Research progress of clinical subtypes of Parkinson′s disease / 中华神经科杂志

Parkinson′s disease (PD) is a widely heterogeneous disorder with a broad list of motor and nonmotor manifestations. PD varies in clinical features, dominant symptoms, and rate of progression from case to case, suggesting the existence of distinct subtypes. Research on PD subtypes aims to understand this heterogeneity. This review summarized the commonly used PD subtyping solutions and discussed the challenges and future perspectives of subtyping. In future study, by designing a more standardized research and comparing the differences of these subtypes in terms of a number of putative biomarkers, that might help to better understand the underlying disease mechanisms, predict prognosis, and eventually design more efficient personalized management strategies.

Parkinson's disease and periodic limb movement in sleep / Doença de Parkinson e movimentos periódicos dos membros durante o sono

Parkinson's disease is a neurodegenerative disease understood as a complex syndrome with motor and non-motor symptoms, including sleep-related conditions, such as periodic limb movements in sleep (PLMS). This paper presents issues regarding Parkinson's disease, motor and non-motor symptoms, sleep physiology, and PLMS. In conclusion, both conditions seem to be correlated through impairment of the dopaminergic system.

A doença de Parkinson é uma doença neurodegenerativa entendida como uma síndrome complexa com sintomas motores e não motores, incluindo condições relacionadas ao sono, como movimentos periódicos dos membros durante o sono (MPMS). Este artigo apresenta questões relacionadas à doença de Parkinson, sintomas motores e não motores, fisiologia do sono e MPMS. Em conclusão, ambas as condições parecem estar correlacionadas por comprometimento do sistema dopaminérgico.

Covid-19 perception and self reported impact of pandemic on Parkinson’s disease symptoms of patients with physically independent Parkinson’s disease

@#Objective: The novel coronavirus disease 2019 (Covid-19) pandemic has affected many people with chronic diseases, including Parkinson’s disease (PD). We aimed to investigate the perception of Covid-19 and the self-reported impact of the pandemic on PD symptoms of a group of patients with physically independent PD from Turkey. Methods: We applied a questionnaire to idiopathic PD patients aged ≥65 years, who did not have known dementia, who were physically independent and who had at least one visit in the year before the telephone interview. The study patients were selected from the medical records of two different centers in Kirikkale, Turkey. Two neurologists conducted a semi-structured telephone interview to evaluate the perception of Covid-19 and new or worsening PD symptoms after the home quarantine. Results: In total, 86 patients were included in the study. Although most of the patients (97.7%) knew of Covid-19, knowledge of the Covid-19 symptoms was moderate (54.7%). Most patients reported that they washed their hands often (100%) and wore a mask (98.8%); 76 (88.4%) of them stayed at home. Compliance with other preventive measures was above 80%. In total, 40 (46.5%) patients (28 male, 12 female) reported worsening bradykinesia. Fatigue (24.4%), daytime sleepiness (20.9%), pain (20.9%) and anxiety (15.2%) were the most common new or worsening non-motor symptoms. Conclusions: The Covid-19 knowledge in a group of patients with PD from Turkey can be considered adequate. They have a high compliance with preventive measures. However, reduced non-exercise physical activity due to the pandemic affected both their motor symptoms and non-motor symptoms.

