Research progress on non motor symptoms of multiple system atrophy / 中国医师杂志

Multiple system atrophy (MSA) is a rapidly developing and serious Degenerative disease of the nervous system. It is characterized by different combinations of prominent autonomic dysfunction, Parkinson′s syndrome and cerebellar Ataxia in clinical practice, and its core symptom is extensive and serious autonomic dysfunction in the early stage of the disease. Non motor symptoms of MSA involve nervous system, cardiovascular system, gastrointestinal system, Genitourinary system and many other fields. Early clinical heterogeneity is large. This article describes the non motor symptoms of MSA, including prodromal symptoms, to help clinicians identify MSA earlier.

Effect of cognitive behavioral therapy on quality of life in patients with Parkinson's disease： a Meta-analysis / 四川精神卫生

BackgroundDepression， anxiety， impulse control disorders， insomnia are prevalent non-motor symptoms of Parkinson's disease， severely impairing the quality of life of patients. Cognitive behavioral therapy （CBT） is a common psychological intervention for various clinical psychological conditions， which can improve anxiety， insomnia and depression in patients with Parkinson's disease. However， the current research evidence on the effects of CBT in improving quality of life in patients with Parkinson's disease remains inconsistent. ObjectiveTo assess the effects of CBT on the quality of life among patients with Parkinson's disease， so as to provide references for the clinical application of CBT in this population. MethodsOn May 25， 2023， a systematic search was conducted across PubMed， PsycINFO， Embase， CNKI， Wanfang Database and VIP Database to identify randomized controlled trials investigating the impact of CBT on the quality of life in patients with Parkinson's disease. Literature screening， quality evaluation and data extraction were performed， focusing on variables related to quality of life， anxiety， and depression. Meta-analysis was performed using Stata 13.0 and RevMan 5.3. ResultsA total of 11 studies with 456 participants were included， comprising 241 in the CBT group and 215 in the control group. The CBT group exhibited significantly higher quality of life compared with the control group （SMD=0.47， 95% CI： 0.27~0.67， P<0.01）. Anxiety and depression scores in CBT group were significantly lower than those in the control group （SMD=-0.63，95% CI：-0.84~-0.43， P<0.01； SMD=-0.83， 95% CI： -1.15~-0.51， P<0.01）. Among the 11 studies， 6 studies delivered CBT remotely and 5 studies implemented CBT face-to-face. Meta-analysis results revealed that remote CBT group yielded significantly higher quality of life （SMD=0.43， 95% CI： 0.17~0.70， P<0.01）， and lower anxiety and depression scores （SMD=-0.62， 95% CI： -0.91~-0.34， P<0.01； SMD=-0.78， 95% CI： -1.34~-0.21， P<0.01） compared with the control group. Similarly， face-to-face CBT group showed better outcomes than the control group in terms of quality of life， anxiety and depression （SMD=0.51， 95% CI： 0.22~0.81， P<0.01； SMD=-0.64， 95% CI： -0.93~-0.35， P<0.01； SMD=-0.90， 95% CI： -1.20~-0.60， P<0.01）. ConclusionCBT may contribute to alleviating anxiety and depression levels of patients with Parkinson's disease， and improving their quality of life.｛Funded by Shanghai 13th Five-Year Key Specialty Construction Project （number， shslczdzk04901）； Nature Fund Project of Shanghai Science and Technology Commission （number， 22ZR1459300）； Shanghai Municipal Health Commission Traditional Chinese Medical Science Non-drug Therapy Demonstration Center Project ［number， ZY（2021-2023） -0204-03］｝

Caracterización de los síntomas no motores en pacientes con enfermedad de Parkinson

Introducción: la enfermedad de Parkinson es una de las enfermedades degenerativas más frecuentes y se caracteriza por presentar manifestaciones clínicas no motoras. Objetivo: caracterizar las manifestaciones clínicas no motoras de los pacientes que padecen de la enfermedad de Parkinson. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. El universo estuvo constituido por los pacientes con enfermedad de Parkinson que acudieron a la consulta de trastornos de movimiento del Hospital Provincial General Carlos Manuel de Céspedes en el período comprendido desde el 1 de julio del 2020 hasta el 31 de diciembre del 2020, mientras que la muestra se conformó con los pacientes que completaron todos las pruebas clinimétricas y que dieron su consentimiento informado para participar en el estudio. Resultados: la edad promedio fue de 69,05 años, predominando el sexo masculino. Las puntuaciones promedios de la Evaluación Cognitiva de Montreal y la Escala Unificada de la Enfermedad de Parkinson modificada por la Sociedad de Trastornos del Movimiento (parte I) fueron de 17,95 y 9,85 respectivamente. Conclusiones: Los dominios más afectados resultaron ser: el urinario, gastrointestinal y sueño/fatiga. La puntuación promedio obtenida al aplicar la Evaluación Cognitiva de Montreal fue baja. El impacto no motor de la enfermedad de Parkinson sobre las experiencias de la vida diaria fue alto.

