Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.425
Filtrar
3.
Acta Neurol Scand ; 142(4): 385-391, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32914881

RESUMO

BACKGROUND: Idiopathic Parkinson's disease (PD) is characterized by clinical motor symptoms including hypokinesia, rigidity and tremor. In addition to the movement disorder, cognitive deficits are commonly described. In the present study, we applied FP-CIT SPECT to investigate the impact of nigrostriatal dopaminergic degeneration on cognitive function in PD patients. METHODS: Fifty-four PD patients underwent [123I]FP-CIT SPECT and CERAD (Consortium to Establish a Registry for Alzheimer's Disease) testing. FP-CIT SPECT visualized the density of presynaptic dopamine transporters in both striata, each subdivided into a limbic, executive and sensorimotor subregion according to the atlas of Tziortzi et al (Cereb Cortex 24, 2014, 1165). CERAD testing quantified cognitive function. RESULTS: In the CERAD testing, PD patients exhibited deficits in the domains of semantic memory, attention, visuospatial function, non-verbal memory and executive function. After correction for multiple testing, the performance of the subtests Figure Recall and Trail-Making Test A correlated significantly with FP-CIT uptake into the ipsilateral executive subregion. The performance of the subtest Figure Saving correlated significantly with FP-CIT uptake into the contralateral executive subregion. CONCLUSIONS: The significant correlation between cognitive function and density of nigrostriatal dopamine transporters, as assessed by FP-CIT SPECT, indicate that striatal dopaminergic pathways-primarily the executive striatal subregion-are relevant to cognitive processing in PD.


Assuntos
Cognição , Corpo Estriado/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Corpo Estriado/metabolismo , Feminino , Humanos , Masculino , Doença de Parkinson/fisiopatologia , Tremor
4.
Fortschr Neurol Psychiatr ; 88(9): 573-581, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32957142

RESUMO

The background of the freezing-of-gait (FOG) phenomenon in Parkinson's syndrome is presented in this review. The following issues are addressed: characterization of the symptom freezing and its subtypes that challenge standardized diagnostic procedures; available assessment methods generating freezing-related parameters that not only support clinical studies but can also be applied in everyday care, and current therapy options. FOG exists in different subtypes, and clinical and diagnostic definitions are limited by subjective characterization and semi-standardized tests. FOG-specific drug options are not existing, apart from the optimization of dopaminergic medication, which may also be due to the poor discriminatory power of standardized diagnostics. This is also true for deep brain stimulation. Both of these therapeutic options may be due not only to the complex neural network alterations as a motor-control correlate of FOG, but also because of challenging diagnostic assessments methodologies. Innovative, wearable, sensor-based diagnostic strategies are currently being developed, and supportive therapies using tools and technologies focusing on 'cueing' are becoming increasingly well accepted. Even though high level evidence is missing, they provide a helpful treatment option for individualized therapy. It can be assumed that these options will become particularly popular due to technological progress and likely alter the everyday treatment challenges faced by doctors and therapists.


Assuntos
Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Marcha , Humanos
5.
Medicine (Baltimore) ; 99(35): e21576, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871874

RESUMO

BACKGROUND: Cellular energetics play an important role in Parkinsons disease etiology, but no treatments directly address this deficiency. Our past research showed that treatment with febuxostat and inosine increased blood hypoxanthine and ATP in healthy adults, and a preliminary trial in 3 Parkinson's disease patients suggested some symptomatic improvements with no adverse effects. METHODS: To examine the efficacy on symptoms and safety in a larger group of Parkinsons disease patients, we conducted a single-arm, open-label trial at 5 Japanese neurology clinics and enrolled thirty patients (nmales = 11; nfemales = 19); 26 patients completed the study (nmales = 10; nfemales = 16). Each patient was administered febuxostat 20 mg and inosine 500 mg twice-per-day (after breakfast and dinner) for 8 weeks. The primary endpoint was the difference of MDS-UPDRS Part III score immediately before and after 57 days of treatment. RESULTS: Serum hypoxanthine concentrations were raised significantly after treatment (Pre = 11.4 µM; Post = 38.1 µM; P < .0001). MDS-UPDRS Part III score was significantly lower after treatment (Pre = 28.1 ±â€Š9.3; Post = 24.7 ±â€Š10.8; mean ±â€ŠSD; P = .0146). Sixteen adverse events occurred in 13/29 (44.8%) patients, including 1 serious adverse event (fracture of the second lumbar vertebra) that was considered not related to the treatment. CONCLUSIONS: The results of this study suggest that co-administration of febuxostat and inosine is relatively safe and effective for improving symptoms of Parkinsons disease patients. Further controlled trials need to be performed to confirm the symptomatic improvement and to examine the disease-modifying effect in long-term trials.


