ABSTRACT
Monotherapy is the recommended initial treatment for early Parkinson's disease. The pharmacological options for initial treatment include dopaminergic agonists, monoamine oxidase B inhibitors, and levodopa formulations. Several factors should be considered when selecting the optimal treatment, such as disease severity, disease duration, age, activity level, and the risk of developing motor and non-motor complications. Early evidence on the potential role of levodopa formulations in the risk of dyskinesia led to levodopa aversion in the late 1990s and early 2000s, favoring the use of levodopa-sparing options like dopamine agonists. This shift resulted in an increase in behavioral adverse effects, such as impulse control disorders, leading to a subsequent dopamine agonist aversion in the mid-2000s. This review aims to provide a comprehensive evaluation of the existing literature regarding the benefits and drawbacks of levodopa versus levodopa-sparing strategies in drug-naive early-stage Parkinson's disease.
Subject(s)
Antiparkinson Agents , Dopamine Agonists , Levodopa , Parkinson Disease , Humans , Levodopa/administration & dosage , Levodopa/therapeutic use , Levodopa/adverse effects , Parkinson Disease/drug therapy , Antiparkinson Agents/therapeutic use , Antiparkinson Agents/pharmacology , Antiparkinson Agents/administration & dosage , Dopamine Agonists/therapeutic use , Dopamine Agonists/administration & dosage , Severity of Illness IndexABSTRACT
INTRODUCTION: Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and fatal central nervous system disease caused by prions. OBJECTIVE: To present the main clinical and paraclinical characteristics of patients with probable CJD in a referral center of Latin America. METHODS: Retrospective study of patients diagnosed with rapidly progressive dementia between 2014 and 2019. Clinical, demographic, electroencephalogram, magnetic resonance imaging, and 14-3-3 protein characteristics were included, as well as positron-emission tomography (PET) data when available. RESULTS: Twenty-four patients met the criteria for sporadic CJD (75% were women). Mean age was 59.29 ± 11.67 years, while mean disease duration from symptom onset to hospital admission was 7.41 ± 6.54 months. The most common first symptom was behavioral changes (41.7%). Delta wave complexes prevailed (54.2%) on electroencephalogram, cortical hyperintensity (83.3%) on magnetic resonance and frontal hypometabolism (37.5%) on PET. Seven cases showed positive total Tau; five, positive 14-3-3 protein; and three, positive phosphorylated tau on cerebrospinal fluid analysis. CONCLUSIONS: There is significant clinical heterogeneity regarding initial symptoms. Auxiliary test findings were consistent with those of other series.
INTRODUCCIÓN: La enfermedad de Creutzfeldt-Jakob (ECJ) es una enfermedad del sistema nervioso central rápidamente progresiva y mortal causada por priones. OBJETIVO: Presentar las principales características clínicas y paraclínicas de pacientes con probable ECJ en un centro de referencia de América Latina. MÉTODOS: Estudio retrospectivo de pacientes diagnosticados con demencia rápidamente progresiva entre 2014 y 2019. Se incluyeron características clínicas, demográficas, del electroencefalograma, imágenes por resonancia magnética, proteína 14-3-3 y tomografía por emisión de positrones (PET), cuando estaba disponible. RESULTADOS: Veinticuatro pacientes cumplieron con los criterios de ECJ esporádica (75 % mujeres), la edad media fue de 59.29 ± 11.67 años, la duración de la enfermedad desde el inicio de los síntomas hasta el ingreso hospitalario fue de 7.41 ± 6.54 meses y las primeras manifestaciones más comunes fueron las alteraciones del comportamiento (41.7 %). Los complejos de ondas delta prevalecieron en el electroencefalograma (54.2 %), la hiperintensidad cortical en la resonancia magnética (83.3 %) y el hipometabolismo frontal en la PET (37.5 %). En el análisis del líquido cefalorraquídeo, siete casos mostraron proteína tau total positiva; cinco, proteína 14-3-3 positiva; y tres, proteína tau hiperfosforilada positiva. CONCLUSIONES: Existe importante heterogeneidad clínica en cuanto a los síntomas iniciales. Los hallazgos de las pruebas auxiliares coincidieron con los de otras series.
