The analysis of relationship between selected sociodemografic factors and disorders of speech organs in Parkinson`s patients.

BACKGROUND: Evaluation of speech disorders in PD taking into account sociodemographic conditions is not frequent. This paper aims to establish correlations between articulation disorders in PD patients and factors such as the patients' sex, age, education and residence. METHODS: The study included 92 patients with idiopathic PD diagnosed by means of multiple neurological examinations, biochemical tests, MRI and CT scanning carried out in accordance with the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) criteria. A speech and language test involved the assessment of the mobility of the speech organs as well as the reflexes inside the oral cavity. Frenchay Dysarthria Assessment was applied for an objective evaluation of dysarthria. RESULTS: The study revealed the existence of significant relationship between the functionality of articulators in PD patients and their education and residence. Big city dwellers demonstrated lower incidence of disorders within speech organs, particularly those affecting mobility of the soft palate while eating. Disorders of moderate intensity were more frequently found in subjects living in villages. Subjects with a university education displayed better position of the lips at rest and better performance of both lips and the mandible while speaking. CONCLUSIONS: Abnormal functioning of the articulatory organs was observed more frequently in PD patients residing in rural areas than in those inhabiting urban areas. As for education, our cohort university graduates displayed a better position of the lips at rest and better performance of the lips and jaw during speaking than those with secondary and vocational education.

Risk Factors of Fatigue in Idiopathic Parkinson's Disease in a Polish Population.

Introduction. Fatigue syndrome is one of the nonmotor symptoms in Parkinson's disease (PD). The aim of the study was assessment of prevalence of fatigue syndrome in PD and answering the question what are the independent risk factors connected with intensity of fatigue in PD. Methods. 114 patients with idiopathic PD (mean age 62.2 + 10.8 years) were enrolled. The fatigue was assessed according to the Fatigue Severity Scale (FSS). We analyzed associations between fatigue and sex, age, education, duration and severity of the disease, everyday activity, intensity of the main symptoms, treatment, presence of dyskinesias and fluctuations, depression and excessive sleep during the day, and presence of pain and nycturia. Results. The fatigue syndrome was detected in 57.9% of patients. The score in the FSS was 1 to 7 points, 4.3 average. Greater fatigue intensity correlated with higher total daily levodopa equivalent dose. Patients with moderate depression had significantly greater fatigue. Conclusions. Fatigue syndrome affects 57.9% of patients with PD. Use of higher LED and presence of moderate depression are independent risk factors of greater intensity of fatigue.

Articulation disorders and duration, severity and L-dopa dosage in idiopathic Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is one of the most common diseases of the central nervous system (CNS). It is frequently heralded by speech disturbances, which are one of its first symptoms. AIM: The aim of this paper is to share our own experience concerning the correlation between the severity of speech disorders and the PD duration, its severity and the intake of L-dopa. MATERIAL AND METHODS: The research included 93 patients with idiopathic PD, aged 26-86 years (mean age 65.1 years). Participants were examined neurologically according to the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale. They were also assessed by Frenchay Dysarthria Assessment. RESULTS: Considerable and severe disorders were concurrent with impairments in the mobility of the tongue, lips, the jaw as well as the pitch and loudness of the voice. The strongest correlation but at a moderate level was found to exist between the severity of labial impairment, voice loudness and the length of the disease. There was also a positive correlation between lip movement while the motions were being diversified, lip arrangement while speaking and the intake of L-dopa. CONCLUSIONS: As PD progresses a significant decline in vocal articulation can be observed, which is due to reduced mobility within the lips and the jaw. Exacerbation of articulation disorders resulting from progression of the disease does not materially influence the UPDRSS scores. L-dopa has been found to positively affect the mobility of the lips while the patient is speaking and their arrangement at rest.

Bioelectrical function and structural assessment of the retina in patients with early stages of Parkinson's disease (PD).

PURPOSE: To determine bioelectrical function and structural changes of the retina in patients with early stages of Parkinson's disease (PD). MATERIALS AND METHODS: Thirty-eight eyes of 20 patients with early idiopathic PD and 38 eyes of 20 healthy age- and sex-matched controls were ophthalmologically examined, including assessment of distance best-corrected visual acuity (DBCVA), slit lamp examination of the anterior and posterior segment of the eye, evaluation of the eye structures: paramacular retinal thickness (RT) and retinal nerve fiber layer (RNFL) thickness with the aid of OCT, and the bioelectrical function by full-field electroretinogram (ERG). Additionally, PD patients were interviewed as to the presence of dopamine-dependent visual functions abnormalities. RESULTS: In patients with early PD, statistically significant changes in comparison with the control group were observed in ERG. They contained a reduction in mean amplitudes of the scotopic a-wave (rod-cone response), the scotopic oscillatory potentials (OPs)--OP2 and OP3, the photopic b-wave, and a reduction in the overall index (OP1 + OP2 + OP3) and a prolongation of mean peak times of the scotopic OP1, OP2, OP3, OP4 (p < 0.05). A questionnaire concerning abnormalities of dopamine-dependent visual functions revealed that PD patients with abnormal peak times of OP1, OP2, and OP3 reported non-specific visual disturbances more frequently in comparison with PD patients with normal peak times of OPs. Other analyzed parameters of ERG, DBCVA, RT, and RNFL did not significantly differ between patients with PD and the control group. CONCLUSION: In patients with early PD, bioelectrical dysfunction of the retina was observed in the ERG test, probably as a result of dopamine deficiency in the retina. The results of our study indicate that ERG may also be a useful tool for understanding the reason for non-specific visual disturbances occurring in PD patients.