Assuntos
Febuxostat/uso terapêutico , Supressores da Gota/uso terapêutico , Inosina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Trifosfato de Adenosina/sangue , Administração Oral , Idoso , Estudos de Casos e Controles , Quimioterapia Combinada , Febuxostat/administração & dosagem , Febuxostat/efeitos adversos , Feminino , Supressores da Gota/administração & dosagem , Supressores da Gota/efeitos adversos , Humanos , Hipoxantina/sangue , Inosina/administração & dosagem , Inosina/efeitos adversos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doença de Parkinson/metabolismo , Doença de Parkinson/fisiopatologia , Segurança , Resultado do Tratamento , Xantina Desidrogenase/antagonistas & inibidores
6.
Medicine (Baltimore) ; 99(31): e21403, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756136

RESUMO

BACKGROUND: A growing number of studies have used surface-based morphometry (SBM) analyses to investigate gray matter cortical thickness (CTh) abnormalities in Parkinson disease (PD). However, the results across studies are inconsistent and have not been systematically reviewed. A clear picture of CTh alterations in PD remains lacked. Coordinate-based meta-analysis (CBMA) is a powerful tool to quantitatively integrate the results of individual voxel-based neuroimaging studies to identify the functional or structural neural substrates of particular neuropsychiatric disorders. Recently, CBMA has been updated for integrating SBM studies. METHODS: The online databases PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and SinoMed were comprehensively searched without language limitations from the database inception to February 2, 2020. We will include all SBM studies that compared regional CTh between patients with idiopathic PD and healthy control subjects at the whole-cortex level using Seed-based d Mapping with Permutation of Subject Images (SDM-PSI). In addition to the main CBMA, we will conduct several supplementary analyses to test the robustness of the results, such as jackknife analyses, subgroup analyses, heterogeneity analyses, publication bias analyses, and meta-regression analyses. RESULTS: This CBMA will offer the latest evidence of CTh alterations in PD. CONCLUSIONS: Consistent and robust evidence of CTh alterations will feature brain morphometry of PD and may facilitate biomarker development. PROSPERO REGISTRATION NUMBER: CRD42020148775.


Assuntos
Córtex Cerebral/fisiopatologia , Doença de Parkinson/fisiopatologia , Córtex Cerebral/diagnóstico por imagem , Bases de Dados Factuais , Humanos , Neuroimagem , Doença de Parkinson/diagnóstico por imagem , Análise de Regressão
7.
Ideggyogy Sz ; 73(7-08): 255-259, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750242

RESUMO

The evaluation of hand dexterity is an important marker for the success of DBS (deep brain stimulation) operation in patients with Parkinson's disease. In this study we applied a simple, semiquantitative optical dental plaque staining technique for the evaluation of the hand dexterity. Ten patient with Parkinson's disease were involved in the study. After dental students aided tooth brushing, bacterial dental deposits (plaque) were stained then photographed, and quantified under standard conditions before and after DBS surgery. Our results showed a significant decrease in dental plaque deposits after DBS operation. This simple technique seems to be a routinely applicable marker for the evaluation of the hand dexterity. Our future plans is repeating the previous experiement on a higher number of cases.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/fisiopatologia , Escovação Dentária , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Destreza Motora , Higiene Bucal , Resultado do Tratamento
8.
PLoS One ; 15(7): e0236258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701955