Subject(s)
Creutzfeldt-Jakob Syndrome , Prions , Humans , Female , Middle Aged , Aged , Male , Creutzfeldt-Jakob Syndrome/diagnostic imaging , Creutzfeldt-Jakob Syndrome/cerebrospinal fluid , Mexico/epidemiology , Retrospective Studies , 14-3-3 Proteins/cerebrospinal fluid , Prions/cerebrospinal fluid , Magnetic Resonance Imaging , Electroencephalography , BrainABSTRACT
OBJECTIVE: To assess the frequency of somatization and its association with motor, nonmotor symptoms, and quality of life in persons with Parkinson disease (PD). METHODS: A cross-sectional case-control study was carried out. Assessments included the List of 90 Symptoms somatic factor (SCL-90-R SOM), Movement Disorder Society Unified Parkinson's Ratings Scale (MDS-UPDRS), Non-Motor Symptom Scale (NMSS), Montreal Cognitive Assessment (MoCA), and Parkinson Questionnaire-8 (PDQ-8). RESULTS: A total 93 persons with PD and 93 controls were included. Somatization within the PD group was 2 times more frequent compared to the control group (43% vs 21.5%, P = .003). Persons with PD had higher NMSS total scores (48.6 ± 42.6 vs 28.3 ± 30.4, P = .001). Patients with PD with somatization had worst MDS-UPDRS, NMSS, MoCA, and PDQ-8 (all P < .05). CONCLUSION: Somatization is more frequent in persons with PD compared to healthy controls. Somatization in PD is associated with nonmotor symptoms and worst quality of life.
Subject(s)
Activities of Daily Living , Parkinson Disease/diagnosis , Quality of Life/psychology , Somatoform Disorders/psychology , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Male , Middle Aged , Parkinson Disease/psychology , Psychometrics , Severity of Illness Index , Somatoform Disorders/diagnosis , Surveys and QuestionnairesABSTRACT
BACKGROUND: The prevalence of Parkinson's disease (PD) increases as the population ages. Studies have shown that some cardiometabolic comorbidities could be associated with risk or protection against developing PD. A retrospective case-control study was carried out to analyze the relationship between PD and cardiometabolic comorbidities. MATERIAL AND METHODS: Subjects with PD and controls without PD were consecutively recruited. Data on type 2 diabetes mellitus, systemic arterial hypertension (SAH), dyslipidemia and body mass index were collected. Logistic regression analyses were carried out. RESULTS: A total of 781 subjects with PD (56.5% males) and 1,000 controls (44.4% males) were included. After adjusting for age and gender, SAH was found as an independent risk factor (OR: 1.32; 95% CI: 1.05-1.67; p = 0.02), and obesity as a protective factor (OR: 0.72; 95% CI: 0.56-0.93; p = 0.01). CONCLUSIONS: Subjects with SAH had a higher risk of having PD, while obese subjects had a lower risk of having PD. The relationship between cardiometabolic disease, its treatment, and PD etiopathogenesis appears to be extremely complex given the amount of contradictory data.
ANTECEDENTES: La prevalencia de la enfermedad de Parkinson (EP) aumenta a medida que la población envejece. Los estudios han demostrado que algunas comorbilidades cardiometabólicas pudieran estar asociadas con el riesgo o la protección de desarrollar la EP. Se realizó un estudio retrospectivo de casos y controles para analizar la relación entre la EP y las comorbilidades cardiometabólicas. MATERIAL Y MÉTODOS: Se reclutaron sujetos con EP y controles sin EP de forma consecutiva. Se recolectaron datos sobre diabetes mellitus tipo 2, hipertensión arterial sistémica (HTA), dislipidemia e índice de masa corporal. Se llevó a cabo análisis de regresión logística. RESULTADOS: Se incluyeron un total de 781 personas con EP (56,5% hombres) y 1,000 controles (44,4% hombres). Después de ajustar por edad y sexo, la HTA se encontró como factor de riesgo independiente (OR 1.32, IC 95% 1.05-1.67, p = 0.02) y la obesidad como factor protector (OR 0.72, IC 95% 0.56-0.93, p = 0.01). CONCLUSIONES: Los sujetos con HTA tienen un mayor riesgo de tener EP; mientras que los sujetos obesos tienen un menor riesgo de tener EP. La relación entre la enfermedad cardiometabólica, su tratamiento y etiopatogenia de la EP parece ser extremadamente compleja dada la cantidad de datos contradictorios.