Prevalence of non-motor symptoms in Parkinson’s disease

Background: Parkinson’s disease is a common neurodegenerative movement disorder characterised by motor symptoms of rest tremor, bradykinesia, rigidity and postural instability and non-motor symptoms (NMS) which include neuropsychiatric symptoms, sleep disturbances, autonomic symptoms, sensory symptoms and symptoms of mixed aetiology. Parkinson’s Disease Non Motor Group (PD-NMG) devised a comprehensive clinic-based self-completed NMS questionnaire that allows easy identification of NMS by the physician. Most NMS have a poor response to dopaminergic therapy as it is due to dysfunction of the serotonergic and noradrenergic pathways. Treatment of these nonmotor symptoms help in improving the quality of life in patients with Parkinson’s disease.Methods: There were 100 patients with Parkinson’s disease who had presented to our neuromedicine movement clinic were included in the study. Patients were diagnosed as PD based on UK Parkinson’s disease brain bank criteria. The inclusion criteria were diagnosis as PD, age >18 yrs, inclusion of both males and females and consent for the study. Patients with atypical parkinsonism and secondary parkinsonism, stroke, intake of antipsychotics were excluded from the study. Non motor symptom questionnaire was given to the study group and frequency of occurrence of each non motor symptoms and their predominance in both males and females were studied. The frequency of each NMS was calculated by computing the number of yes response and calculating the percentage related to the number of patients in the sample. Analysis was done to calculate the frequency of all NMS among the enrolled patient.Results: Nocturnal sleep disturbances (43%) were most common followed by constipation (29%).The most common non motor symptoms in males were constipation (20%), urinary urgency (18%) and nocturia (11%).The most common non motor symptoms in females were nocturnal sleep disturbance (25%), feeling sad (19%), unexplained pains (17%) and being anxious (13%).Conclusions: Non motor symptom questionnaire helps in screening patients with Parkinson’s disease of non-motor symptoms and aims at providing holistic treatment improving the quality of life.

Clinical Predictors of Excessive Daytime Sleepiness in Patients with Parkinson's Disease

BACKGROUND AND PURPOSE: Excessive daytime sleepiness (EDS) is a common complaint among patients with Parkinson's disease (PD). Several factors have been associated with EDS in PD, especially neuropsychiatric symptoms. This study aimed to determine the relationships between neuropsychiatric symptoms, sociodemographic and clinical parameters, and EDS in PD. METHODS: This cross-sectional study analyzed 85 patients with PD. All patients underwent socioeconomic and clinical data evaluations followed by a psychiatric interview and a neurological examination, including the assessment of sleep features. Patients were divided into two groups according to the presence or absence of EDS, which was defined as a score higher than 10 on the Epworth Sleepiness Scale. Binary logistic regression was performed in order to describe the predictors of EDS. RESULTS: We found that EDS affects 40% of PD patients and is associated with older age, restless legs syndrome, depressive and anxious symptoms, and worse sleep quality. In the multivariate analysis, older age, levodopa use, and worse sleep quality remained as significant predictors of EDS in PD. CONCLUSIONS: Nighttime sleep problems, older age, and levodopa use are significantly associated with EDS in PD. A careful assessment and the management of sleep problems in PD patients might help to improve their quality of life.

Analysis on the non-motor symptoms of essential tremor / 中华老年医学杂志

Objective To explore the the characteristics of non-motor symptoms of essential tremor(ET).Methods Totally 50 ET patients and 45 age-gender-matched healthy volunteers,admitted in Department of Neurology,The Second Affiliated Hospital of Zhejiang University School of Medicine from May 2015 to April 2016,were included.Clinical data and tremor analyses under different postures were obtained.The non-motor symptoms were evaluated using the Pittsburgh Sleep Quality Index(PSQI),Hamilton anxiety scale(HAMA),Hamilton's Depression Scale(HAMD),and the MOS item short from health survey (SF-36).Cognitive functions were evaluated by the Minimental state examination(MMSE).Results ET group had lower MMSE total score of (25.81 ±2.75 vs.28.16 ± 1.71),increased rate of dyssomnia (62.0％ vs.15.6％) and higher PQSI score (6.42±2.71 vs.3.84±2.13)compared with the control group(all P＜0.05).Moreover,more patients in the ET group had moderate and severe anxiety(60.0 ％ vs.37.8 ％),moderate and severe depression (34.0％ vs.15.6％)than the control group(both P ＜ 0.05).Anxiety and depression had effects on physical and mental health and were also related to the quality of life.Conclusions Non-motor symptoms,such as mild cognitive deficits,depression,anxiety and dyssomnia are common in ET patients.Furthermore,depression and anxiety have negative effects on physical and mental health.