RESUMO

Parkinson's disease (PD) is a neurodegenerative disease inducing dystrophy of the motor system. Automatic movement analysis systems have potential in improving patient care by enabling personalized and more accurate adjust of treatment. These systems utilize machine learning to classify the movement properties based on the features derived from the signals. Smartphones can provide an inexpensive measurement platform with their built-in sensors for movement assessment. This study compared three feature selection and nine classification methods for identifying PD patients from control subjects based on accelerometer and gyroscope signals measured with a smartphone during a 20-step walking test. Minimum Redundancy Maximum Relevance (mRMR) and sequential feature selection with both forward (SFS) and backward (SBS) propagation directions were used in this study. The number of selected features was narrowed down from 201 to 4-15 features by applying SFS and mRMR methods. From the methods compared in this study, the highest accuracy for individual steps was achieved with SFS (7 features) and Naive Bayes classifier (accuracy 75.3%), and the second highest accuracy with SFS (4 features) and k Nearest neighbours (accuracy 75.1%). Leave-one-subject-out cross-validation was used in the analysis. For the overall classification of each subject, which was based on the majority vote of the classified steps, k Nearest Neighbors provided the most accurate result with an accuracy of 84.5% and an error rate of 15.5%. This study shows the differences in feature selection methods and classifiers and provides generalizations for optimizing methodologies for smartphone-based monitoring of PD patients. The results are promising for further developing the analysis system for longer measurements carried out in free-living conditions.


Assuntos
Teste de Esforço , Aprendizado de Máquina , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Smartphone , Caminhada/fisiologia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processamento de Sinais Assistido por Computador , Estatística como Assunto , Máquina de Vetores de Suporte
9.
PLoS One ; 15(7): e0236391, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730325

RESUMO

BACKGROUND: There is growing evidence that aquatic physiotherapy may be effective for people with Parkinson's Disease (PD) but most studies have investigated land based type exercises in the aquatic environment. Few studies have examined customised aquatic therapies such as the Halliwick concept which focuses on trunk rotation and core stabilisation. OBJECTIVE: The primary aim was to determine the feasibility of a Halliwick style aquatic physiotherapy intervention for people with PD. The secondary aim was to compare the Halliwick intervention with traditional aquatic and land based physiotherapy in terms of disease severity, balance and fear of falling. METHODS: Halliwick style aquatic, traditional aquatic and land based physiotherapy were trialled in a single blind pilot study. All interventions ran for 60 minutes per week over 12 weeks. Feasibility outcomes were safety, adherence and attrition. Secondary outcomes included the Unified Parkinson's Disease Rating Scale motor subsection (UPDRS-III), Berg Balance Scale (BBS), Mini BESTest and modified Falls Efficacy Scale (mFES). RESULTS: 30 participants with moderate PD were recruited. Participant mean age was 72 years (SD 8.4; range 51-86) with moderate disease severity (median Hoehn & Yahr score 3; IQR 1).No falls occurred during intervention sessions, however ten participants reported falls during the study period. No other adverse consequences were reported. All groups had adherence over 85%. No within group significant differences were found in UPDRS-III, BBS or mFES scores post-intervention for all groups, but the Halliwick aquatic group improved significantly in the Mini BESTest post-intervention (p = 0.011, 95% CI -7.36,-1.31, t (10) = -2.98). CONCLUSIONS: Despite people with PD being a vulnerable population, aquatic physiotherapy, including the Halliwick style is a safe treatment option. Promising results for balance in the Halliwick aquatic group were observed, but further studies with larger sample sizes is required to increase confidence in the results.