Subject(s)
Diabetes Mellitus, Type 2 , Hypertension , Parkinson Disease , Case-Control Studies , Diabetes Mellitus, Type 2/epidemiology , Female , Humans , Hypertension/epidemiology , Male , Parkinson Disease/epidemiology , Retrospective StudiesABSTRACT
BACKGROUND: People with Parkinson's disease (PwP) are at higher risk of developing malnutrition. Several factors have been suggested to be involved including motor symptoms, non-motor symptoms, and treatment-related complications. OBJECTIVE: The objective of the study was to analyze the combined effect of motor, non-motor, and pharmacological factors in the risk of malnutrition in PwP. METHODS: Eighty-seven consecutive PwP were included in the study. Clinical data and pharmacological treatment were collected. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA) questionnaire. Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-motor Symptoms Scale (NMSS), Hamilton Depression Rating Scale HAM-D, and Montreal Cognitive Assessment were applied. RESULTS: Thirty (34.4%) PwP were at risk of malnutrition and seven had malnutrition (8%). Abnormal nutritional status was associated with lower education, higher MDSUPDRS Parts I, II, and III and total scores, and higher scores in the NMSS domain of sleep disorders and fatigue. MDS-UPDRS motor score remained as a determinant of abnormal nutritional status, defined as MNA < 23.5, with an odds ratio 1.1 (95% confidence interval 1.01-1.10, p = 0.02). CONCLUSION: The main factor associated with nutritional status was severity of the motor symptoms as assessed by the MDS-UPDRS Part III. Non-motor symptoms and treatment-related complications were not associated with malnutrition.
ABSTRACT
INTRODUCTION: Cognitive impairment is common in Parkinson's disease and represents a risk for dementia. Identifying associated factors will help implement early interventions and study its progression. OBJECTIVE: To identify factors associated with cognitive impairment. METHOD: Cross-sectional study of 306 subjects with Parkinson's disease who were assessed for 12 months. Demographics and clinical variables were analyzed as explanatory variables, and cognitive impairment as outcome variable. Significant variables were used to construct a cognitive impairment predictive model. RESULTS: Cognitive impairment was reported in 43.8%. Female gender (p = 0.001, odds ratio [OR] = 1.77), age at diagnosis (p < 0.001, mean deviation [MD] = 5.7), level of education (p < 0.001, MD = -2.9), disease duration (p = 0.003, MD = 1.7), MDS-UPDRS part III score (p < 0.001, MD = 9.7), presence of anxiety (p = 0.007, OR = 2.11), hallucinations (p = 0.029, OR = 2.27) and freezing of gait (p = 0.048, OR = 1.91) were predictors for cognitive impairment. The use of type B monoamine oxidase inhibitors was associated with less cognitive impairment (p = 0.001). CONCLUSIONS: Predictive factors that were consistent with those previously reported were identified. Prospective studies are required in order to clarify the effect of type B monoamine oxidase inhibitors on cognition.
INTRODUCCIÓN: El deterioro cognitivo en Parkinson es común y representa un riesgo para demencia. Identificar los factores asociados ayudará a implementar intervenciones tempranas y estudiar la progresión del deterioro cognitivo. OBJETIVO: Identificar factores asociados con deterioro cognitivo. MÉTODO: Estudio transversal de 306 sujetos con Parkinson evaluados durante los últimos 12 meses. Se estudiaron variables demográficas y clínicas como explicativas y el deterioro cognitivo como desenlace. Las variables significativas se utilizaron para construir un modelo predictor de deterioro cognitivo. RESULTADOS: El 43.8 % reportó deterioro cognitivo. El sexo femenino (p = 0.001, RM = 1.77), edad al diagnóstico (p < 0.001, desviación media [DM] 5.7), escolaridad (p < 0.001, DM −2.9), duración de enfermedad (p = 0.003, DM 1.7), puntuación en MDS-UPDRS parte III (p < 0.001, DM 9.7), presencia de ansiedad (p = 0.007, RM = 2.11), de alucinaciones (p = 0.029, RM = 2.27) y congelamientos de la marcha (p = 0.048, RM = 1.91) fueron predictores para deterioro cognitivo. El uso de inhibidores monoamina-oxidasa tipo B se asoció con menor deterioro cognitivo (p = 0.001). CONCLUSIONES: Se identificaron factores predictores consistentes con lo reportado previamente. Se requieren estudios prospectivos para aclarar el efecto de los inhibidores monoamina-oxidasa tipo B en la cognición.