Introduction: Parkinson's disease is one of the most frequent degenerative diseases and is characterized by non-motor clinical manifestations. Objective: to characterize the non-motor clinical manifestations of patients suffering from Parkinson's disease. Methods: an observational, descriptive, cross-sectional study was conducted. The universe consisted of patients with Parkinson's disease who attended the movement disorders consultation of the Carlos Manuel de Céspedes General Provincial Hospital in the period from July 1, 2020 to December 31, 2020, while the sample was made up of patients who completed all clinimetric tests and who gave their informed consent to participate in the study. Results: the mean age was 69.05 years, predominantly male. The average scores of the Montreal Cognitive Assessment and the Unified Parkinson's Disease Scale modified by the Society for Movement Disorders (part I) were 17.95 and 9.85 respectively. Conclusions: The most affected domains were: urinary, gastrointestinal and sleep/fatigue. The average score obtained when applying the Montreal Cognitive Assessment was low. The non-motor impact of Parkinson's disease on daily life experiences was high.

Introdução: a doença de Parkinson é uma das doenças degenerativas mais frequentes e é caracterizada por manifestações clínicas não motoras. Objetivo: caracterizar as manifestações clínicas não motoras de pacientes que sofrem da doença de Parkinson. Métodos: foi realizado um estudo observacional, descritivo e transversal. O universo consistiu em pacientes com Mal de Parkinson que atenderam à consulta de distúrbios de movimento do Hospital Geral Provincial Carlos Manuel de Céspedes no período de 1º de julho de 2020 a 31 de dezembro de 2020, enquanto a amostra foi composta por pacientes que concluíram todos os exames clinimétricos e que deram seu consentimento informado para participar do estudo. Resultados: a média de idade foi de 69,05 anos, predominantemente do sexo masculino. Os escores médios da Avaliação Cognitiva de Montreal e da Escala Unificada da Doença de Parkinson modificada pela Sociedade para Transtornos do Movimento (parte I) foram de 17,95 e 9,85, respectivamente. Conclusões: Os domínios mais afetados foram: urinário, gastrointestinal e sono/fadiga. O escore médio obtido na aplicação da Avaliação Cognitiva de Montreal foi baixo. O impacto não motor da doença de Parkinson nas experiências diárias de vida foi alto.

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.

White matter lesions and Parkinson disease / 中华行为医学与脑科学杂志

White matter lesions (WMLs) are the extensive damage of periventricular and subcortical white matter caused by different etiology.Previous studies have shown that WMLs is associated with cognitive function, motor function, mood and urination function.Parkinson disease (PD) is a common chronic degenerative disease of the central nervous system.Recently, evidences showed that PD patients have a high susceptibility to WMLs which participates in the progression of motor and cognitive impairment.PD patients have higher risk of WMLs because of cardiovascular autonomic nerve dysfunction, long-term dopamine (DA) treatment and β-amyloid peptides (Aβ) deposition along vessels.Furthermore, recently, more and more evidences showed that WMLs could impact on the motor and cognitive symptoms of PD.WMLs had a significant influence on axial motor symptoms, and was related to executive function, attention, memory, visual-spatial ability and other cognitive impairment.Moreover, the severity of WMLs affects drug and surgical efficacy of patients with PD.Taking active measures to slacken the WMLs progression of PD will contribute to improve symptoms and curative effect.This article summarized the roles of WMLs in the occurrence and development of PD, in order to provide theoretical basis for prevention, diagnosis and treatment of PD.

