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.

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.

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.

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.

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.

Depression in Parkinson's disease / 中国实用内科杂志

Parkinson's disease(PD) is a chronic progressive neurodegenerative disease. Its clinical manifestations include motor symptoms and non-motor symptoms. Many more researches have focused on non-motor symptoms, especially depression, which seriously affects the quality of life of PD, but in clinical practice, it is difficult to detect depression and get it treated properly. This review will present the situation of depression in PD, including etiology, diagnosis and treatment.

Effect of deep brain stimulation on Parkinson's disease non-motor symptoms / 中华神经科杂志

Deep brain stimulation (DBS) has been widely recognized for improving motor symptoms of Parkinson's disease,but its effect on non-motor symptoms is still unclear.This article reviews recent DBS-related studies and discusses the effects of DBS treatment on non-motor symptoms,including olfaction,depression,cognition,sleep,and pain.Current studies find that the impact of DBS on olfactory functions and depression is not clear.DBS may increase the suicide rate in postoperative patients,and the rising suicide rate could stem from the reduction of postoperative levodopa equivalent dosage.DBS shows no significant impairment on cognition,and postoperative cognitive decline of patients may result from the progression of Parkinson's disease.DBS may ameliorate insomnia,but could worsen restless legs syndrome and rapid eye movement sleep behavior disorder.In addition,DBS may help to relieve Parkinson's disease-related pain,but the mechanism of improvement is yet to be clarified.

Study on Gender Specific Variability of Gastrointestinal, Genitourinary and Depression Related Non Motor Symptoms of Parkinson Disease

Introduction: Parkinson’s disease is a second most common neurodegenerative disorder after Alzheimer’s disease. It affects 1% of population over age of 50 years. Three main features of PD is asymmetric onset of bradykinesia, rigidity and resting tremors. Non motor symptoms are common in patients of Parkinson’s Disease. These remain undiagnosed most of the time. Aim and Objectives: To analyse gender specific, age related and demographic variability of non motor symptoms (Gastrointestinal, genitourinary and depression related symptoms) of Parkinson’s disease. Material and Methods: Present study Included 100 cases (65 Males and 35 Females) of Parkinson’s disease presenting at department of neurology, Dayanand Medical College and hospital, Ludhiana. 30 questionnaire of non motor symptoms in hindi and Punjabi were given to patients. Gender, age, duration of non motor symptoms, Parkinson’s phenotype and complete demographic profile of each patient taken into account for study. Thereafter results were statistically analysed for all parameters. Conclusion: It is concluded that mean age and duration of non-motor symptoms were higher in males as compared to females. GI symptoms amongst non-motor symptoms were commonest and amongst GI symptoms constipation was most common and there was positive correlation of H&Y with age and non motor symptoms especially gastrointestinal, genitourinary and depression related symptoms.

Study on Gender Specific Variability of Gastrointestinal, Genitourinary and Depression Related Non Motor Symptoms of Parkinson Disease

Introduction: Parkinson’s disease is a second most common neurodegenerative disorder after Alzheimer’s disease. It affects 1% of population over age of 50 years. Three main features of PD is asymmetric onset of bradykinesia, rigidity and resting tremors. Non motor symptoms are common in patients of Parkinson’s Disease. These remain undiagnosed most of the time. Aim and Objectives: To analyse gender specific, age related and demographic variability of non motor symptoms (Gastrointestinal, genitourinary and depression related symptoms) of Parkinson’s disease. Material and Methods: Present study Included 100 cases (65 Males and 35 Females) of Parkinson’s disease presenting at department of neurology, Dayanand Medical College and hospital, Ludhiana. 30 questionnaire of non motor symptoms in hindi and Punjabi were given to patients. Gender, age, duration of non motor symptoms, Parkinson’s phenotype and complete demographic profile of each patient taken into account for study. Thereafter results were statistically analysed for all parameters. Conclusion: It is concluded that mean age and duration of non-motor symptoms were higher in males as compared to females. GI symptoms amongst non-motor symptoms were commonest and amongst GI symptoms constipation was most common and there was positive correlation of H&Y with age and non motor symptoms especially gastrointestinal, genitourinary and depression related symptoms.

Clinical Study on Acupuncture Treatment for Parkinson's Non-motor Symptoms / 上海针灸杂志

Parkinson disease (PD) is a neurodegenerative disorder resulting from alpha-synuclein lesions, which affects about eight million patients over the world. PD is manifested in progressive motor and non-motor symptoms. With understanding of PD gradually deepened, motor symptoms mainly manifested in resting tremor are not the only manifestations of PD. Clinically many non-motor symptoms such as autonomic nervous symptoms, mental symptoms and paresthesia are also the important manifestations of PD and can appear earlier than motor symptoms. The effect of the non-motor symptoms on the patients' life is often not less than that of the motor symptoms. Clinically the changeable non-motor symptoms are far more complex and more difficult to treat than the motor symptoms. Conventional anti-PD drugs such as levodopa have little effect on the non-motor symptoms. Present clinical studies have showed that acupuncture has a certain therapeutic effect on the non-motor symptoms of PD. This provides important help for expanding the way to treat PD.

Clinical analysis of non?motor symptoms in patients with Parkinson′s disease and essential tremor / 中国综合临床

Objective To compare the incidence rate of non-motor symptoms including constipation, depression,REM sleep disorder(RBD)in patients with Parkinson′s disease(PD)and essential tremor(ET). Methods Sixty patients with PD and 40 patients with ET treated in the department of neurology of Tianjin People′s Hospital from October 2015 to June 2016 were enrolled in the study.The clinical data were recorded.The incidence rates of constipation,depression,REM sleep disorder in PD patients and ET patients were compared in order to analyze the correlation among HY staging and the duration of constipation,depression and RBD in PD patients.Results The incidence rates of constipation,depression,REM sleep disorder in PD group were significantly higher than those in ET group(88.3%(53/60)vs.10.0%(4/40); 61.7%(37/60) vs.27.5%(11/40),51.7%(31/60)vs.7.5%(3/40)),the differences were statistically significant(χ2=60.08,11.22,20.86,P<0.05).Spearman rank correlation analysis showed that the HY staging of patients with PD was related to the duration of constipation,the duration of depression and the duration of RBD(r=0.570,0.369,0.439,P<0.01).Conclusion The degree of correlation between constipation and HY staging is relatively high in PD patients.PD patients with constipation,depression,REM sleep disorder can provide reference for early diagnosis and differential diagnosis of ET patients.