Subject(s)
Cognitive Dysfunction/etiology , Monoamine Oxidase Inhibitors/administration & dosage , Parkinson Disease/complications , Age Factors , Aged , Aged, 80 and over , Cognitive Dysfunction/epidemiology , Cross-Sectional Studies , Disease Progression , Female , Humans , Male , Mexico , Middle Aged , Monoamine Oxidase Inhibitors/pharmacology , Parkinson Disease/physiopathology , Risk Factors , Sex Factors , Time FactorsABSTRACT
BACKGROUND: The use of single-photon emission computed tomography and positron emission tomography (PET) has proven to be helpful in differentiating Parkinson's disease (PD) from other movement disorders with a sensitivity of up to 95%. OBJECTIVE: The objective of this study was to determine the accuracy of [11C]DTBZ PET imaging in patients with clinically uncertain parkinsonism from a tertiary referral center in Mexico City. MATERIALS AND METHODS: Patients who underwent [11C]DTBZ PET brain scan due to clinically uncertain parkinsonism where divided into two groups: PD or non-PD. A scan was considered positive when visual assessment revealed a decrease in [11C]DTBZ uptake typical for PD; a scan was considered negative when visual assessment showed no decrease in [11C]DTBZ uptake or showed a decrease in tracer uptake in a non-PD pattern. Sensitivity, specificity, and positive and negative predictive values were calculated using a 2 × 2 table, with a 95% confidence interval. RESULTS: A total of 39 patients were included in the study. 14 PET studies were deemed positive and 25 PET studies were deemed negative; 12 true positives and 23 true negatives were found. This yielded a sensitivity of 92.9% (95% CI, 66.1-99.8), specificity of 92% (95% CI, 74-99), PPV of 86.7% (95% CI, 63.1-96.1), and NPV of 95.8% (95% CI, 79.1-98.4). CONCLUSIONS: The [11C]DTBZ PET has an excellent accuracy for differentiating idiopathic PD from other disorders.
Subject(s)
Brain/diagnostic imaging , Parkinson Disease/diagnostic imaging , Parkinsonian Disorders/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Adult , Aged , Carbon Radioisotopes , Female , Humans , Male , Mexico , Middle Aged , Parkinson Disease/physiopathology , Parkinsonian Disorders/physiopathology , Predictive Value of Tests , Radiopharmaceuticals/chemistry , Reproducibility of Results , Sensitivity and Specificity , Tetrabenazine/analogs & derivatives , Tetrabenazine/chemistryABSTRACT
The original description of what currently is known as Parkinson's disease was published 200 years ago. During both these centuries, knowledge on symptomatology, pathophysiology, genetics and pharmaceutical and surgical treatment has significantly increased; however, this nosological entity continues to be of imprecise origin and progressive evolution. In the present review, the historical events that contributed to describe and improve the understanding of this disease are summarized.
La descripción original de lo que ahora conocemos como enfermedad de Parkinson fue publicada hace 200 años. Durante estos dos siglos, el conocimiento sobre la sintomatología, fisiopatología, genética, tratamiento farmacológico y quirúrgico se ha incrementado notablemente; no obstante, esta entidad nosológica continúa siendo de origen impreciso y de curso progresivo. En la presente revisión se resumen los acontecimientos históricos que contribuyeron a describir y mejorar el entendimiento de esta enfermedad.
Subject(s)
Parkinson Disease/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Parkinson Disease/physiopathology , Parkinson Disease/therapyABSTRACT
An Essay on the Shaking Palsy, by James Parkinson, was published in 1817. Later, Jean-Martin Charcot better described some of the motor features of the disease and named the condition as "La Maladie de Parkinson." As understanding about the disease progressed, aided by both clinical expertise and technological developments, the definition of what is Parkinson's disease has evolved. Motor phenotype, non-motor symptoms, monogenic mutations, genetic risk factors, disease subtyping, and data-driven clusters, among other concepts, have given rise to the hypothesis that Parkinson's disease may be not one well-defined entity but several different diseases encompassed as a levodopa-responsive Parkinsonism. This review present and discusses several of these factors and how they may support or not the notion of Parkinson's being one or more diseases. In summary, current evidence appears to be insufficient at this moment to clarify this issue. Parkinson's disease will continue to be an evolving concept over the years to come.