Assuntos
Acidentes por Quedas , Hidroterapia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Modalidades de Fisioterapia , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Medo , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente , Projetos Piloto
10.
Proc Natl Acad Sci U S A ; 117(29): 17359-17368, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32636265

RESUMO

Sleep disorders are among the most debilitating comorbidities of Parkinson's disease (PD) and affect the majority of patients. Of these, the most common is insomnia, the difficulty to initiate and maintain sleep. The degree of insomnia correlates with PD severity and it responds to treatments that decrease pathological basal ganglia (BG) beta oscillations (10-17 Hz in primates), suggesting that beta activity in the BG may contribute to insomnia. We used multiple electrodes to record BG spiking and field potentials during normal sleep and in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinsonism in nonhuman primates. MPTP intoxication resulted in severe insomnia with delayed sleep onset, sleep fragmentation, and increased wakefulness. Insomnia was accompanied by the onset of nonrapid eye movement (NREM) sleep beta oscillations that were synchronized across the BG and cerebral cortex. The BG beta oscillatory activity was associated with a decrease in slow oscillations (0.1-2 Hz) throughout the cortex, and spontaneous awakenings were preceded by an increase in BG beta activity and cortico-BG beta coherence. Finally, the increase in beta oscillations in the basal ganglia during sleep paralleled decreased NREM sleep, increased wakefulness, and more frequent awakenings. These results identify NREM sleep beta oscillation in the BG as a neural correlate of PD insomnia and suggest a mechanism by which this disorder could emerge.


Assuntos
Gânglios da Base/fisiopatologia , Doença de Parkinson/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , Sono/fisiologia , 1-Metil-4-Fenil-1,2,3,6-Tetra-Hidropiridina/efeitos adversos , Animais , Ritmo beta/fisiologia , Córtex Cerebral/patologia , Haplorrinos , Humanos , Doença de Parkinson/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Vigília
11.
Rev. neurol. (Ed. impr.) ; 70(11): 393-405, 1 jun., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191899

RESUMO

OBJETIVO: Revisar de manera exhaustiva la bibliografía referente a la evaluación instrumental cuantitativa de la voz en pacientes con enfermedad de Parkinson (EP) y realizar un metaanálisis para definir las principales características de los trastornos de la voz en la EP. Pacientes y métodos. Búsquedas bibliográficas con las palabras clave «Parkinson» y «voice» en PubMed, EMBASE, Cochrane Library y Web of Science. Los principales criterios de aceptación fueron: EP con confirmación clínica y medición instrumentada de los parámetros de la voz mediante análisis acústico. RESULTADOS: Catorce publicaciones cumplieron los criterios de aceptación y se incluyeron en el metaanálisis. De los datos incorporados al metaanálisis, se dedujo que varios parámetros vocales, como el jitter, el shimmer y la variación de la frecuencia fundamental, presentan variaciones significativas en los pacientes con EP frente a los controles sanos. Se hallaron variaciones significativas de la frecuencia fundamental y de su desviación estándar, del tiempo máximo de fonación y de la razón armónicos-ruido, si bien con una alta heterogeneidad entre los estudios. En cambio, no se observaron variaciones sustanciales de la razón ruido-armónicos, en el índice s/z ni en la variación de la amplitud. CONCLUSIÓN: El análisis acústico de la voz por medio de un sistema electrónico permite detectar los cambios de los parámetros vocales de cara a predecir el empeoramiento de la enfermedad y elegir una intervención específica. Entre dichos parámetros, el jitter y el shimmer aumentaron significativamente en los pacientes con EP


AIM: To systematically review all the literature, focusing on instrumental quantitative assessment of voice in patients with Parkinson’s disease (PD). Furthermore, a meta-analysis was performed to identify the main characteristics of voice disturbances in PD. PATIENTS AND METHODS: Literature searches with the keywords «Parkinson» and «voice» were conducted in PubMed, EMBASE, Cochrane Library and Web of Science. Main inclusion criteria were: clinically confirmed PD and instrumented measurement of voice parameters with acoustic analysis of voice. RESULTS: Fourteen publications met the inclusion criteria and were included in the meta-analysis. The data within the meta-analysis revealed that several voice parameters including jitter, shimmer and fundamental frequency variation presented significant variations between patients with EP and healthy controls. Significant variations of fundamental frequency, maximum phonation time, harmonic to noise ratio, standard deviation of fundamental frequency were observed, but with a high heterogeneity between the studies. On the other hand, significant variations of noise to harmonic ratio, s/z ratio, variation of amplitude were not observed. CONCLUSION: Acoustic analysis of voice, using an electronic system, allows the identification of changes in voice parameters for predicting the worsening of disease and for targeting specific intervention. Among the voice parameters, jitter and shimmer significantly increased in patients with PD


