ± 61.0mg/dl; p = 0.016) and lower BMI compared to patients with PSP (26.1 ± 4.0kg/m2 vs 29.3 ± 4.4 kg/m2; p = 0.024), but there were no statistically significant differences in triglycerides (TG) and HDL cholesterol levels. Males with PD presented greater frequency of IFG (35.05% vs 50.6%; p = 0.042), higher fasting glycemia (99.1 ± 14.3mg/dl vs 103.7 ± 14.7mg/dl; p = 0.006), lower total cholesterol, HDL cholesterol, and BMI compared to women with PD. Conclusion: Our investigation supports an association between synucleinopathies and glucose metabolism dysregulation.

Senior Fitness Test in the assessment of the physical fitness of people with Parkinson's disease.

Parkinson's disease (PD) is worth special attention among all the diseases and disorders of the nervous system, since its effects impact the capability of undertaking physical activity. The aim of the study was to analyze the use of the Senior Fitness Test (SFT) in determining the influence of physical rehabilitation on the level of physical fitness, and to assess the correlation between SFT and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) in patients with PD both participating and not participating in physical rehabilitation. The study was conducted in a group of 69 people (age 63.86 ± 5.43 y), with diagnosed idiopathic PD in 2nd stage in the Hoehn and Yahr scale (duration 6.52 ± 5.72 y). To determine the level of mobility of the subjects, the SFT and parts II, III, and IV of the MDS-UPDRS were used. Subjects were divided into participants (A) and non-participants (B) in physical rehabilitation. Correlation coefficients between the MDS-UPDRS and SFT were calculated after the 6-month study period. Participation in the process of physical rehabilitation significantly improved the physical fitness of the exercisers. A strong correlation was observed between the results obtained in the SFT and the assessment obtained on the basis of the MDS-UPDRS scale. It has been found that the SFT is a sensitive diagnostic tool in assessing the physical fitness of people with PD.

Risk Factors for Apathy in Polish Patients with Parkinson's Disease.

Apathy, a feeling of indifference or a general lack of interest and motivation to engage in activity, is one of the most common neuropsychiatric symptoms in Parkinson's disease (PD). The large variation in prevalence and the underlying pathophysiological processes remain unclear due to heterogeneous PD populations. The purpose of this study was to identify risk factors for apathy, the modification or treatment of which may be clinically relevant and improve quality of life and caregiver burden for patients with Parkinson's disease. Caucasian subjects with Parkinson's disease were included in the study. Baseline demographics, neurological deficit, medications taken, cognitive and neuropsychiatric status, and the polymorphisms in the brain-derived neurotrophic factor gene were assessed. Apathy was diagnosed in 53 (50.5%) patients. They were less educated (OR 0.76 CI 0.64-0.89; p = 0.001), more frequently depressed (OR 1.08 CI 1.01-1.15; p = 0.018), and less frequently treated with inhibitors of monoamine oxidase-B (MAOB-I) (OR 0.07 CI 0.01-0.69; p = 0.023). Although apathetic patients were more likely to carry the Met/Met genotype, differences in the brain-derived neurotrophic factor BDNF rs6265 polymorphism between apathetic and non-apathetic PD patients were not statistically significant in multivariate analysis. Some risk factors for apathy may be clinically modifiable. Further studies are needed to assess whether modeling modifiable apathy risk factors will affect the prevalence of this neuropsychiatric symptom in patients with Parkinson's disease.