Parkinson's Disease with Fatigue: Clinical Characteristics and Potential Mechanisms Relevant to α-Synuclein Oligomer

BACKGROUND AND PURPOSE: The aim of this study was to identify the clinical characteristics and potential mechanisms relevant to pathological proteins in Parkinson's disease (PD) patients who experience fatigue. METHODS: PD patients (n=102) were evaluated using a fatigue severity scale and scales for motor and nonmotor symptoms. The levels of three pathological proteins-α-synuclein oligomer, β-amyloid (Aβ)(1-42), and tau-were measured in 102 cerebrospinal fluid (CSF) samples from these PD patients. Linear regression analyses were performed between fatigue score and the CSF levels of the above-listed pathological proteins in PD patients. RESULTS: The frequency of fatigue in the PD patients was 62.75%. The fatigue group had worse motor symptoms and anxiety, depression, and autonomic dysfunction. The CSF level of α-synuclein oligomer was higher and that of Aβ1-42 was lower in the fatigue group than in the non-fatigue group. In multiple linear regression analyses, fatigue severity was significantly and positively correlated with the α-synuclein oligomer level in the CSF of PD patients, after adjusting for confounders. CONCLUSIONS: PD patients experience a high frequency of fatigue. PD patients with fatigue have worse motor and part nonmotor symptoms. Fatigue in PD patients is associated with an increased α-synuclein oligomer level in the CSF.

Loss of Autonomic Nervous System Control of Blood Pressure in Patients with Parkinson’s Disease.

Parkinson’s disease (PD) manifests with motor symptoms of tremor, bradykinesia, muscle rigidity and postural instability. However, various nonmotor symptoms (NMS) have recently been recognized, among which autonomic dysfunction is observed long before the advent of motor symptoms and is aggravated through the course of the disease. Blood pressure (BP) abnormalities also result from autonomic dysfunction which induces orthostatic hypotension (OH), postprandial hypotension (PPH), nocturnal hypertension (NH) and, in particular, great fluctuation of BP over the range of 100 mmHg in a day that is often monitored by 24-hour ambulatory blood pressure monitoring (ABPM). A number of investigations on autonomic dysfunction in PD using 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy, neuropathology and immunohistochemistry indicate the centripetal degeneration of the cardiac sympathetic nerves and other autonomic pathology in other organs. Since PD patients have lost neural control of BP, their BP should depend on humoral factors that cannot respond to changes in and out of the body as promptly as autonomic nerves. This may be one of the reasons for irregularly fluctuating and unpredictable BP. Hypertensive fluctuation is much riskier than OH and PPH for vascular events of cerebrovascular disease, cardiovascular disease and other organopathies. Non-medical and medical treatments such as calcium channel blocking may be effective to stabilize BP in patients.

Prevalence and Characteristics of Nonmotor Symptoms in Korean Parkinson's Disease Patients and Its Relationship With Experience of Alternative Therapies

BACKGROUND: The aim of this study was to determine the prevalence and characteristics of nonmotor symptoms (NMS)and alternative therapies (ATs) in Korean PD and to elucidate its association. METHODS: Demographic, social, and motor (Hoehn and Yahr stage; HY stage, motor section of Unified Parkinson Disease Rating Scale; mUPDRS) and NMS questionnaire were recorded in all PD patients (N=50) without significant cognitive impairment. RESULTS: Mean age and HY stage were 70.1 years and 2.3. Mean total numbers of positive NMS (tNMS) per patient was 12.9 and all patients had at least five NMS (range, 5-25). The most common items were nocturia (82%), constipation (70%) and memory disturbance (66%). Urinary (68%) domain was the most frequently involved. The tNMS was higher in female and in the group with higher mUPDRS score. Sleep and depression/anxiety domains were more involved in women. 63% of patients had experienced ATs and among them 29% of patients used ATs simultaneously. Health related food (32%), herbal medicine (32%), ginseng (32%) and acupuncture (23%) were the most commonly used. There was no association between ATs usage and demographic, social, motor and nonmotor characteristics. Among the ATs users, 20% of patients reported the effectiveness of ATs but the mean ATs costs was 12.4 fold higher than the medical costs. CONCLUSIONS: We suggest that mean tNMS is higher in Korean PD patients comparing with other previous studies. Women might be more vulnerable to NMS than men expecially in sleep and depression/anxiety. We couldn't found the associated between usage of ATs and clinical variables including NMS.