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In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor-Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range-IQR = 23-60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = -0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care.
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BACKGROUND: Depression is more frequently associated with akinetic-rigid/postural instability gait difficulty subtypes of Parkinson's disease than with tremor-dominant subtype. OBJECTIVES: The aim of the study is to investigate the frequency of exposure to antidepressant drugs, as proxy of depression, before motor onset according to Parkinson's disease subtypes. METHOD: Based on a historical cohort design, the exposure to antidepressant drugs before Parkinson's disease motor onset was obtained from the drug prescription database and assessed in the resident population of the Local Healthcare Trust of Bologna (443,117 subjects older than 35 years). Diagnosis of Parkinson's disease and subtype (tremor dominant, non-tremor dominant) at onset were recorded by neurologists and obtained from the "ParkLink Bologna" record linkage system. Exposure to antidepressants was compared both to the general population and between the two subtypes. RESULTS: From 2006 to 2018, 198 patients had a tremor dominant subtype at onset whereas 450 did not. Comparison with the general population for antidepressant exposure showed an adjusted hazard ratio of 0.86 (95% CI 0.44-1.70) for the tremor dominant subtype and 1.66 (1.16-2.39) for the non-tremor dominant subtype. Comparison of non-tremor dominant with tremor dominant subtypes showed an adjusted odds ratio of 1.86 (1.05-3.95) for antidepressant exposure. CONCLUSIONS: In our study, non-tremor dominant Parkinson's disease at onset was significantly associated with exposure to antidepressants in comparison to the general population and in comparison with the tremor dominant subtype. These results support the hypothesis of different biological substrates for different Parkinson's disease subtypes even before motor onset.
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Antidepresivos/administración & dosificación , Depresión/fisiopatología , Enfermedad de Parkinson/clasificación , Enfermedad de Parkinson/fisiopatología , Síntomas Prodrómicos , Temblor/fisiopatología , Adulto , Anciano , Estudios de Cohortes , Depresión/tratamiento farmacológico , Depresión/epidemiología , Depresión/etiología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/epidemiología , Temblor/epidemiología , Temblor/etiologíaRESUMEN
BACKGROUND: The risk of COVID-19 and related death in people with Parkinson's disease or parkinsonism is uncertain. The aim of the study was to assess the risk of hospitalization for COVID-19 and death in a cohort of patients with Parkinson's disease or parkinsonism compared with a control population cohort, during the epidemic bout (March-May 2020) in Bologna, northern Italy. METHODS: Participants of the ParkLink study with the clinical diagnosis of Parkinson's disease or parkinsonism and people anonymously matched (ratio 1:10) for sex, age, district, and Charlson Index were included. The hospital admission rate for COVID-19 (February 26-May 31, 2020) and the death rate for any cause were the outcomes of interest. RESULTS: The ParkLink cohort included 696 subjects with Parkinson's disease and 184 with parkinsonism, and the control cohort had 8590 subjects. The 3-month hospitalization rate for COVID-19 was 0.6% in Parkinson's disease, 3.3% in parkinsonism, and 0.7% in controls. The adjusted hazard ratio (age, sex, district, Charlson Index) was 0.8 (95% CI, 0.3-2.3, P = 0.74) in Parkinson's disease and 3.3 (1.4-7.6, P = 0.006) in parkinsonism compared with controls. Twenty-nine of the infected subjects died; 30-day fatality rate was 35.1%, without difference among the 3 groups. Six of 10 Parkinson's disease/parkinsonism patients had the infection during hospitalization or in a nursing home. CONCLUSIONS: Parkinson's disease per se probably is not a risk factor for COVID-19 hospitalization. Conversely, parkinsonism is an independent risk factor probably because of a more severe health status, entailing higher care dependence and placement in high-infection-risk accommodations. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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COVID-19/epidemiología , Enfermedad de Parkinson/epidemiología , Trastornos Parkinsonianos/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/mortalidad , Estudios de Cohortes , Femenino , Anciano Frágil , Hospitalización/estadística & datos numéricos , Humanos , Italia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Casas de Salud , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/mortalidad , Trastornos Parkinsonianos/complicaciones , Trastornos Parkinsonianos/mortalidad , Admisión del Paciente/estadística & datos numéricos , RiesgoRESUMEN
OBJECTIVE: The co-morbidity between Parkinson's disease (PD) and restless legs syndrome (RLS) is currently controversial, mainly because in most of the studies so far conducted, the patients were already on therapy with dopamine(DA)ergic drugs. This study has been carried out to assess the prevalence of RLS in de novo PD patients previously unexposed to DAergic drugs. METHODS: One hundred nine cognitively unimpaired outpatients with PD (70M/39F), mean age 66.89 years±9.37 SD were included in the study. The mean duration of PD was 15.81 months±11.24 SD, and the median Hoehn and Yahr (H&Y) stage was 2 (range 1.5-3). All patients underwent interview to assess the occurrence of overall life-time and current "primary" form of RLS according to the criteria of the International RLS Study Group (IRLSSG). One hundred sixteen age and sex matched subjects (74M/42F, mean age 66.52.years±8.65 SD) free from a history of neurological diseases, were taken as controls and likewise interviewed. "Secondary" forms of RLS in both patients and controls were subsequently excluded. RESULTS: No significant difference was found (chi-square test) in the frequency of overall life-time and of current "primary" RLS between PD patients and controls (6 out of 109 versus 5 out of 116 and 3 out of 109 versus 3 out of 116, respectively). CONCLUSIONS: This survey does not support the concept of a co-morbid association between the two conditions and confirm indirectly the findings of previous studies reporting the onset of RLS after diagnosis of PD has been made in the great majority of patients and so likely on ongoing DAergic treatment. Therefore, we speculate that RLS occurring in these patients could be related to DAergic therapy for PD.