Analysis of clinical features of mild motor symptoms in prodromal Parkinson′s disease / 中华神经科杂志

Objective:To investigate the characteristics and evolution of mild motor symptoms (MMS) in patients with prodromal Parkinson′s disease (pPD).Methods:Based on the pPD cohort screened by Parkinson′s Disease Prodromal Clinical Assessment Scale in Nanjing community from July 2018 to December 2020, the clinical data of 30 patients with pPD who completed the baseline assessment and were followed up for at least 1 year were analyzed. According to the Unified Parkinson Diease Rating Scale Ⅲ (UPDRS-Ⅲ) score, the patients were divided into MMS group (UPDRS-Ⅲ score>3) and non-MMS group (NMMS group, UPDRS-Ⅲ score≤3). The differences and evolution characteristics of clinical characteristics between the 2 groups were compared. Multivariate linear regression was used to analyze the risk factors of motor symptom progression in pPD patients.Results:Among the 30 patients with pPD, 7 of 23 patients in the MMS group were converted to PD at the end of follow-up, 1 of 7 patients in the NMMS group were converted to PD at the end of follow-up. The UPDRS-Ⅲ score [10.00 (7.00, 17.00)], Montreal Cognitive Assessment Scale (MoCA) score [25.50 (24.75, 28.00)] and the Hamilton Anxiety Scale (HAMA) score [9.00 (5.00, 13.00)] at the end of follow-up of pPD patients were significantly higher than those at baseline [7.00 (4.00, 12.00), 24.00 (22.75, 25.25) and 8.00 (2.00, 11.00)], and the differences were statistically significant ( Z=-3.505, P<0.001; Z=-2.956, P=0.003; Z=-2.427, P=0.015).Subgroup analysis showed that UPDRS-Ⅲ score [11.00 (7.00, 18.00)], MoCA score [25.00 (24.00, 27.00)] and HAMA score [ 9.00 (6.00, 15.00)] at the end of follow-up in the MMS group were higher than those at baseline [8.00 (6.00, 12.00), 24.00 (22.00, 25.00) and 9.00 (3.00, 11.00)], and the difference was statistically significant (Z=-2.768, P=0.006; Z=-2.457, P=0.014; Z=-2.250, P=0.024). The Non-Motor Symptoms Questionnaire score at the end of follow-up in the MMS group (8.96±5.20) was significantly lower than that in the baseline (11.04±4.41), and the difference was statistically significant ( t=2.441, P=0.023).There was no significant difference in Mini-Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Rapid Eyes Movement Sleep Behavior Disorder Questionnaire-Hong Kong (RBDQ-HK) and Sniffin′ sticks olfactory test score at the end of follow-up in the MMS group. Only UPDRS-Ⅲ score in the NMMS group was increased at the end of follow-up [7.00 (5.00, 8.00)] compared with the baseline [4.00 (1.00, 4.00)], and the difference was statistically significant ( Z=-2.375, P=0.018). There was no significant difference in MoCA, MMSE, HAMA, HAMD, RBDQ-HK, and Sniffin′ sticks olfactory test score between the NMMS group and the baseline at the end of follow-up. Conclusion:The clinical conversion rate of pPD patients with MMS is high,and screening of this population should be paid attention.

Characteristics of motor and non-motor symptoms in patients with rapid eye movement sleep behavior disorder and early Parkinson disease / 中华行为医学与脑科学杂志

