Emerging issues on selection criteria of levodopa carbidopa infusion therapy: considerations on outcome of 28 consecutive patients.

Many studies confirmed the efficacy and safety of continuous infusion of intrajejunal levodopa/carbidopa gel (CIILG) for advanced Parkinson's disease (PD). Although this treatment is widely used, definite inclusion/exclusion criteria do not exist. In this prospective open-label study, we evaluated the long-term outcome in 28 consecutive patients and sought to detect any predictive factor to identify the best candidates for CIILG therapy. The assessment was carried out routinely at baseline, after 6 months and every year with UPDRS III-IV, FOG Questionnaire, non-motor symptoms scale, PD questionnaire (PDQ-8), cognitive and psychiatric status evaluation (MMSE, FAB, NPI) and caregiver's quality of life. 17/28 patients reached the 24-month follow-up. A statistically significant beneficial effect was shown on motor complications in short- and long-term follow-up, also on axial symptoms like gait disturbances. A concomitant improvement in PDQ8 score was observed, with a parallel mild amelioration, but not significant, on Caregivers QoL. When classified according to their outcome on QoL, the only predictive positive factor was less severe at Neuropsychiatric Inventory (NPI) score at baseline. Considering the improvement in motor scores (duration of "off" period), the more advanced age was associated with a poorer outcome. Our results confirmed a sustained efficacy and safety in long-term follow-up and suggest that younger age at operation and absence or mild presence of psychiatric/behavioural symptoms could be considered valid predicting factors in selecting the best candidates for this efficacious therapy.

[Copying and free drawing by patients with Alzheimer disease of different dementia stages]. / Abzeichnen und freies Zeichnen bei Alzheimer-Patienten mit unterschiedlicher Demenzausprägung.

In this study we assessed the drawing abilities in 37 patients with probable Alzheimer's disease according to NINCDS-ADRDA criteria. Drawing abilities (drawing: house, flower, clock; Rey-Osterrieth figure; copying: MMST-figure; Rey-Osterrieth figure) were quantified with different rating schemes and related to other neuropsychological assessments. All patients underwent a positron emission tomography with 18-FDG. Drawing performance was highly correlated with severity of dementia--expressed in MMST scores (r = 0.78; p < 0.0001)--with visuo-spatial short-term memory (r = -0.69; p = 0.001), and writing abilities (r = -0.77; p < 0.0001). The summarized drawing score showed a statistically significant correlation with the rate of temporoparietal glucose metabolism measured with positron emission tomography and 18-FDG (r = 0.39; p = 0.017). In the drawings of AD patients omittings and simplifications were typical, whereas perseverations rarely occurred. In severely demented patients closing-in phenomenons could be described, too. A subgroup of AD patients with visuo-constructive impairment as the leading symptom could not be identified.