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Enfermedad de Parkinson/epidemiología , Síndrome de las Piernas Inquietas/epidemiología , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Comorbilidad , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Masculino , Pacientes Ambulatorios , Enfermedad de Parkinson/diagnóstico , Prevalencia , Escalas de Valoración Psiquiátrica , Síndrome de las Piernas Inquietas/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
We have carried out a case-control survey of the prevalence of restless legs syndrome (RLS) in 118 Parkinson's disease out-patients with different stage of disease severity by using the International restless legs syndrome Study Group clinical criteria. This study failed to demonstrate a significantly augmented prevalence of either primary and secondary restless legs syndrome pooled together or primary restless legs syndrome alone among Parkinson's disease patients as compared to age and gender matched controls. The results of our survey do not confirm a significant co-morbid occurrence of the two disorders. However, an unavoidable limitation of this and all previous studies is that most of the patients examined were already treated with dopaminomimetic drugs, which could have abolished a mild unrecognized RLS anteceding the diagnosis of Parkinson's disease or possibly masked the subsequent emergence of the sensory-motor disorder following the onset of Parkinson's disease.
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Enfermedad de Parkinson/epidemiología , Síndrome de las Piernas Inquietas/epidemiología , Distribución por Edad , Anciano , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Estudios de Casos y Controles , Sistema Nervioso Central/fisiopatología , Comorbilidad , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Sistema Nervioso Periférico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Prevalencia , Radiculopatía/diagnóstico , Radiculopatía/epidemiología , Radiculopatía/fisiopatología , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/fisiopatología , Trastornos de la Sensación/diagnóstico , Trastornos de la Sensación/epidemiología , Trastornos de la Sensación/fisiopatología , Distribución por SexoAsunto(s)
Cefalalgia Histamínica/genética , Polimorfismo Genético/genética , Transactivadores/genética , Alelos , Proteínas CLOCK , Cefalalgia Histamínica/epidemiología , ADN/genética , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Italia/epidemiología , Masculino , Receptores de Orexina , Polimorfismo de Nucleótido Simple , Receptores Acoplados a Proteínas G/genética , Receptores de Neuropéptido/genéticaRESUMEN
The temperature of the human body is not constant during the day, and is related to a double modulation of both homeostatic and circadian processes. The circadian rhythm of body core temperature (CRT) is known to depend on the central mechanism involved in thermoregulatory variations. The role of sweating in the nocturnal fall of body core temperature (BcT) is not clear. We evaluated the CRT in a 45-year-old female with a lack of sweating since birth because of congenital generalized anhidrosis. She referred episodes of heat intolerance when ambient temperature was around 35 degrees C. Skin biopsies of both forearms and left axilla revealed atrophy and morphologic changes of eccrine glands. Neurological examination, nerve conduction studies, sympathetic skin response and cardiovascular reflex tests were normal. The study of CRT was performed by monitoring rectal temperature continuously in controlled conditions (ambient temperature 24 +/- 1 degrees C and humidity 40-50% in a light-dark schedule). The rhythmometric analysis showed normal 24-hour fluctuations. This case represents an "experiment of nature"demonstrating that the physiological nocturnal fall of BcT is independent of sweating.