Objective:To investigate the motor and non-motor symptoms and polysomnographic features in patients with rapid eye movement sleep behavior disorder (RBD), early Parkinson's disease (PD) with and without RBD.Methods:Patients with idiopathic RBD (IRBD) and early PD were collected from the clinics in West China Hospital of Sichuan University from August 2020 to May 2021.All the patients were divided into 3 groups including IRBD group (67 cases), PD with RBD (PD+ RBD) group (19 cases), and PD without RBD (PD-RBD) group (22 cases). Unified Parkinson's disease rating scale part 3 (UPDRS-Ⅲ), Hoehn-Yahr(H-Y) stage, Epworth sleepiness scale (ESS), REM sleep behavior disorder questionnaire-Hong Kong (RBDQ-HK), 17-item Hamilton depression scale(HAMD-17), mini-mental state examination(MMSE), Sniffin’Sticks olfactory function test, visual analogue scale (VAS), and scale for outcomes in Parkinson's disease-AUT(SCOPA-AUT) were used to assess the motor and non-motor symptoms including sleepiness, RBD, depression, cognitive function, olfactory function, pain and autonomic function respectively.All patients were performed to the polysomnography (PSG) examination.One-way ANOVA, Krukal-Wallis test, χ2 test and Fisher accurate test were used to analyze the data of motor and non-motor symptoms and sleep parameters among the 3 groups accordingly. Results:There were statistically significant differences in motor symptoms among the three groups ( F=57.009, P<0.05), and the scores of UPDRS Ⅲ and H-Y stage were higher in the PD+ /- RBD group than those in the IRBD group(both P<0.05). However, there was no significant difference in motor symptoms between PD+ RBD group and PD-RBD group ( P>0.05). There were no significant differences in the scores of ESS, MMSE, olfactory function test and VAS (all P>0.05). But the HAMD-17 score was significantly higher in the PD+ RBD group(2(1, 9)) than that in the IRBD group (0(0, 3)( P<0.05). The SCOPA-AUT scores of autonomic function were significant differences in the three groups, mainly in the digestive system, urinary system, and sexual function ( P<0.05). Notably, the IRBD group (8(4, 14)) and PD+ RBD group (11(7, 14)) had higher scores of SCOPA-AUT compared with PD-RBD group (4(4, 5.75)(all P<0.05), especially in the digestive dysfunction(all P<0.05). The PD+ RBD group(3.47±1.17) had higher scores of sexual function compared with IRBP group(1.78±0.60)( P<0.05), and the urinary system scores also higher than PD-RBD group( P<0.05). The PD-RBD group(21.30 (6.10, 34.00)/h) had a significantly higher oxygen desaturation index in REM sleep compared with that of IRBD group(5.90(2.70, 16.73)/h) ( P<0.05). Conclusions:Early PD with RBD has more severe non-motor symptoms, especially depression and autonomic dysfunction.RBD can be related with the earlier and more widely autonomic dysfunction.

Effect of abdominal torsion movement on depression, constipation, motor symptoms and quality of life in patients with Parkinson's disease / 中国康复理论与实践

@#Objective To observe the effects of abdominal torsion movement on depression, constipation, motor symptoms and quality of life in patients with Parkinson's disease. Methods From March to October, 2021, 66 patients with Parkinson's disease hospitalized in Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group (n = 33) and experimental group (n = 33). Both groups were given conventional rehabilitation training and medication, and the experimental group was given abdominal torsion movement in addition, for eight weeks. They were assessed with Hamilton Depression Scale (HAMD), Chronic Constipation Severity Scale (CSS), Timed "Up and Go" Test (TUGT), Berg Balance Scale (BBS), and the Parkinson's Disease Questionnaire (PDQ-39), and the movement track length and ellipse area of pressure center within 30 seconds were compared before and after treatment. Results Before treatment, there was no significant difference in the scores of HAMD, CSS, BBS and PDQ-39, and the time of TUGT, the movement track length of pressure center and movement ellipse area between two groups (P > 0.05). All the indexes significantly improved after treatment in both groups (t > 9.674, P < 0.001), and were better in the experimental group than in the control group (t > 3.120, P < 0.01). Conclusion Abdominal torsion movement could improve the symptoms of depression, constipation and motor, and quality of life in Parkinson's patients.

Glutamatergic Neurons in the Caudal Zona Incerta Regulate Parkinsonian Motor Symptoms in Mice / 神经科学通报·英文版

Parkinson's disease (PD) is the second most common and fastest-growing neurodegenerative disorder. In recent years, it has been recognized that neurotransmitters other than dopamine and neuronal systems outside the basal ganglia are also related to PD pathogenesis. However, little is known about whether and how the caudal zona incerta (ZIc) regulates parkinsonian motor symptoms. Here, we showed that specific glutamatergic but not GABAergic ZIc

Effects of binary dance rhythm compared with quaternary dance rhythm in fatigue, sleep, and daily sleepiness of individuals with Parkinson's disease: A randomized clinical trial

Abstract Aim: People with Parkinson's disease constantly demonstrate low levels of physical activity, which is why dance has become increasingly important for the treatment of the disease. This study aimed to analyze the influence of binary and quaternary rhythm on fatigue, sleep, and daytime sleepiness in individuals with Parkinson's disease. Methods: 31 individuals participated in this randomized clinical trial with a mean age of 66.6 ± 10.2 years, 71% were male and 29% were female, allocated into two groups, binary and quaternary, where they participated in different dance interventions lasting 12 weeks. A questionnaire was applied including personal and clinical information; Mental State Mini-Examination (MMSE), Hoehn and Yahr (H&Y), Fatigue Severity Scale (FSS), Sleep Scale for Parkinson's Disease (PDSS), and Daytime Sleepiness Epworth Scale (ESS). Results: The groups that participated in binary rhythm classes showed improvement in sleep quality and daytime sleepiness after 12 weeks of intervention. However, no significant differences were found in the group that participated in the quaternary rhythm classes. Moreover, it was noted that the binary group managed to raise the heart rate during the 12 weeks of intervention, given that these results were not obtained in the quaternary group. Conclusion: The results showed the effectiveness of binary rhythm on non-motor symptoms and heart rate increase in individuals with Parkinson's disease. Thus, it is concluded that the binary rhythm was more effective than the quaternary rhythm.

