Novel Pattern of Iron Deposition in the Fascicula Nigrale in Patients with Parkinson's Disease: A Pilot Study.

Background and Purpose. To determine whether the pattern of iron deposition in the fascicula nigrale in patients with Parkinson's disease would be different from age-matched controls by utilizing quantitative susceptibility mapping to measure susceptibility change. Methods. MRIs of the brain were obtained from 34 subjects, 18 with Parkinson's disease and 16 age- and gender-matched controls. Regions of interest were drawn around the fascicula nigrale and substantia nigra using SWI mapping software by blinded investigators. Statistical analyses were performed to determine susceptibility patterns of both of these regions. Results. Measurements showed significantly increased susceptibility in the substantia nigra in Parkinson's patients and an increased rostral-caudal deposition of iron in the fascicula nigrale in all subjects. This trend was exaggerated with significant correlation noted with increasing age in the Parkinson group. Conclusion. The pattern of an exaggerated iron deposition gradient of the fascicula nigrale in the Parkinson group could represent underlying tract dysfunction. Significant correlation of increasing iron deposition with increasing age may be a cumulative effect, possibly related to disease duration.

Clinical Outcomes in Patients with Parkinson's Disease Treated with a Monoamine Oxidase Type-B inhibitor: A Cross-Sectional, Cohort Study.

STUDY OBJECTIVE: To evaluate the long-term risk of developing cognitive symptoms (e.g., dementia, hallucinations), dyskinesia, falls, and freezing of gait (FoG) in patients with Parkinson's disease (PD) who received monoamine oxidase type B inhibitors (MAOB-Is) compared with patients who had never received MAOB-Is. DESIGN: Retrospective, cross-sectional, cohort study. SETTING: Academic movement disorders clinic. PATIENTS: One hundred eighty-one patients with idiopathic PD who were receiving MAOB-I therapy on a long-term basis for a minimum of 1 year (MAOB-I current-user cohort) and 121 patients with idiopathic PD who had never received MAOB-I therapy (MAOB-I never-user cohort [control group]) between January 1, 1996, and November 30, 2011. MEASUREMENTS AND MAIN RESULTS: The five study outcome variables were dementia, dyskinesia, falls, FoG, and hallucinations. Baseline and outcome data were collected from medical records. Patients in the MAOB-I current-user group were included only if absence of the specified outcomes was documented at baseline. Adjusted multiple logistic regression analyses were performed to calculate the odds ratios (ORs) for MAOB-I use versus never use on clinical outcomes. MAOB-I treatment was associated with a 44.7% reduced risk of dyskinesia (adjusted OR 0.553, 95% confidence interval 0.314-0.976, p=0.041), with the greatest risk reduction observed after 2 years of treatment. No significant association was noted with MAOB-I use and development of dementia, falls, FoG, or hallucinations. CONCLUSION: Long-term use of MAOB-I therapy was associated with reduced risk of dyskinesia in patients with PD.

Iron Accumulation Is Not Homogenous among Patients with Parkinson's Disease.

Background. Iron is considered to lead to neurodegeneration and has been hypothesized as a possible cause of Parkinson's disease (PD). Susceptibility-weighted imaging (SWI) is a powerful tool to measure phase related iron content of brain. Methods. Twelve de novo patients with PD were recruited from the Movement Disorders Clinic, Department of Neurology, Loma Linda University. Twelve age- and sex-matched non-PD subjects were recruited from neurology clinic as controls. Using SWI, the phase related iron content was estimated from different brain regions of interest (ROIs). Results. There was a trend between increasing age and iron accumulation in the globus pallidus and putamen in all subjects. Iron accumulation was not significant in different ROIs in PD patients compared to controls after adjustment for age. Our data revealed heterogeneity of phase values in different brain ROIs among all subjects with an exaggerated trend at SN in PD patients. Conclusions. Our data suggest a nonhomogeneous pattern of iron accumulation in different brain regions among PD patients. Further studies are needed to explore whether this may correlate to the progression of PD. To our knowledge, this is the first study demonstrating the heterogeneity of iron accumulation in the brain, among patients with PD.

Effect of exercise on motor and nonmotor symptoms of Parkinson's disease.

Background. Novel rehabilitation strategies have demonstrated potential benefits for motor and non-motor symptoms of Parkinson's disease (PD). Objective. To compare the effects of Lee Silverman Voice Therapy BIG (LSVT BIG therapy) versus a general exercise program (combined treadmill plus seated trunk and limb exercises) on motor and non-motor symptoms of PD. Methods. Eleven patients with early-mid stage PD participated in the prospective, double-blinded, randomized clinical trial. Both groups received 16 one-hour supervised training sessions over 4 weeks. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Modified Fatigue Impact Scale (MFIS). Five patients performed general exercise and six patients performed LSVT BIG therapy. Post-intervention evaluations were conducted at weeks 4, 12 and 24. Results. The combined cohort made improvements at all follow-up evaluations with statistical significance for UPDRS total and motor, BDI, and MFIS (P < 0.05). Conclusion. This study demonstrated positive effects of general exercise and LSVT BIG therapy on motor and non-motor symptoms of patients with PD. Our results suggest that general exercise may be as effective as LSVT BIG therapy on symptoms of PD for patients not able to readily access outpatient LSVT BIG therapy.

Repetition of suicide-related behavior: a study of the characteristics, psychopathology, suicidality and negative life events in Iran.

OBJECTIVE: Repetition of suicide-related behavior (SRB) is a risk factor for further suicidal behavior and death. The purpose of this study was to compare characteristics of patients with and without repeated episodes of SRB to determine whether characteristics of suicide attempt, psychopathology, and psychiatric comorbidity differ between groups, and if specific aspects of core suicidality may help guide screening of individuals at risk of further suicidal behaviors. METHODS: Thirty-five patient with repeated episodes of SRB and 49 with a single episode who came to the emergency room of two Qazvin referral hospitals after an episode of SRB were compared on demographic and background characteristics, the circumstances of the suicide attempts, levels of suicidality (i.e., ideation), and psychological characteristics. RESULTS: Patients with repeated episodes were more depressed, hopeless, and impulsive, had higher scores on factors associated with expected outcome and planning activities of the Suicide Intent Scale. They displayed greater suicidality, psychiatric comorbidity, and reported more negative life events, dissatisfaction with life, and poorer perceive social support. CONCLUSIONS: Some of the characteristics of patients with repeated suicide-related behavior propose major clinical challenges that should be addressed in an endeavor to reduce suicide risk.

Attempted suicide among Iranian population.

Predictors of suicide attempts in Iran, to distinguish any similarities and differences of these predictors between suicide attempts in Iran and other developed and developing countries and to investigate the relation between general psychiatric symptoms and repetition of suicidal attempts were assessed. The validated Farsi version of the General Health Questionnaire-28 (GHQ-28) was used to assess multiple dimensions of quality of life of suicide attempters as depression, anxiety, social dysfunction, and somatic symptoms. Pivotal differences emerged in the clinical profiles of suicide attempters living in a developing country versus developed countries. In developing countries, those who attempt suicides are more likely to have no psychiatric disorder and are less likely to have used alcohol as part of the suicide attempt, but are more likely to have been assaulted physically or verbally. The results on the GHQ-28 indicate that the process through which individuals move from suicidal thought to action may decrease multiple dimensions of quality of life.