Subject(s)
Antiparkinson Agents/therapeutic use , Parkinson Disease/physiopathology , Parkinsonian Disorders/physiopathology , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Levodopa/therapeutic use , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/drug therapy , Risk FactorsABSTRACT
BACKGROUND: Outpatient clinics for movement disorders provide specialized diagnosis and treatment services for the specific needs of this patient population. OBJECTIVE: Describe the impact of implementing a Movement Disorder Clinic on the trends of consultations per year and hospitalizations of subjects with Parkinson's disease at a tertiary referral center. METHODS: A retrospective study was carried out. We collected data from the Clinical File Archive and the Epidemiology Department at the National Institute of Neurology and Neurosurgery in Mexico. Data from January 1, 1999 through December 31, 2015 were included for analysis. RESULTS: The number of total consultations had an increase of 632.1% between 1999 and 2015. Follow-up visits represented up to 95% of the consultations. Peaks found correlated with the inclusion of new specialists in the clinic. Regarding hospitalization, the number of patients discharged with a diagnosis of Parkinson's disease increased from a median of 17 (range 9-35) to 46 patients (range 31-53) per year. CONCLUSIONS: The implementation of a multidisciplinary Movement Disorders Outpatient Clinic in a tertiary referral center had a direct impact on the total number of consultations per year, mainly follow-up visits. The latter may reflect in an improvement in the quality of care.
Subject(s)
Ambulatory Care Facilities , Movement Disorders/therapy , Parkinson Disease/therapy , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Interdisciplinary Communication , Mexico , Movement Disorders/diagnosis , Parkinson Disease/diagnosis , Referral and Consultation , Retrospective Studies , Tertiary Care CentersABSTRACT
INTRODUCTION: Parkinson's disease is characterized by a broad spectrum of neuropsychiatric manifestations. Its pathophysiology has been associated with the disease itself as well as with the dopaminergic treatment. MATERIAL AND METHODS: A cross-sectional study was conducted in drug-naive patients with early Parkinson's disease. All participants were evaluated through a set of scales for specific neuropsychiatric symptoms including: cognition, depression, anxiety, apathy, psychosis, and impulse control disorder. RESULTS: A total of 63 patients with Parkinson were included, of whom 26 (41.3%) subjects had some degree of cognitive impairment; seven (11.1%) had depression and 11 (15.8%) subjects had anxiety. Regarding the other symptoms, a total of 12 (19%) patients showed apathy, seven (11.1%) had psychosis, and eight (12.6%) patients had symptoms related to impulse control disorders. CONCLUSION: Neuropsychiatric disorders are common in drug-naive patients with early Parkinson's disease. Given the impact of these symptoms on quality of life, identification and proper treatment is essential.
Subject(s)
Cognition Disorders/epidemiology , Mental Disorders/epidemiology , Parkinson Disease/complications , Quality of Life , Aged , Anxiety/epidemiology , Anxiety/etiology , Cognition Disorders/etiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/etiology , Female , Humans , Male , Mental Disorders/etiology , Mental Disorders/physiopathology , Middle Aged , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Prevalence , Psychotic Disorders/epidemiology , Psychotic Disorders/etiologySubject(s)
Parkinson Disease , Humans , Incidence , Mexico/epidemiology , Parkinson Disease/epidemiologyABSTRACT
BACKGROUND: Psychosis prevalence in Parkinson's disease is estimated at 8-30%. Proton magnetic resonance spectroscopy measures specific metabolites as markers of cell functioning. OBJECTIVE: To study N-acetyl-aspartate and glutamate levels in the caudate and putamen nuclei in subjects with Parkinson's disease with and without psychosis. METHODS: We included 20 non-demented Parkinson's disease patients with psychosis and 20 Parkinson's disease patients without psychosis matched for age, sex, disease duration, and levodopa equivalent daily dose, all attended at an academic medical center. Proton magnetic resonance spectroscopy scans were performed in a 3T GE whole-body scanner. RESULTS: Decreased glutamate levels scaled to creatine were found in the dorsal caudate (p = 0.005) and putamen (p = 0.007) of the Parkinson's disease psychosis group compared with the without psychosis group. Glutamate plus glutamine levels scaled to creatine and N-acetyl-aspartate levels scaled to creatine were also significantly reduced in the dorsal caudate of the Parkinson's disease with psychosis group (p = 0.018 and p = 0.011, respectively). No group differences were found for any of the other metabolites in the two regions of interest. CONCLUSIONS: Our findings suggest that decreased metabolite levels in specific brain areas may be implicated in the development of psychosis in Parkinson's disease.