Recognition and management of non-motor symptoms of Parkinson′s disease / 中华神经科杂志

The non-motor symptoms of Parkinson′s disease have received more and more attention, and they have become a hot spot in the study of Parkinson′s disease. The non-motor symptoms related to Parkinson′s disease, including sensory disturbances, neuropsychiatric symptoms, sleep disturbances, and autonomic dysfunctions were reviewed in this article, and their clinical manifestations, evaluation methods, and managements were emphasized.

Effects of Baduanjin and Balancer Exercise on Motor and Non-motor Symptoms of Parkinson's Disease / 中国康复理论与实践

Objective:To explore the effects of Baduanjin and balancer exercise on motor and non-motor symptoms for patients with mild to moderate Parkinson's disease (PD). Methods:From May, 2017 to September, 2018, 31 patients with PD were collected from the inpatients, outpatients and outside of our hospitals. The patients accepted Baduanjin and balancer exercise successively, three weeks for each exercise, and were assessed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part I, II, III and IV, and Non-motor Symptoms Scale (NMSS) before and after each exercise. Results:Four cases dropped out during Baduanjin exercise. The total score, the scores of part I, II and III of MDS-UPDRS, and NMSS score (t > 3.274, P < 0.01) decreased significantly after Baduanjin exercise. Other three cases dropped out during balancer exercise. The total score and the score of part III of MDS-UPDRS decreased significantly after balancer exercise (t > 2.763, P < 0.05). Conclusion:Baduanjin exercise can improve the motor and non-motor symptoms of mild to moderate PD, but not significant for motor complications; while balancer exercise can improve the motor symptoms, but not significant for non-motor symptoms and motor complications.

Malnutrition and Associated Motor and Non-motor Factors in People with Parkinson's Disease

Background: People with Parkinson’s disease (PwP) are at higher risk of developing malnutrition. Several factors have been suggested to be involved including motor symptoms, non-motor symptoms, and treatment-related complications. Objective: The objective of the study was to analyze the combined effect of motor, non-motor, and pharmacological factors in the risk of malnutrition in PwP. Methods: Eighty-seven consecutive PwP were included in the study. Clinical data and pharmacological treatment were collected. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA) questionnaire. Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Non-motor Symptoms Scale (NMSS), Hamilton Depression Rating Scale HAM-D, and Montreal Cognitive Assessment were applied. Results: Thirty (34.4%) PwP were at risk of malnutrition and seven had malnutrition (8%). Abnormal nutritional status was associated with lower education, higher MDS-UPDRS Parts I, II, and III and total scores, and higher scores in the NMSS domain of sleep disorders and fatigue. MDS-UPDRS motor score remained as a determinant of abnormal nutritional status, defined as MNA <23.5, with an odds ratio 1.1 (95% confidence interval 1.01-1.10, p = 0.02). Conclusion: The main factor associated with nutritional status was severity of the motor symptoms as assessed by the MDS-UPDRS Part III. Non-motor symptoms and treatment-related complications were not associated with malnutrition. (REV INVEST CLIN. 2020;72(5):293-9)

The impact of brazilian samba on parkinson's disease: analysis by the disease subtypes / O impacto do samba brasileiro na doença de parkinson: análise através dos subtipos da doença / El impacto del samba brasileño en la enfermedad de parkinson: análisis a través de los subtipos de la enfermedad