Assuntos
Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/complicações , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Acústica da Fala
12.
World Neurosurg ; 138: 672-679, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32545020

RESUMO

OBJECTIVE: In this study, we considered the treatment of cognitive characteristics of Parkinson's subtypes under resting magnetic resonance imaging scans, and used magnetic resonance imaging to analyze brain activity characteristics of patients with Parkinson's subtypes at rest. METHODS: In this study, patients with neurological Parkinson's disease subtypes were selected: 27 patients in the tremor group, 33 patients in the orthostatic gastric instability group, and 3 patients with mild cognitive impairment and neuropathic Parkinson's disease. Scientific treatment was adopted. RESULTS: Nineteen patients had mild cognitive dysfunction tremor and unstable posture, and 23 of them had mild cognitive dysfunction. Fifteen healthy controls were subjected to resting state functional magnetic resonance imaging by plane echo imaging sequence scanning. Neurological diseases-Regional consistency analysis of brain regions in patients with Parkinson's disease increased, including the right lower lobe, while regional consistency analysis of brain regions decreased, including the right frontal gyrus, right middle anterior gyrus, and lateral cerebellum. CONCLUSIONS: The experimental results show that the local consistency analysis method based on resting magnetic resonance imaging scan can effectively detect the differences in early neural activity in patients with Parkinson's disease subtype cognitive impairment, and can effectively reflect the brain characteristics of Parkinson's disease.


Assuntos
Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Cognição , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Feminino , Neuroimagem Funcional , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Descanso , Tremor/fisiopatologia
13.
Neurology ; 95(6): e685-e696, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32540937

RESUMO

OBJECTIVE: To test the relationship between clinically relevant types of GBA mutations (none, risk variants, mild mutations, severe mutations) and ß-glucocerebrosidase activity in patients with Parkinson disease (PD) in cross-sectional and longitudinal case-control studies. METHODS: A total of 481 participants from the Harvard Biomarkers Study (HBS) and the NIH Parkinson's Disease Biomarkers Program (PDBP) were analyzed, including 47 patients with PD carrying GBA variants (GBA-PD), 247 without a GBA variant (idiopathic PD), and 187 healthy controls. Longitudinal analysis comprised 195 participants with 548 longitudinal measurements over a median follow-up period of 2.0 years (interquartile range, 1-2 years). RESULTS: ß-Glucocerebrosidase activity was low in blood of patients with GBA-PD compared to healthy controls and patients with idiopathic PD, respectively, in HBS (p < 0.001) and PDBP (p < 0.05) in multivariate analyses adjusting for age, sex, blood storage time, and batch. Enzyme activity in patients with idiopathic PD was unchanged. Innovative enzymatic quantitative trait locus (xQTL) analysis revealed a negative linear association between residual ß-glucocerebrosidase activity and mutation type with p < 0.0001. For each increment in the severity of mutation type, a reduction of mean ß-glucocerebrosidase activity by 0.85 µmol/L/h (95% confidence interval, -1.17, -0.54) was predicted. In a first longitudinal analysis, increasing mutation severity types were prospectively associated with steeper declines in ß-glucocerebrosidase activity during a median 2 years of follow-up (p = 0.02). CONCLUSIONS: Residual activity of the ß-glucocerebrosidase enzyme measured in blood inversely correlates with clinical severity types of GBA mutations in PD. ß-Glucocerebrosidase activity is a quantitative endophenotype that can be monitored noninvasively and targeted therapeutically.


Assuntos
Glucosilceramidase/genética , Mutação , Doença de Parkinson/genética , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Seguimentos , Estudos de Associação Genética , Glucosilceramidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Doença de Parkinson/enzimologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Locos de Características Quantitativas , Índice de Gravidade de Doença
14.
Arch Phys Med Rehabil ; 101(9): 1580-1589, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32540135

RESUMO

OBJECTIVE: To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN: Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING: Assessments took place at Emory University. PARTICIPANTS: Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS: Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS: Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.


