Sleep disturbances and gastrointestinal dysfunction are associated with thalamic atrophy in Parkinson's disease.

BACKGROUND: Non-motor symptoms are common aspects of Parkinson's disease (PD) occurring even at the prodromal stage of the disease and greatly affecting the quality of life. Here, we investigated whether non-motor symptoms burden was associated with cortical thickness and subcortical nuclei volume in PD patients. METHODS: We studied 41 non-demented PD patients. Non-motor symptoms burden was assessed using the Non-Motor Symptoms Scale grading (NMSS). Cortical thickness and subcortical nuclei volume analyses were carried out using Free-Surfer. PD patients were divided into two groups according to the NMSS grading: mild to moderate (NMSS: 0-40) and severe (NMSS: ≥ 41) non-motor symptoms. RESULTS: Thalamic atrophy was associated with higher NMSQ and NMSS total scores. The non-motor symptoms that drove this correlation were sleep/fatigue and gastrointestinal tract dysfunction. We also found that PD patients with severe non-motor symptoms had significant thalamic atrophy compared to the group with mild to moderate non-motor symptoms. CONCLUSIONS: Our findings show that greater non-motor symptom burden is associated with thalamic atrophy in PD. Thalamus plays an important role in processing sensory information including visceral afferent from the gastrointestinal tract and in regulating states of sleep and wakefulness.

Be vigilant for dementia in Parkinson's disease.

It is estimated that up to 80% of patients with Parkinson's disease will eventually develop cognitive impairment over the course of their illness. Even at the time of diagnosis, cognitive impairment has been reported in 20-25% of patients. Commonly affected cognitive domains are executive function, visuospatial ability and attention control. In addition, patients with Parkinson's disease dementia may present with deficits in language function and verbal memory. Psychosis may occur in approximately 40% of patients with Parkinson's disease, and is associated with an increased risk of developing cognitive impairment. Studies have shown that patients with Parkinson's disease with a history of visual hallucinations had an increased risk of developing dementia, four to eight years following diagnosis of the disease. Other clinical risk factors associated with cognitive decline in patients with Parkinson's disease include older age of onset, severe motor symptom burden and in particular akinetic-rigid subtype and olfactory dysfunction. Patients with Parkinson's disease who present with symptoms of cognitive decline, behavioural changes or psychotic symptoms should be referred for further investigation.

Effects of resistance training and detraining on muscle strength and functional performance of older adults aged 80 to 88 years.

BACKGROUND AND AIMS: Limited data exist on the effects of resistance training and detraining on functional performance in very old adults aged >80 years. First, to determine the effects of an 8-week resistance exercise program on muscle strength and functional performance in very old men. Second, to examine the effect of a 6-week detraining period in muscle strength and functional performance. METHODS: Twenty- two men, aged >80 years, were randomized to three groups: resistance exercise-detraining group (RDT; n=8), resistance exercise group (RT; n=7) and control group (CON; n=7). RT and RDT groups performed an 8 week resistance exercise program for lower and upper muscle groups, two times a week. Thereafter, RDT underwent a 6-week detraining period, whereas the RT group continued resistance exercise. 3-RM strength, 6-minute walk distance (6-MWD), chair rising time, and Timed-Up and Go (TUG) tests were assessed at baseline, and at week 8 and week 14. RESULTS: Significant improvements were observed in 3-RM strength (25% to 55%; p<0.001) and functional performance (15 to 25%; p<0.001) tests, in RDT and RT after 8 weeks of exercise. RT continued to improve muscle strength and 6-MWD significantly (p<0.05) until the end of the exercise period, whereas significant declines in muscle strength (60 to 87%; p<0.05) and functional performance (36 to 70%; p<0.05) gains occurred during the exercise period were observed in RDT during the 6-week detraining period. No significant differences were observed in the control group. CONCLUSIONS: Results indicate that a resistance exercise program induces favorable muscular and functional adaptations in very old adults. However, a significant part of the favorable adaptations obtained after resistance exercise may be lost within 6 weeks of detraining. Therefore, very old adults should follow a long-term and systematic routine of exercise throughout life, in order to improve and maintain their physical functions and to ameliorate their life status.

The development and implementation of a software tool and its effect on the quality of provided clinical nutritional therapy in hospitalized patients.

The authors developed "DIET", a computerized system preparing dietary prescriptions in clinical settings. "DIET" has the ability to calculate the nutritional requirements and to produce daily menus of patients automatically. Also, it serves as an electronic medical and dietetic record and it can produce daily reports regarding portions, quantities and cost of meals. The authors also conducted a preliminary evaluation of the system by comparing the design of nutritional plans for 135 patients using "DIET" versus the customary manual methods. Its use resulted in a decrease of the error percentages, concerning appropriate food choices, data recording and calculations of daily nutrient requirements; from 12% to 1.5%. Additionally, there was a reduction by 50% of the time required to obtain and process data as well as design a patient's menu. "DIET" implementation resulted in error decrease and thus in improvement of menu planning, accuracy and recovery of data and decreased the time spent on menu planning.

The 2004 Olympic Games: physiotherapy services in the Olympic Village polyclinic.

OBJECTIVE: First, to document the injuries sustained during the 2004 Olympic Games in a sample of patients visiting the physiotherapy department of the Olympic Village polyclinic. Second, to provide information and data about the physiotherapy services for planning future Olympics and other mass gatherings. DESIGN: Observational study. SETTING: Olympic Village polyclinic. PARTICIPANTS: 457 patients aged 15-72 years visited the physiotherapy department from 30 July through 30 August. RESULTS: The department's workload was at a peak during the last 15 days of the Olympic Games (periods B and C). The most common injuries were overuse injuries (47.3%). The most common pathology for physiotherapy attendance was myofascial pain/muscle spasm (32.5%), followed by tendinopathy (19.2%) and ligament sprain (18.7%). The most prevalent site of injury was the thigh (21%), followed by the knee (14.1%) and the lumbar spine (13.5%). Most injuries had symptoms of <7 days' duration. The geographical region with the greatest demand for physiotherapy services was Africa (40.6%). Most patients were athletes (74.8%), although team officials accounted for a considerable number (14%). CONCLUSIONS: The smallest national teams--especially those from developing countries--were more likely to take advantage of services, probably because the larger teams had their own medical and physiotherapy staff. The characteristics of patients, their sustained injuries and the subsequent treatment varied by the accreditation status of the patients. The physiotherapy department's workload was dependent on the Olympic Games schedule.