ABSTRACT Introduction: People with Parkinson's disease constantly have low levels of physical activity. Dancing has become increasingly important for treating the disease and can help improve non-motor symptoms. Objective: To analyze the influence of Brazilian samba on the non-motor symptoms of PD according to TD and PGID subtypes. Methods: A 12-week, non-randomized clinical trial, through comparison with a control group. The 23 individuals who agreed to participate in the activities formed the experimental group (EG) and the 24 individuals who opted not to participate in the Brazilian samba classes comprised the control group (CG). A questionnaire was applied, composed of validated instruments. Mini Mental State Examination - MMSE; HY - Disability Scale; Unified Parkinson's Disease Rating Scale - UPDRS 1 and total values; Parkinson's Disease Questionnaire - PDQ-39, Parkinson's Disease Sleep Scale - PDSS; Beck Depression Inventory - BDI; Fatigue Severity Scale - FSS and Magnitude of Perceived Changes. Results: After the twelve weeks of intervention, it was observed that the EG showed improvement in the scores of all the tests. The comparison between groups, however, indicated a significant difference in the post-UPDRS1 period in which the EG presented improvement in cognitive impairment, while the CG presented a deficit in these values. The results of the division between disease subtypes show a greater change in the values between individuals of the TD group, when comparing the EG with the CG. For the EG, the greatest difference between pre- and post- intervention was fatigue. Conclusion: There was a positive trend in all the variables studied after the application of the protocol. This demonstrates that interventions such as dance may have greater effects on non-motor symptoms, depending on the expected progression of the disease. The scarcity of studies that use this approach in their analyses may explain the lack of evidence in this symptomatology related to dance. Level of evidence II; Therapeutic studies - Investigating the results of treatment.

RESUMO Introdução: As pessoas com doença de Parkinson constantemente apresentam baixos níveis de atividade física. A dança tem se tornado cada vez mais importante para o tratamento da doença e pode ajudar a melhorar os sintomas não motores. Objetivo: Analisar a influência do samba brasileiro nos sintomas não motores da DP, segundo os subtipos TD e PGID. Métodos: Ensaio clínico não randomizado com duração de 12 semanas por meio de comparação com grupo controle. Os 23 indivíduos que aceitaram participar das atividades formaram o grupo experimental (GE) e os 24 indivíduos que optaram por não participar das aulas de dança brasileira formaram o grupo controle (GC). Um questionário foi aplicado, composto por instrumentos validados: Mini Exame do Estado Mental - MEEM; HY - Escala de Grau de Incapacidade; Escala Unificada de Avaliação da Doença de Parkinson - UPDRS 1 e valores totais; Questionário sobre a Doença de Parkinson - PDQ-39; Escala de Sono para a Doença de Parkinson - PDSS; Inventário de Depressão de Beck - BDI; Escala de Severidade de Fadiga - FSS e Magnitude das Alterações Percebidas. Resultados: Após doze semanas de intervenção, observou-se que o GE apresentou melhora nos escores de todos os testes. A comparação entre os grupos, no entanto, indicou uma diferença significativa no período pós-UPDRS1 em que o GE apresentou melhora no comprometimento cognitivo, enquanto o GC apresentou déficit nesses valores. Os resultados da divisão entre os subtipos da doença apresentam uma maior mudança nos valores entre os indivíduos do grupo TD ao comparar o GE com o GC. Em relação ao GE, a maior diferença entre a pré e pós-intervenção foi relacionada à fadiga. Conclusão: Houve tendência positiva em todas as variáveis estudadas após a aplicação do protocolo. Isso demonstra que intervenções como a dança podem ter maiores efeitos sobre os sintomas não motores, dependendo da progressão esperada da doença. A escassez de estudos que utilizam essa abordagem em suas análises pode explicar a falta de evidências nessa sintomatologia relacionadas à dança. Nível de evidência II; Estudos terapêuticos-Investigação dos resultados do tratamento.

RESUMEN Introducción: Las personas con enfermedad de Parkinson constantemente presentan bajos niveles de actividad física. La danza se ha vuelto cada vez más importante para el tratamiento de la enfermedad y puede ayudar a mejorar los síntomas no motores. Objetivo: Analizar la influencia del samba brasileño en los síntomas no motores de la EP, según los subtipos TD y PGID. Métodos: Ensayo clínico no aleatorizado con duración de 12 semanas, por medio de comparación con grupo control. Los 23 individuos que aceptaron participar en las actividades formaron el grupo experimental (GE) y los 24 individuos que optaron por no participar en las clases de danza brasileña formaron el grupo control (GC). Fue aplicado un cuestionario, compuesto por instrumentos validados: Mini Examen del Estado Mental - MEEM; HY - Escala del Grado de Incapacidad; Escala unificada de evaluación de la Enfermedad de Parkinson - UPDRS 1 y valores totales; Cuestionario sobre la Enfermedad de Parkinson - PDQ-39; Escala de Sueño de la Enfermedad de Parkinson - PDSS; Inventario de Depresión de Beck - BDI; Escala de Severidad de la Fatiga - FSS y Magnitud de las Alteraciones Percibidas. Resultados: Después de doce semanas de intervención, se observó que el GE presentó una mejora en los puntajes de todos los tests. La comparación entre los grupos, sin embargo, indicó una diferencia significativa en el período post-UPDRS1 en que el GE presentó una mejora en el compromiso cognitivo, mientras que el GC presentó déficit en esos valores. Los resultados de la división entre los subtipos de la enfermedad presentan un mayor cambio en los valores entre los individuos del grupo TD al comparar el GE con el GC. Con relación al GE, la mayor diferencia encontrada entre la pre y post intervención fue relacionada a la fatiga. Conclusión: Hubo tendencia positiva en todas las variables estudiadas después de la aplicación del protocolo. Eso demuestra que intervenciones como la danza pueden tener mayores efectos sobre los síntomas no motores, dependiendo de la progresión esperada de la enfermedad. La escasez de estudios que utilizan ese abordaje en sus análisis, puede explicar la falta de evidencias en esa sintomatología cuando relacionadas a la danza. Nivel de evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

