Improving Conversations about Parkinson's Dementia.

BACKGROUND: People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. OBJECTIVES: To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia. METHODS: We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. RESULTS: While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals. CONCLUSION: Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.

What are the modifiable factors of treatment burden and capacity among people with Parkinson's disease and their caregivers: A qualitative study.

BACKGROUND: People with long-term conditions must complete many healthcare tasks such as take medications, attend appointments, and change their lifestyle. This treatment burden and ability to manage it (capacity) is not well-researched in Parkinson's disease. OBJECTIVE: To explore and identify potentially modifiable factors contributing to treatment burden and capacity in people with Parkinson's disease and caregivers. METHODS: Semi-structured interviews with nine people with Parkinson's disease and eight caregivers recruited from Parkinson's disease clinics in England (ages 59-84 years, duration of Parkinson's disease diagnosis 1-17 years, Hoehn and Yahr (severity of Parkinson's disease) stages 1-4) were conducted. Interviews were recorded and analyzed thematically. RESULTS: Four themes of treatment burden with modifiable factors were identified: 1) Challenges with appointments and healthcare access: organizing appointments, seeking help and advice, interactions with healthcare professionals, and caregiver role during appointments; 2) Issues obtaining satisfactory information: sourcing and understanding information, and satisfaction with information provision; 3) Managing medications: getting prescriptions right, organizing polypharmacy, and autonomy to adjust treatments; and 4) Lifestyle changes: exercise, dietary changes, and financial expenses. Aspects of capacity included access to car and technology, health literacy, financial capacity, physical and mental ability, personal attributes and life circumstances, and support from social networks. CONCLUSIONS: There are potentially modifiable factors of treatment burden including addressing the frequency of appointments, improving healthcare interactions and continuity of care, improving health literacy and information provision, and reducing polypharmacy. Some changes could be implemented at individual and system levels to reduce treatment burden for people with Parkinson's and their caregivers. Recognition of these by healthcare professionals and adopting a patient-centered approach may improve health outcomes in Parkinson's disease.

Subjective visual vertical perception and sense of smell in Parkinson disease.

This article describes an open cross-sectional observational study involving 47 participants with Parkinson disease (PD) and 47 (age- and sex-matched) nondisabled controls without PD. The aim was to determine the profiles of subjective visual vertical (SVV) perception and sense of smell perception in both groups. There was a statistically significant difference (p < 0.001) between patients and controls on their smell test performance. Controls were more likely to correctly identify odors, with a median score of 10 out of 12 compared with 6.5 out of 12 for patients with PD. The median SVV error for the PD group when the frame was untilted was 0.75 degrees compared with 0.50 degrees for controls. This difference was statistically significant (p = 0.02). When the frame was tilted, the median SVV error for the PD group was 2.31 degrees compared with 2.00 degrees for controls (not statistically significant), with both groups showing similar distribution pattern of errors. There was no statistical correlation between number of correctly identified odors and an individual's SVV error. However, a statistically significant negative correlation (r = -0.45, p = 0.01) was found between Mini-Mental State Examination score and mean time taken to complete each rod and frame test in patients with PD, suggesting that SVV errors might be more correlated with cognitive function than with loss of sense of smell.

Direct switch from levodopa/benserazide or levodopa/carbidopa to levodopa/carbidopa/entacapone in Parkinson's disease patients with wearing-off: efficacy, safety and feasibility--an open-label, 6-week study.

The study objective was to assess the efficacy, safety and feasibility of switching from levodopa/benserazide (LB) or levodopa/carbidopa (LC) to levodopa/carbidopa/entacapone (LCE) in Parkinson's disease (PD) patients with wearing-off. This was a multicenter, open-label, 6-week study; the primary outcome was success rate based on the patient-assessed Clinical Global Impression of Change (P-CGI-C). Secondary outcomes included investigator-assessed CGI-C (I-CGI-C), change from baseline in Unified Parkinson's Disease Rating Scale (UPDRS), motor/non-motor wearing-off symptoms and quality of life-visual analog scale (QoL-VAS). After switching to LCE, 77% of patients reported an 'improvement' (p < 0.0001 vs. patients reporting 'no change or worsening'). Significant improvements were seen in I-CGI-C, UPDRS and QoL-VAS, regardless of prior therapy. Oral levodopa dosing was increased in 28% of patients; the primary outcome remained significant when these patients were excluded. The data suggest that switching from LB/LC to LCE provided a significant benefit in PD patients with wearing-off.

A case of corticobasal degeneration presenting with alien limb syndrome.

Alien limb syndrome (ALS) is a very rare condition where the affected persons are not able to recognise the affected limb as their own, and regard it as being foreign or alien to them. We present a patient with ALS secondary to corticobasal degeneration, which is a rare neurodegenerative parkinsonian disorder. We discuss the clinical features, neuropathology and management of corticobasal degeneration.

Mild cognitive impairment.

Mild cognitive impairment refers to the transitional period between normal cognition and dementia, but is not an extension of normal ageing. Subjects with mild cognitive impairment have subtle but measurable cognitive impairment that is not severe enough to interfere with independent living or fulfil diagnosis criteria of dementia.

A case of cerebral amyloid angiopathy.

UNLABELLED: BACKGROUND; Cerebral amyloid angiopathy (CAA) is a condition characterized by amyloid deposition in the walls of leptomeningal and cerebral cortical blood vessels. Clinically, CAA results in recurrent lobar haemorrhage that frequently presents with cognitive impairment or recurrent cerebral ischaemic events. CAA is widely believed to b eunder-diagnosed. CASE REPORT: An 84 year old patient presented with a history of recurrent unexplained collapses on a background of cognitive impairment. CT imaging of the brain demonstrated several lobar haemorrhages. In the absence of other causes of cerebral haemorrhage, the patient fulfilled the Boston diagnosis criteria for probable CAA. CONCLUSIONS: CAA should be considered in patients with multiple lobar haemorrhages, especially in the presence of cognitive impairment, and in the absence of other causes of cerebral haemorrhage such as trauma, space occupying lesion or a coagulopathy. The diagnosis of CAA is an important one because of the likely implication it has on future management targeted to reducing the future risk of further bleeding.

Progressive supranuclear palsy.

Progressive supranuclear palsy, also known as Steele-Richardson-Olszewski syndrome, is an uncommon neurodegenerative parkinsonian disorder that starts in middle and late life, and is frequently misdiagnosed as Parkinson's disease. This review will cover the epidemiology, clinical picture, differential diagnosis and management of patients with progressive supranuclear palsy.