Assuntos
Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Idoso , Agnosia/fisiopatologia , Antiparkinsonianos/uso terapêutico , Transtornos Cognitivos/fisiopatologia , Função Executiva/fisiologia , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/tratamento farmacológico , Equilíbrio Postural/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Navegação Espacial/fisiologia
15.
BMC Neurol ; 20(1): 245, 2020 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534583

RESUMO

BACKGROUND: Parkinson's Disease (PD) is a heterogeneous, progressive neurodegenerative disorder which is characterized by a variety of motor and non-motor symptoms. To date, no disease modifying treatment for PD exists. Here, the study protocol of the Dutch Parkinson Cohort (DUPARC) is described. DUPARC is a longitudinal cohort study aimed at deeply phenotyping de novo PD patients who are treatment-naïve at baseline, to discover and validate biomarkers for PD progression, subtypes and pathophysiology. METHODS/DESIGN: DUPARC is a prospective cohort study in which 150 de novo PD subjects will be recruited through a collaborative network of PD treating neurologists in the northern part of the Netherlands (Parkinson Platform Northern Netherlands, PPNN). Participants will receive follow-up assessments after 1 year and 3 years, with the intention of an extended follow-up with 3 year intervals. Subjects are extensively characterized to primarily assess objectives within three major domains of PD: cognition, gastrointestinal function and vision. This includes brain magnetic resonance imaging (MRI); brain cholinergic PET-imaging with fluoroethoxybenzovesamicol (FEOBV-PET); brain dopaminergic PET-imaging with fluorodopa (FDOPA-PET); detailed neuropsychological assessments, covering all cognitive domains; gut microbiome composition; intestinal wall permeability; optical coherence tomography (OCT); genotyping; motor and non-motor symptoms; overall clinical status and lifestyle factors, including a dietary assessment; storage of blood and feces for additional analyses of inflammation and metabolic parameters. Since the start of the inclusion, at the end of 2017, over 100 PD subjects with a confirmed dopaminergic deficit on FDOPA-PET have been included. DISCUSSION: DUPARC is the first study to combine data within, but not limited to, the non-motor domains of cognition, gastrointestinal function and vision in PD subjects over time. As a de novo PD cohort, with treatment naïve subjects at baseline, DUPARC provides a unique opportunity for biomarker discovery and validation without the possible confounding influences of dopaminergic medication. TRIAL REGISTRATION: NCT04180865; registered retrospectively, November 28th 2019.


Assuntos
Biomarcadores/análise , Progressão da Doença , Estudos Observacionais como Assunto , Doença de Parkinson , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Estudos de Validação como Assunto
16.
Neurology ; 95(7): e889-e897, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32546656

RESUMO

OBJECTIVE: To determine predicting factors and frequency of phenoconversion from pure autonomic failure (PAF) into a synucleinopathy with motor or cognitive involvement of multiple system atrophy (MSA), Parkinson disease (PD), or dementia with Lewy bodies (DLB). METHODS: We performed a retrospective review of all patients with PAF from 2001 to 2011 evaluated at Mayo Clinic, Rochester. Clinical follow-up and patient telephone calls were used to assess for development of symptoms and diagnosis of MSA, PD, or DLB. Clinical and laboratory variables were extracted with factors predictive of evolution assessed using group comparison, odds ratio, and logistical regression. RESULTS: Among 275 patients with PAF at presentation, 67 (24%) phenoconverted to a synucleinopathy with motor or cognitive involvement; 34 met criteria for MSA, while 33 met criteria for PD or DLB. Age at onset was younger in MSA phenoconverters. Clinical features at presentation influenced phenoconversion: severe bladder symptoms were more common in MSA phenoconverters; subtle motor signs were more frequent in MSA and PD/DLB phenoconverters. MSA phenoconverters were more likely to have higher supine norepinephrine levels and preganglionic pattern of anhidrosis. Presentation variables predicting MSA phenoconversion included subtle motor signs, supine norepinephrine levels, severe bladder symptoms, and dream enactment behavior. Presentation variables predictive of PD/DLB phenoconversion included subtle motor signs, dream enactment behavior, and constipation. CONCLUSIONS: Our findings suggest that at least a quarter of patients with PAF phenoconvert to MSA, PD, or DLB. Presentation features determine patients at risk for evolution with specific patterns indicative of phenoconversion to MSA vs PD/DLB. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that several presentation variables including subtle motor signs, severe bladder symptoms, and dream enactment behavior are associated with an increased risk of developing a synucleinopathy with motor or cognitive involvement.