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.

Diagnósticos fonoaudiológicos y síntomas no motores en pacientes con Enfermedad de Parkinson / Phonoaudiological diagnoses and non-motor symptoms in patients with Parkinson's disease

Objetivo: Este estudio descriptivo se orientó a conocer el perfil clínico-epidemiológico de la Enfermedad de Parkinson (EP) y la coexistencia entre síntomas no motores (SNM) y diagnósticos fonoaudiológicos (DF). Método: La muestra estuvo conformada por 34 personas con Parkinson idiopático (26 hombres y 8 mujeres), cuyas historias clínicas fueron analizadas para describir la coexistencia de DF, como la hipofonía, la disprosodia, la disartria y la disfagia, con síntomas no motores, tales como: trastornos gastrointestinales, depresión, trastornos del sueño y deterioro cognitivo. Resultados: Los resultados señalan que las personas con Parkinson tenían edades entre los 25 a los 86 años. En cuanto a la fase, se clasificaron en: estadio I el 11,7%, II el 17,6%, III el 47%, IV el 14,7% y V el 8,8%. El 47% de los pacientes llegó al servicio de Fonoaudiología en una etapa avanzada de la EP. Los SNM más frecuentes fueron trastornos del sueño (67,6%), depresión (58,8%), alteraciones gastrointestinales (29,4%) y deterioro cognitivo (15%). Los DF se distribuyeron así: disprosodia (38%), hipofonía (33%), disartria (18%) y disfagia (11%). Discusión: se observa una alta frecuencia tanto de SNM (como la depresión y los trastornos del sueño), como de SF (especialmente disprosodia e hipofonía). Esta sintomatología provoca, por una parte, la reducción del deseo de relacionarse socialmente y por otro, dificultades para hacerse entender al presentar un volumen de voz reducido o prosodia (además de trastornos de la melodía, inflexiones, marcadores paralingüísticos) de la expresión oral del lenguaje. Conclusión: los trastornos del sueño y la depresión podrían tener un impacto negativo significativo en las funciones fonoaudiológico de las personas con Parkinson.

Objective: This descriptive study was aimed at understanding the clinical-epidemiological profile of Parkinson's disease (PD) and the coexistence between non-motor symptoms (NMS) and phonoaudiological diagnoses (PD). Methods: The sample comprised 34 people with idiopathic Parkinson's (26 men and 8 women). Their clinical histories were analysed to describe the coexistence of PD, such as hypophonia, dysprosody, dysarthria and dysphagia, with non-motor symptoms, such as gastrointestinal disorders, depression, sleep disorders and cognitive impairment. Results: The results indicate that people with Parkinson's are between the ages of 25 and 86. In terms of phase, they were classified as: stage I 11.7%, II 17.6%, III 47%, IV 14.7% and V 8.8%. 47% of patients reached the Speech Therapy service at an advanced stage of PD. The most frequent NMS were sleep disorders (67.6%), depression (58.8%), gastrointestinal disorders (29.4%) and cognitive impairment (15%). The PD were distributed as follows: dysprosody (38%), hypophonia (33%), dysarthria (18%) and dysphagia (11%). Discussion: a high frequency of both NMS (such as depression and sleep disorders) and PD (especially dysprosody and hypophonia) is observed. This symptomatology causes a reduction in the desire to relate socially, and difficulties in making oneself understood by presenting a reduced voice volume or prosody (in addition to melody of speech disorders, inflections, paralinguistic markers) of the oral language expression. Conclusion: sleep disorders and depression could have a significant negative impact on the speech and hearing functions of people with Parkinson's.

