Impaired self-awareness of motor deficits in Parkinson's disease: association with motor asymmetry and motor phenotypes.

BACKGROUND: This study investigated impaired self-awareness of motor deficits in nondemented, nondepressed Parkinson's disease (PD) patients during a defined clinical on state. METHODS: Twenty-eight PD patients were examined. Patients' self-ratings and experts' ratings of patients' motor performance were compared. Patient-examiner discrepancies and level of impairment determined severity of impaired self-awareness. Motor exam assessed overall motor functioning, hemibody impairment, and 4 motor phenotypes. Neuropsychological tests were also conducted. RESULTS: Signs of impaired self-awareness were present in 17 patients (60.7%). Higher severity of impaired self-awareness correlated significantly with higher postural-instability and gait-difficulty off scores (r = .575; P = .001), overall motor off scores (r = .569; P = .002), and higher left hemibody off scores (r = .490; P = .008). In multiple linear regression analyses, higher postural-instability and gait-difficulty off scores remained as the only significant predictor of impaired self-awareness severity. CONCLUSIONS: Postural instability and gait difficulties, disease severity, and right hemisphere dysfunction seem to contribute to impaired self-awareness.

A U.S. survey of patients with Parkinson's disease: satisfaction with medical care and support groups.

Relatively little is known about patient satisfaction with Parkinson's disease (PD) care and the use of support groups in the United States. We surveyed members of the Muhammad Ali Parkinson's Disease Registry to assess satisfaction with medical care and to evaluate support group use. Satisfaction was measured on a 5-point Likert scale, with high satisfaction defined as a four or five. We used multiple logistic regression to identify factors associated with high satisfaction and support group use. The response rate was 38% (726 of 1923). Most (57%) expressed high satisfaction with PD care. Individuals were most satisfied with the time their provider spent with them (61%) and PD education (56%) but least satisfied with prognostic information (35%) and information about non-drug interventions (28%). Patients seeing a PD specialist were three times more satisfied with their care than those seeing a general neurologist (OR = 3.00, 95% CI: 1.92-4.71; P < 0.0001). Support group use is common, and 61% of survey respondents had attended one at any point. Caucasian race (OR = 2.85, 95% CI: 1.45-5.61), PD duration (OR = 1.05 per year, CI: 1.01-1.10), and PD specialist care (OR = 1.80, CI: 1.16-2.77) were associated with greater support group attendance. Overall, 49% reported high satisfaction with their support group. The greatest concerns were specific needs not being addressed (15%) and insufficient expertise within the group (14%). Most individuals with Parkinson's disease expressed high levels of satisfaction, especially with specialist care. Specialty care and improved education, in the clinic or through support groups, may enhance satisfaction and health care quality.

The calcium-modulated structures of calmodulin and S100b proteins are useful to monitor hydrogen/deuterium exchange efficiency using matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

Hydrogen/deuterium exchange (HDX) using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) is a sensitive, salt-tolerant and high-throughput method useful to probe protein conformation and molecular interactions. However, a drawback of the MALDI HDX technique is that sample preparation methods can typically result in higher levels of artificial deuterium in-exchange and/or hydrogen back- exchange just prior to or during mass analysis; this may impair data reproducibility and impede structural and kinetic data interpretation. While methods to minimize effects of back-exchange during protein analyte deposition on MALDI plates have been reported, this study presents a readily available, highly sensitive protein control set to facilitate rapid MALDI HDX protocol workup. The Ca(2+)-induced solvent accessible surface area (ASA) changes of calmodulin (CaM) and S100 proteins were employed to monitor and optimize HDX protocol efficiency. Under non- stringent room temperature conditions, the Ca(2+)-induced deuterium exchange of CaM, DeltaD(ca2+ -apo), MH(+) shifts -17 to -24 Da, while S100 DeltaD(ca2+ -apo) MH(+) shifts +8 to +12 Da. By comparing the divergent CaM and S100 Ca(2+)-induced deuterium mass shift differences, HDX sample workup and MALDI plate spotting conditions can easily be monitored.

Biomechanic characteristics of patients with spastic and dystonic hypertonia in cerebral palsy.

OBJECTIVE: To determine what biomechanic characteristics of knee joint motion and walking show potential to quantitatively differentiate spasticity and dystonia in cerebral palsy (CP). DESIGN: Descriptive measurement study. SETTING: University hospital. PARTICIPANTS: Seventeen pediatric and adult patients with CP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured the resistance of the knee joint at different velocities and positions, maximum muscle activation during external motion, amplitude of knee tendon reflexes, maximum isometric flexion and extension torques, velocity of walking, and knee kinematics during the gait cycle. Patients were classified into 2 groups (dystonia or spasticity) if at least 2 of 3 physicians agreed that a prominent component of dystonia was present. RESULTS: Patients with dystonia had a greater degree of co-contraction and an increased resistance to external motion at slow velocities. The tendon reflexes were almost normal in patients with dystonia, whereas they were increased in patients with spasticity. Muscle strength was more impaired in patients with dystonia, probably as a result of greater muscle co-contraction. They also walked slower, with smaller knee ranges of motion, during the stance phase of walking. CONCLUSIONS: The measurement of resistance and of muscle activation during passive motion and tendon reflexes shows potential to differentiate dystonia from spasticity in CP patients with a mixed form of hypertonia. More studies are needed to confirm these results.