Subject(s)
Antiparkinson Agents/therapeutic use , Parkinson Disease/psychology , Proton Magnetic Resonance Spectroscopy/methods , Psychotic Disorders/diagnosis , Academic Medical Centers , Aged , Antiparkinson Agents/administration & dosage , Aspartic Acid/analogs & derivatives , Aspartic Acid/metabolism , Brain/metabolism , Brain/pathology , Caudate Nucleus/metabolism , Female , Glutamic Acid/metabolism , Humans , Male , Middle Aged , Parkinson Disease/drug therapy , Psychotic Disorders/etiology , Putamen/metabolismABSTRACT
INTRODUCTION: Psychosis associated with Parkinson's disease is a major neuropsychiatric complication; it has been reported that 60% of patients will develop psychosis during the disease evolution. Its pathophysiology is multifactorial and clinically psychotic phenomena include minor hallucinations and confusional states. MATERIAL AND METHODS: We performed a cross-sectional study in patients with Parkinson's disease from a tertiary hospital using a thoughtful neurological and neuropsychiatric evaluation along with specific scales for non-motor symptoms, depression, cognition, and presence and severity of psychotic symptoms and hallucinations. RESULTS: We included a total of 236 patients with Parkinson's disease, of which 33 (13.9%) patients met the criteria for psychosis at the time of the evaluation. Visual hallucinations were the most common symptom. Age (p = 0.004), age at onset of the disease (p = 0.007) and its duration (p = 0.004), use of levodopa (p = 0.02), and use of amantadine (p = 0.004) were the main factors associated with the presence of psychosis. CONCLUSION: Psychosis in Parkinson's disease is a relatively common manifestation and is mainly associated with clinical and demographic factors. Early recognition will optimize management and improve the quality of life of patients and their caregivers.
Subject(s)
Parkinson Disease/complications , Psychotic Disorders/etiology , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Parkinson Disease/psychology , PrevalenceABSTRACT
Apathy is one of the most common behavioral disturbances in Parkinson's disease (PD) with a reported prevalence of 17-51 %. Apathy has been associated with depression, cognitive deficits, and poor quality of life. The objective of this study was to determine the prevalence of apathy in Mexican subjects with PD and its correlation with clinical and demographic characteristics. A cross-sectional, descriptive, and analytic study was carried out. Consecutive subjects with PD attending the National Institute of Neurology and Neurosurgery in Mexico City were included. Demographic and other relevant clinical data were collected. The Apathy Scale was applied to all subjects. A cut-off score of ≥ 14 was used. A total of 241 non-demented patients (52.7 % male) were included. Apathy was found in 43 % of subjects. Lower body mass index, older age of PD onset, cognitive decline and disease severity were all related to apathy. The use of dopamine agonists or rasagiline was more common in patients with low apathy scores. Our results show that the prevalence of apathy in Mexican subjects with PD is similar to other reports.
Subject(s)
Apathy , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Age of Onset , Antiparkinson Agents/therapeutic use , Body Mass Index , Cross-Sectional Studies , Dopamine Agonists/therapeutic use , Female , Humans , Indans/therapeutic use , Male , Mexico/epidemiology , Middle Aged , Parkinson Disease/drug therapy , Prevalence , Psychiatric Status Rating Scales , Severity of Illness IndexABSTRACT
Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR) is an autoimmune disorder characterized by neuropsychiatric symptoms, hyperkinetic movements, and even central hypoventilation. Anti-NMDAR encephalitis is a recently described disease, but is already considered one of the most frequent etiologies of noninfectious encephalitis. We report the case of 16-year-old man in which it the presence of anti-NMDAR antibodies in the absence of a neoplasm was identified. Disease course and gradual recovery, as well as a brief review of the syndrome, is presented. To our knowledge this is the first proven case of anti-NMDAR encephalitis in Mexico.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Adolescent , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Humans , MaleABSTRACT
INTRODUCTION: Parkinson's disease is characterized by a wide spectrum of motor and non-motor symptoms with an insidious onset. Identification of these symptoms by the patient as well as by the physician is determinant in order to achieve an early diagnosis. OBJECTIVE: To determine the time from motor symptoms onset to the diagnosis of Parkinson's disease and analyze the clinical and demographic factors related to it. MATERIAL AND METHODS: A cross-sectional study was carried out including subjects with Parkinson's disease seen during the 2011-2012 period and belonging to the Mexican National Parkinson's Registry. Time from symptom onset to the diagnosis was collected; its relation with demographic and clinical characteristics was assessed. RESULTS: A total of 1,062 subjects were included. Delay in diagnosis was 29.5 months. Predictive factors for a longer diagnostic delay were symptoms onset before 40 years of age (B: -0.350; p < 0.001) and a positive family history of Parkinson's disease (B: 0.224; p < 0.001). CONCLUSIONS: The diagnosis of Parkinson´s disease in Mexico is two and a half times greater than what has been reported for other countries.