Non-motor symptoms in amyotrophic lateral sclerosis / 西安交通大学学报(医学版)

Amyotrophic lateral sclerosis (ALS) is a degenerative disease of the nervous system caused by the loss of motor neurons in the brain and spinal cord. At present, ALS is considered as a multi-system disease, with both motor and non-motor features. Motor neuron involvement usually begins in a single functional region (medulla oblongata, cervical vertebra, lumbosacral and thoracic vertebra) and gradually spreads throughout the motor system. Non-motor features may be caused by pathological damage from the motor region to the adjacent non-motor region or by other unknown causes. There is no uniform definition of non-motor features of ALS. Sometimes they refer to symptoms caused by damage to the non-pyramidal system, and sometimes they also include ALS syndrome. They can be divided into neuropsychiatric, autonomic, vascular and gastrointestinal dysfunctions. More than 50% of patients with ALS have symptoms of neuropsychiatric disorder, which are extremely heterogeneous. Such clinical heterogeneity is based on neuroimaging, genetics and neuropathology, which has updated the concept of ALS, leading to the present recognition of the spectrum disorder of ALS and frontotemporal dementia. The core features of the ALS diagnosis model should also be multi-axis diagnosis, using three main "diagnostic axes", i.e., axis to define motor neuron symptom variations, axis Ⅱ to define cognitive and behavioral dysfunction, and axis III to define other non-motor symptoms. This paper introduces ALS cognitive and behavioral dysfunction, ALS plus syndrome and other non-motor features associated with ALS so as to improve clinicians' understanding of managing the overall health status of ALS patients, make rational scientific evidence-based decisions and contribute to improving the quality of life of ALS patients.

Asymptomatic Hearing Impairment Frequently Occurs in Early-Onset Parkinson's Disease

OBJECTIVE: Recent reports of hearing impairment in Parkinson's disease (PD) have suggested that auditory dysfunction could be a non-motor manifestation of PD. These reports were based on observations of elderly patients for whom presbycusis may, to some extent, have contributed to hearing dysfunction. Therefore, we aimed to explore the auditory functions in younger patients with PD. METHODS: We conducted a case-control study in a relatively younger (< 55 years of age at study time) population of PD patients and healthy volunteers to test whether auditory dysfunction is a significant non-motor dysfunction in PD. Pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA) were performed in all participants. RESULTS: None of the patients or controls reported hearing deficits. Fifty-one patients with PD and 50 healthy volunteers who were age- and gender-matched to the patients participated. PTA-detected hearing impairment was found in 64.7% of patients and 28% of controls (p < 0.001) for both low-mid and/or high frequencies. Hearing impairment was more frequent in the younger subgroups of patients than age-matched controls, while the frequency of hearing impairment was similar in older groups of subjects. BERA was not different between patients and controls. CONCLUSION: Asymptomatic auditory dysfunction is a common non-motor manifestation of early-onset PD and more frequent in younger patients, indicating that it may be independent of aging. The mechanism underlying this dysfunction appears to be peripheral, although a central dysfunction cannot be ruled out based on the findings of this study.

The clinical research progress of non-motor symptoms in myasthenia gravis / 中华神经科杂志

Myasthenia gravis (MG) is an acquired autoimmune disease involving neuromuscular junctions transmit dysfunction. The main clinical manifestations are partial or systemic skeletal muscle weakness and extreme fatigue, increased symptoms after activity, relieved after rest and treatment with cholinesterase inhibitors. However, recent studies have found that patients of MG are not only accompanied by motor symptoms such as muscle weakness and dysphagia, but also with non-motor symptoms. This article reviews the clinical research progress of non-motor symptoms in MG.

The clinical research progress of non?motor symptoms in myasthenia gravis / 中华神经科杂志

Myasthenia gravis (MG) is an acquired autoimmune disease involving neuromuscular junctions transmit dysfunction. The main clinical manifestations are partial or systemic skeletal muscle weakness and extreme fatigue, increased symptoms after activity, relieved after rest and treatment with cholinesterase inhibitors. However, recent studies have found that patients of MG are not only accompanied by motor symptoms such as muscle weakness and dysphagia, but also with non?motor symptoms. This article reviews the clinical research progress of non?motor symptoms in MG.