Assuntos
Doença por Corpos de Lewy/diagnóstico , Atrofia de Múltiplos Sistemas/diagnóstico , Valor Preditivo dos Testes , Insuficiência Autonômica Pura/diagnóstico , Idade de Início , Idoso , Feminino , Humanos , Doença por Corpos de Lewy/fisiopatologia , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Insuficiência Autonômica Pura/fisiopatologia , Transtorno do Comportamento do Sono REM/diagnóstico , Estudos Retrospectivos
17.
Arq Neuropsiquiatr ; 78(7): 419-423, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520233

RESUMO

BACKGROUND: The Berg Balance Scale is widely used to measure balance ability in clinical practice. Recently, the original version was redefined from 14 into 12 items. Its psychometric properties were investigated for different populations. However, for Parkinson disease the new version has not been validated yet. OBJECTIVE: The purpose of the present study was to evaluate psychometric properties of the 12-item Berg Balance Scale (BBS-12) in a population with Parkinson disease. METHODS: Internal consistency was evaluated with Cronbach's alpha coefficient, whereas reliability was assessed with the intraclass correlation coefficient. For validity analysis, the Pearson correlation coefficient of the BBS-12 was evaluated with the Tinetti Scale and the Physical Activity Scale for the Elderly. RESULTS: The BBS-12 was applied to 50 individuals with a mean age of 65.6 years (SD 11.8). The internal consistency showed a good value (Cronbach's alpha 0.886) and reproducibility reveled very high performances for both inter-rater and intra-rater reliabilities (ICC 0.987 and 0.986, respectively). The validity study demonstrated good linear correlation with the Tinetti Scale (p<0.01) and with the Sport and Home Subscales of the Physical Activity Scale for the Elderly (p<0.01). CONCLUSIONS: The present findings revealed the BBS-12 as a reliable and valid assessment tool to measure balance ability in Parkinson disease. Italian health professionals can now use it with more confidence.


Assuntos
Envelhecimento/fisiologia , Avaliação Geriátrica/métodos , Doença de Parkinson/fisiopatologia , Equilíbrio Postural/fisiologia , Inquéritos e Questionários/normas , Idoso , Estudos Transversais , Humanos , Itália , Psicometria , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
18.
Clin Nucl Med ; 45(8): e342-e348, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32520498

RESUMO

PURPOSE: The aim of this study was to investigate the association between autonomic dysfunction and striatal dopamine depletion or metabolic changes in de novo Parkinson disease (PD). METHODS: Based on the Composite Autonomic Severity Score (CASS), patients with de novo PD were classified into PD with (PD-AUT+) and without autonomic dysfunction (PD-AUT-) groups. We compared the dopamine transporter (DAT) availability in the striatum by quantitatively measuring F-FP-CIT PET between both groups. We also assessed the association between DAT availability and the CASS. In addition, we compared regional uptake in early-phase images of F-FP-CIT PET as well as cortical thickness between the PD-AUT+ and PD-AUT- groups. RESULTS: The PD-AUT+ group had significantly lower DAT availability in all striatal subregions than did the PD-AUT- group. The total CASS was significantly correlated with DAT availability in all striatal subregions. In addition, the subscores of the adrenergic component were correlated with DAT availability in all striatal subregions. The subscores of the cardiovagal component were negatively correlated with DAT availability in the caudate and ventral striatum. In early-phase F-FP-CIT PET, the PD-AUT+ group exhibited decreased regional perfusion in the parieto-occipital areas and increased regional perfusion in the pallidothalamic, pontocerebellar, inferior frontal, and primary motor areas compared with the PD-AUT- group. There were no regions of different cortical thickness between the PD groups. CONCLUSIONS: The present study revealed that autonomic dysfunction is closely linked to striatal dopamine depletion and prominent PD-related perfusion patterns in de novo PD, suggesting a greater pathological burden in patients with dysautonomia.