ABSTRACT
PURPOSE: To determine the total alpha-synuclein (αSyn) reflex tears and its association with retinal layers thickness in Parkinson's disease (PD). METHODS: Fifty-two eyes of 26 PD subjects and 52 eyes of age-and sex-matched healthy controls were included. Total αSyn in reflex tears was quantified using a human total αSyn enzyme-linked immunosorbent assay (ELISA) kit. The retinal thickness was evaluated with spectral-domain optical coherence tomography. The Movement Disorder Society-Unified Parkinsons Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), and Montreal Cognitive Assessment (MoCA) were used to assess motor, non-motor, and cognition. RESULTS: In PD, total αSyn levels were increased compared to control subjects [1.76pg/mL (IQR 1.74-1.80) vs 1.73pg/mL (IQR 1.70-1.77), p < 0.004]. The nerve fiber layer, ganglion cell layer, internal plexiform layer, inner nuclear layer, and outer nuclear layer were thinner in PD in comparison with controls (p < 0.05). The outer plexiform layer and retinal pigment epithelium were thicker in PD (p < 0.05). The total αSyn levels positively correlated with the central volume of the inner nuclear layer (r = 0.357, p = 0.009). CONCLUSION: Total αSyn reflex tear levels were increased in subjects with PD compared to controls. PD patients showed significant thinning of the inner retinal layers and thickening of outer retinal layers in comparison with controls. Total αSyn levels positively correlate with the central volume of the inner nuclear layer in PD. The combination of these biomarkers might have a possible role as a diagnostic tool in PD subjects.
Subject(s)
Parkinson Disease , Humans , Parkinson Disease/diagnosis , alpha-Synuclein , Nerve Fibers , Retina , Retinal Pigment Epithelium , Tomography, Optical Coherence/methodsABSTRACT
Parkinson's disease (PD) is characterized by the progressive loss of dopaminergic neurons in the substantia nigra pars compacta, which results in a prominent reduction of striatal dopamine levels leading to motor alterations. The mechanisms underlying neurodegeneration in PD remain unknown. Here, we generated an induced pluripotent stem cell line from dermal fibroblasts of a Mexican patient diagnosed with sporadic PD (UNAMi002-A) and another cell line from dermal fibroblasts of a patient carrying the point mutation c.1423delC in PINK1 (UNAMi003-A). These patient-derived iPS cell lines offer the possibility of modeling PD and understanding the mechanisms that contribute to dopamine neuron loss.
Subject(s)
Induced Pluripotent Stem Cells , Parkinson Disease , Humans , Parkinson Disease/genetics , Parkinson Disease/metabolism , Induced Pluripotent Stem Cells/metabolism , Dopaminergic Neurons/metabolism , Dopamine/metabolism , Protein Kinases/genetics , Mutation/geneticsABSTRACT
Deep brain stimulation (DBS) is an interdisciplinary and reversible therapy that uses high-frequency electrical stimulation to correct aberrant neural pathways in motor and cognitive neurological disorders. However, the high frequency of the waves used in DBS can interfere with electrical recording devices (e.g., electrocardiogram, electroencephalogram, cardiac monitor), creating artifacts that hinder their interpretation. The compatibility of DBS with these devices varies and depends on factors such as the underlying disease and the configuration of the neurostimulator. In emergencies where obtaining an electrocardiogram is crucial, the need for more consensus on reducing electrical artifacts in patients with DBS becomes a significant challenge. Various strategies have been proposed to attenuate the artifact generated by DBS, such as changing the DBS configuration from monopolar to bipolar, temporarily deactivating DBS during electrocardiographic recording, applying frequency filters both lower and higher than those used by DBS, and using non-standard leads. However, the inexperience of medical personnel, variability in DBS models, or the lack of a controller at the time of approach limit the application of these strategies. Current evidence on their reproducibility and efficacy is limited. Due to the growing elderly population and the rising utilization of DBS, it is imperative to create electrocardiographic methods that are easily accessible and reproducible for general physicians and emergency services.