ABSTRACT
BACKGROUND: The impact of Nordic walking (NW) in Parkinson's disease (PD) has been investigated in several studies but results are inconsistent. This may be due to different cohorts studied and the heterogeneity of their PD symptoms which impact the outcome of NW. This study aimed at determining predictive factors for a positive effect of NW on PD. METHODOLOGY AND PRINCIPAL FINDINGS: Primary outcome was to define the baseline disease-associated and demographic parameters that distinguish patients who demonstrate improvement in the Unified PD rating scale (UPDRS) motor part following NW training ("U+") from those patients with no improvement after the same intervention ("U-"). The potentially predictive parameters were: age, age at onset, disease duration, gait velocity, step length, daily step number, UPDRS-motor part, Berg-Balance-Scale, Parkinson-Neuropsychometric-Dementia-Assessment, verbal-fluency-test and Becks-Depression-Inventory-II. Twenty-two PD patients (H&Y stage 2-2.5) performed twelve weeks of NW training. Eighteen patients were included in the final analysis. Overall, the UPDRS motor part did not improve significantly; however, eight patients had an improvement in the UPDRS motor part from baseline to end of study (U+). When comparing the potentially predictive factors of the U+ cohort with those ten patients who did not improve (U-), there was a notable difference in gait velocity and step length, and showed a significant correlation with an improvement in the UDPRS motor part scores. CONCLUSION: Gait velocity and step length can predict the outcome of NW training as determined by the UPDRS motor part, indicating that PD patients with only slightly impaired gait performance benefit most.
Subject(s)
Exercise Therapy/methods , Gait/physiology , Outcome Assessment, Health Care , Parkinson Disease/diagnosis , Parkinson Disease/therapy , Walking/physiology , Aged , Humans , Middle Aged , PrognosisABSTRACT
HISTORY AND ADMISSION FINDINGS: We report on a patient presenting with renal failure who developed mutliple episodes of flash pulmonary edema. INVESTIGATIONS: Volume retention due to ischemic nephropathy was found to be the cause. DIAGNOSIS, TREATMENT AND COURSE: She was diagnosed to have a high grade renal artery stenosis in a functional solitary kidney and underwent percutaneous angioplasty. After being anuric and dialysis-dependent, she regained her kidney function leading to resolution of the volume retention and could be weaned from dialysis. CONCLUSIONS: Ischemic nephropathy is often accompanied by recurrent episodes of flash pulmonary edema and responds well to an interventional treatment.
Subject(s)
Pulmonary Edema/diagnosis , Pulmonary Edema/etiology , Renal Artery Obstruction/complications , Renal Artery Obstruction/diagnosis , Renal Insufficiency/diagnosis , Renal Insufficiency/etiology , Aged , Diagnosis, Differential , Female , Humans , Pulmonary Edema/prevention & control , Renal Artery Obstruction/therapy , Renal Insufficiency/prevention & controlABSTRACT
OBJECTIVE: Insulin-like growth factor 1 (IGF-1) provides protection against loss of dopaminergic neurons in animal models of Parkinson's disease (PD). The aim of this study was to measure serum IGF-1 in patients with PD and assess its correlation with the clinical presentation. METHODS: Serum IGF-1 and growth hormone (GH) levels were measured in 12 patients with idiopathic PD and 12 matched healthy controls, three times over a period of 6 months after overnight fasting. Based on the results, serum IGF-1 was measured in six additional, yet untreated, PD patients. RESULTS: IGF-1 values were stable over the whole period (r=0.83-0.93) in patients and controls. IGF-1 was significantly higher in treated PD patients than in controls at all time points (all p<0.001). There were no significant differences in serum GH levels between patients and controls. Receiver operating characteristics showed a cut-off at 114 ng/ml for differentiation of treated patients and controls (area under the curve=0.90). In the patient group, higher serum IGF-1 levels were correlated with shorter disease duration (r=-0.56, p=0.001). In the healthy control group, higher IGF-1 was correlated with slightly impaired motor performance, as measured by the Unified Parkinson's Disease Rating Scale motor score (r=0.46, p=0.005). In the untreated patient group, serum IGF-1 levels were significantly higher than in healthy controls (p<0.001). Applying the cut-off value of 114 ng/ml, all untreated patients were correctly classified as PD patients. CONCLUSION: Increased IGF-1 might be an interesting serum marker for early PD and potentially for subclinical dopaminergic dysfunction.