Assuntos
Circulação Cerebrovascular , Dopamina/metabolismo , Neostriado/metabolismo , Doença de Parkinson/complicações , Disautonomias Primárias/complicações , Disautonomias Primárias/metabolismo , Adulto , Idoso , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Disautonomias Primárias/fisiopatologia
19.
Medicine (Baltimore) ; 99(19): e20154, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384503

RESUMO

To investigate the effect of multi-disciplinary teamwork on balance performance of Parkinson's disease (PD).Sixteen primary Parkinson's disease patients (8 male, 8 female) treated with bilateral subthalamic nucleus deep brain stimulation (STN-DBS) were included in the study. The median age of patients was 60.5 years; all patients were in the Hoehn&Yahr (H&Y) 3 stage; the median PD duration of the disease was 9 years. For each patient, multi-disciplinary teamwork treatment including DBS, medication, physical therapy and psychotherapy proceeded. levodopa equivalent daily dose (LEDD, mg/day), life quality (PDQ-39), Motor disability (MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS, Limits of Stability LoS) were assessed in different time and status respectively: preoperation (Med-off, Med-on), postoperation (Stim-Off/Med-Off, Stim-On/Med-Off, Stim-On/Med-On), 6 months postoperation (Stim-On/ Med-Off, Stim-On/Med-On) and 12 months postoperation (Stim-On/Med-Off, Stim-On/Med-On).The LEDD, life quality (PDQ-39) continued to improve during the follow-up, statistical difference were found in both 6 months postoperation and 12 months postoperation compared with preoperation. The Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) and the LoS (target acquisition percentage, trunk swing angle standard deviation, time) showed significant improvement in Stim-On/med-Off 6 months postoperation and 12 months postoperation separately compared with Med-Off preoperation.Multi-disciplinary teamwork for PD patients with STN-DBS could improve balance performance.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Modalidades de Fisioterapia , Equilíbrio Postural/fisiologia , Idoso , Antiparkinsonianos/uso terapêutico , Terapia Combinada , Avaliação da Deficiência , Pessoas com Deficiência , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Equipe de Assistência ao Paciente , Psicoterapia/métodos , Qualidade de Vida , Núcleo Subtalâmico/patologia
20.
Braz J Med Biol Res ; 53(6): e9275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428131

RESUMO

Evidence from previous voxel-based morphometry (VBM) studies indicates that widespread brain regions are involved in Parkinson's disease with mild cognitive impairment (PD-MCI). However, the spatial localization reported for gray matter (GM) abnormalities is heterogeneous. The aim of the present study was to quantitatively integrate studies on GM abnormalities observed in PD-MCI in order to determine whether a pattern exists. Eligible whole-brain VBM studies were identified by a systematic search of articles in PubMed and EMBASE databases spanning from 1995 to January 1, 2019. A meta-analysis was performed to investigate regional GM abnormalities in PD-MCI. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of PD-MCI compared with PD patients with normal cognitive function (PD-NC). A total of 12 studies comprising 243 PD-MCI patients and 326 PD-NC were included in the meta-analysis. PD-MCI patients showed a robust GM decrease in the left insula and left superior temporal gyrus. Moreover, meta-regression analysis demonstrated that age, PD duration and stage, and Unified Parkinson's Disease Rating Scale III and Mini-Mental State Examination scores might be partly correlated with the GM abnormalities observed in PD-MCI patients. The convergent findings of this quantitative meta-analysis revealed a characteristic neuroanatomical pattern in PD-MCI. The findings provide some evidence that MCI in PD may result in the breakdown of the insula and temporal gyrus, which may serve as specific regions of interest for further investigations.


Assuntos
Disfunção Cognitiva/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Disfunção Cognitiva/fisiopatologia , Feminino , Substância Cinzenta/patologia , Substância Cinzenta/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA