Neuropsychiatric symptoms in Parkinson's disease: association with caregiver distress and disease severity.

OBJECTIVES: The condition of caregivers is important to the quality of care received by people with Parkinson's disease (PD), especially at the late disease stages. This study addresses the distress placed on caregivers by participants' neuropsychiatric symptoms at different stages of PD in Taiwan. METHODS: This prospective study enrolled 108 people with PD. All participants were examined with the Unified Parkinson's Disease Rating Scale (UPDRS), Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), and Clinical Dementia Rating (CDR) scale. Caregiver distress was measured using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Statistical analysis was used to explore the PD-related factors that contribute to caregiver distress. RESULTS: The mean follow-up interval in the 108 PD participants were 24.0 ± 10.2 months with no participant lost to follow-up due to death. NPI-distress (the sum of NPI caregiver distress scale across the 12 domains of the NPI) was positively correlated with NPI-sum (the total score across the 12 domains of the NPI) (r = 0.787, p < 0.001), CDR (r = 0.403, p < 0.001), UPRDS (r = 0.276, p = 0.004), and disease duration (r = 0.246, p = 0.002), but negatively correlated with CASI (r = -0.237, p = 0.043) and MMSE (r = -0.281, p < 0.001). Multiple linear regression analysis showed that only NPI-sum and disease duration were independently correlated with NPI-distress. CONCLUSION: The disease duration and NPI-sum are independent predictors of caregiver distress in Taiwanese populations with PD. Early detection and reduction of neuropsychiatric symptoms in people with PD can help decrease caregiver distress.

Brain mediators of systemic oxidative stress on perceptual impairments in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is well documented to be associated with elevated systemic oxidative stress and perceptual impairments. Furthermore, the striatum and extrastriatal cortical areas, which are involved in the coordination of perceptual functions, are impaired at an early stage of the disease. However, the possible pathophysiology involved in perceptual impairments remains unclear. This raises the possibility that structural abnormalities might mediate the relationship between oxidative stress and perceptual impairments. METHODS: We explored the differences between 27 patients with PD and 25 healthy controls in terms of serum oxidative stress, perceptual functions, and regional gray matter. A single-level three-variable mediation model was used to investigate the possible relationships between serum oxidative stress, regional gray matter volume, and different domains of perceptual functioning. RESULTS: The results demonstrate that increased serum oxidative stress (as indicated by thiobarbituric acid reactive substances) was associated with declined perceptual functioning in PD patients. We further explored significant gray matter volume reductions in the bilateral temporal gyri (middle temporal gyrus and fusiform gyrus), bilateral frontal gyri, limbic lobe (hippocampus and uncus), left inferior parietal lobule, right caudate nucleus, and insula in PD. Further mediation analysis showed that gray matter volumes in the middle temporal gyrus, inferior parietal lobule, hippocampus, and insula served as brain mediators between elevated serum oxidative stress and perceptual impairments. CONCLUSIONS: These results suggest that higher oxidative stress levels adversely impact perceptual functions by causing temporal and mesolimbic abnormalities.

Clinical Features Associated with Frozen Shoulder Syndrome in Parkinson's Disease.

Background. Frozen shoulder syndrome is a common musculoskeletal disease of idiopathic Parkinson's disease (PD) that causes long-term pain and physical disability. A better understanding of the associated factors can help identify PD patients who will require prevention to improve their quality of life. Methodology. This prospective study evaluated 60 shoulders of 30 PD patients. Correlation analysis was used to evaluate the relationships between clinical factors and shoulder sonography findings. Results. Frozen shoulder syndrome was found in 14 of 30 PD patients affecting 19 shoulders, including bilateral involvement in five and unilateral involvement in nine. There was a significant positive correlation between the parameters of sonography findings and frozen shoulder syndrome (i.e., thickness of bicipital effusion and tendon thickness of the subscapularis and supraspinatus) and mean ipsilateral Unified Parkinson's Disease Rating Scale (UPDRS) III and its subscores (tremor, rigidity, and bradykinesia scores). Conclusions. Higher ipsilateral UPDRS and subscores are associated with increased effusion around the biceps tendon, with increased tendon thickness of subscapularis and supraspinatus. Preventing frozen shoulder syndrome in the high-risk PD group is an important safety issue and highly relevant for their quality of life.

Structural covariance networks of striatum subdivision in patients with Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder associated with the striatum. Previous studies indicated that subdivisions of the striatum with distinct functional connectivity profiles contribute to different pathogeneses in PD. Segregated structural covariance (SC) pattern between the striatum and neocortex observed in healthy subjects, however, remain unknown in PD. The purpose of this study is to map and compare the subregional striatal SC network organization between 30 healthy controls and 48 PD patients and to investigate their association with the disease severity. The striatal SC network was statistically inferred by correlating the mean gray matter (GM) volume of six striatal subdivisions (including the bilateral dorsal caudate, superior ventral striatum, inferior ventral striatum, dorsal caudal putamen, dorsal rostral putamen, and ventral rostral putamen) with the entire neocortical GM volume in voxel-wise manner. The PD patients revealed marked atrophy in the striatum, cerebellum, and extra-striatum neocortices. As predicted, segregated striatal SC network patterns were observed in both groups. This suggests that in PD, pathological processes occurring in the striatum affect the same striato-cortical networks that covary with the striatum in healthy brains. The PD patients further demonstrated atypical striatal SC patterns between the caudate, parahippocampus temporal cortices, and cerebellum, which corresponded to dopaminergic associated network. The areas with significant group differences in SC were further associated with disease severity. Our findings support previous studies indicating that PD is associated with altered striato-cortical networks, and suggest that structural changes in the striatum may result in a cascade of alterations in multiple neocortices.

Peripheral leukocyte apoptosis in patients with Parkinsonism: correlation with clinical characteristics and neuroimaging findings.

Apoptosis of both brain neurons and peripheral blood leukocyte is believed to be an important biomarker for evaluating the functional status of Parkinson's disease (PD). However, their correlation remains unknown. A better understanding of the pathophysiology of neurodegeneration is essential for the treatment and prevention of PD. The present study demonstrated that leukocyte apoptosis is significantly higher in PD patients and is associated with central dopamine neuron loss by using (99m)Tc-TRODAT-1 SPECT. The leukocyte apoptosis and striatal dopamine transporter uptake ratios were further associated with increased severity and longer duration of disease. The interaction between brain and systemic inflammation may be responsible for the neurodegenerative disease progression.

Factors associated with fall-related fractures in Parkinson's disease.

PURPOSE: Fall-related fracture is one of the most disabling features of idiopathic Parkinson's disease (PD). A better understanding of the associated factors is needed to predict PD patients who will require treatment. METHODS: This prospective study enrolled 100 adult idiopathic PD patients. Stepwise logistic regressions were used to evaluate the relationships between clinical factors and fall-related fracture. RESULTS: Falls occurred in 56 PD patients, including 32 with fall-related fractures. The rate of falls in the study period was 2.2 ± 1.4 per 18 months. The percentage of osteoporosis was 34% (19/56) and 11% in PD patients with and without falls, respectively. Risk factors associated with fall-related fracture were sex, underlying knee osteoarthritis, mean Unified Parkinson's Disease Rating Scale score, mean Morse fall scale, mean Hoehn and Yahr stage, and exercise habit. By stepwise logistic regression, sex and mean Morse fall scale were independently associated with fall-related fracture. Females had an odds ratio of 3.8 compared to males and the cut-off value of the Morse fall scale for predicting fall-related fracture was 72.5 (sensitivity 72% and specificity 70%). DISCUSSION: Higher mean Morse fall scales (>72.5) and female sex are associated with higher risk of fall-related fractures. Preventing falls in the high-risk PD group is an important safety issue and highly relevant for their quality of life.

Statin pre-treatment is associated with lower platelet activity and favorable outcome in patients with acute non-cardio-embolic ischemic stroke.

INTRODUCTION: Statins reportedly have anti-inflammatory and anti-thrombotic effects aside from cholesterol-lowering. This study aimed to evaluate the effect of pre-existing statin use on platelet activation markers and clinical outcome in acute ischemic stroke patients. METHODS: This prospective study evaluated 172 patients with acute ischemic stroke divided in two groups: patients with pre-existing statin (n = 43) and without pre-existing statin (66 cases with statins initiated post-stroke and 63 without statin treatment). Platelet activation markers (CD62P and CD63) were measured by flow cytometry at different time points after stroke and analyzed with clinical outcome. RESULTS: The CD62P and CD63 expressions on platelets were significantly lower in the patients with pre-existing statin use compared to the patients without pre-existing statin use on Day 1 post-stroke (p < 0.05). The CD62P expression was significantly lower in the patients with pre-existing statin use on 90 days after the acute stroke (p < 0.05). Patients with pre-existing statin use had lower incidences of early neurologic deterioration (END) than those without treatment (p < 0.05). Among several baseline clinical variables, admission NIHSS score, history of coronary artery disease, and pre-existing statin use were independent predictions of good clinical outcome at three months. CONCLUSIONS: Pre-existing statin use is associated with decreased platelet activity as well as improved clinical outcome and reduced END in patients with acute ischemic stroke.

The association between symptomatic delayed cerebral infarction and serum adhesion molecules in aneurysmal subarachnoid hemorrhage.

BACKGROUND: Serum concentrations of adhesion molecules may be connected to the pathogenesis of delayed cerebral infarction (DCI) after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE: To test the hypothesis that levels of adhesion molecules are substantially increased after DCI and decreased thereafter and that these levels can predict treatment outcomes. METHODS: Serial circulating markers of adhesion molecules were examined in 21 consecutive SAH patients and 2 risk control subjects. All underwent cerebral angiography and magnetic resonance imaging to confirm the DCI. The timing of magnetic resonance imaging was fixed in the acute phase and before hospital discharge. RESULTS: Symptomatic DCI developed in 33% of the patients (7 of 21). Statistical analysis of levels of adhesion molecules between patients with and those without DCI revealed that soluble (s) L-selectin, sP-selectin, and sE-selectin concentrations significantly increased after symptomatic DCI (P=.003, .013, and .043, respectively). Only higher sL-selectin level on presentation (cutoff value > 636 ng/mL) was significantly associated with poor outcome after 6 months of follow-up. CONCLUSION: Increased sL-selectin, sP-selectin, and sE-selectin levels imply risks of symptomatic DCI after aneurysmal SAH. The high frequency of symptomatic DCI and higher sL-selectin level on presentation may be associated with worse outcomes.

The effectiveness of interactive computer assisted instruction compared to videotaped instruction for teaching nurses to assess neurological function of stroke patients: a randomized controlled trial.

BACKGROUND: Teaching inexperienced nurses to assess neurologic function of acute ischemic stroke patients poses challenges to educators in Taiwan. OBJECTIVES: The purpose of this study was to examine the effectiveness of two programs that teach nurses the use of the Chinese version of the National Institute of Health Stroke Scale (C-NIHSS), and to evaluate the level of learner satisfaction with these teaching programs. DESIGN: An experimental research design with two groups, one pre-test and two post-tests was utilized. SETTING: Six neurology and neurosurgery wards at two hospitals in southern Taiwan. PARTICIPANTS: Participating nurses were stratified based on their clinical level of experience and prior training on the National Institute of Health Stroke Scale (NIHSS). They were randomly assigned to either the experimental C-NIHSS interactive computer assisted instruction (ICAI) group (n=44) or the Instructor-led videotape learning program (IVLP) group (n=40) to learn the C-NIHSS. METHODS: The measurement tools included the score verification unit (SVU) (score range from 0 to 45, content validity index, CVI=0.96, percentage agreement=84%) and the learner satisfaction scale (CVI=0.92, Cronbach's alpha=0.97). RESULTS: Both groups' scores on the assessment of correctness significantly increased (F=35.50, p=0.00) after intervention. However, there was an insignificant difference between the changes in the two groups (F=0.02, p=0.89). After using one-way ANCOVA analysis, and adjusting for the length of experience in neurological nursing, the results showed that in the second post-test, the ICAI group's score was significantly higher than that of the IVLP group (F=4.81, p=0.03). There was a positive correlation between assessment correctness on the second post-test and length of experience in neurological nursing (r=0.35, p<0.05). It was concluded that nurses with less experience in neurological nursing, who receive ICAI will perform a better assessment of stroke patients than those who received IVLP. CONCLUSION: The C-NIHSS ICAI teaching program contributed to better assessment correctness after adjusting for the length of experience in neurological nursing, and to some extent increased satisfaction for the participating nurses. Therefore it is worth promoting the use of ICAI for in-service education of nurses, especially for nurses with less experience in neurological nursing, in order to enhance long-term effects of learning.