Ophthalmological features of Parkinson disease.

BACKGROUND: The aim of this study was to determine the type and frequency of ophthalmologic changes occurring in patients with Parkinson disease (PD). MATERIAL/METHODS: One hundred consecutive patients (196 eyes) with idiopathic PD and a control group consisting of 100 healthy patients (196 eyes) matched for age and sex underwent a complete ophthalmological examination of both eyes, including assessment of patient medical history, dry eye questionare, and visual hallucinations questionnaire, distance and near best corrected visual acuity (DBCVA, NBCVA), color vision, distance photopic contrast sensitivity, near point of convergence, slit lamp examination of the eye anterior segment, tear film osmolarity and breakup time, aqueous tear production, and intraocular pressure, as well as fundus examination and evaluation of the perimacular retinal thickness (RT) and peripapillary retinal nerve fiber layer (RNFL) thickness. RESULTS: In the eyes of PD patients DBCVA, NBCVA, contrast sensitivity, and color discrimination were significantly reduced. We also detected increased frequency of convergence insufficiency, seborrhoic blepharitis, meibomian gland disease (MGD), dry eye syndrome, nuclear and posterior subcapsular cataract, and glaucoma (p<0.05). However, intraocular pressure (IOP) was significantly lower in the PD group compared to controls. The frequency of visual hallucinations, age-related macular degeneration (ARMD), and other ophthalmological diseases, as well as RT and RNFL thickness, did not significantly differ between investigated groups. CONCLUSIONS: Clinicians need to be aware of the association between PD and ophthalmological changes. Restoration of good-quality vision has a great impact on PD patients' quality of life, reduction of costs of treatment and care, and rehabilitation.

BDNF G196A (Val66Met) polymorphism associated with cognitive impairment in Parkinson's disease.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin widely expressed in the mammalian brain, regulating neuronal survival and known to influence dopaminergic neurons and cognitive processes. The present study investigated the BDNF Val66Met polymorphism associations with PD risk, and cognitive impairment in PD. A total of 486 study subjects (244 PD and 242 age and sex matched controls) were included in the study. UPDRS score, Hoehn-Yahr staging and the Schwab-England scale were used to assess motor abilities and activity during daily life. The patients were classified into groups with dementia (PDD, n=69) and without it (nPDD, n=166) on the basis of neuropsychological assessment. The most common functional polymorphism in BDNF Val66Met (rs6265, G196A) gene was determined using TaqMan real-time PCR assay. Frequencies of evaluated BDNF alleles and genotypes were similar in PD and the controls. The mean age of disease onset among BDNF Met/Met carriers was later (65.00±6.13) in comparison to Val/Val (57.45±10.68) and Val/Met (56.33±10.91) subjects (p=0.077). The studied BDNF polymorphism was not associated with cognitive status in PD patients. However, patients with Met/Met alleles demonstrated better delayed recall of information than patients with Val/Val alleles. The results of multivariate logistic regression analysis revealed age (p=0.0003) and the disease stage (p=0.002) as independent risk factors predisposing to PD dementia.

The impact of MRI white matter hyperintensities on dementia in Parkinson's disease in relation to the homocysteine level and other vascular risk factors.

BACKGROUND: The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear. OBJECTIVE: The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD. METHODS: A total of 192 patients with PD and 184 age- and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined. RESULTS: Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH. CONCLUSIONS: WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.

Is there an effect of folic acid supplementation on the coagulation factors and C-reactive protein concentrations in subjects with atherosclerosis risk factors?

INTRODUCTION: Folic acid (FA) may delay the formation of atherosclerotic lesions. Increased plasma levels of von Willebrand factor (VWF) are observed in cardiovascular disease, which leads to higher risk of thrombosis. Fibrinogen (Fb) is a well-documented risk factor of cardiovascular disease. The aim of this study was to analyze the effect of FA supplementation on the Fb, VWF and C-reactive protein (CRP) plasma concentrations in subjects with atherosclerosis risk factors. MATERIAL/METHODS: The study enrolled 124 Caucasian individuals (60 M, 64 F) with atherosclerosis risk factors--family history of premature ischaemic stroke, arterial hypertension, dyslipidaemia, overweight and obesity, cigarette smoking and low physical activity. The participants were asked to take FA in the low dose of 0.4 mg/24 h for three months. RESULTS: After FA supplementation a significant reduction of the VWF concentrations in females (76.6 vs 72.3%; p=0.028) and in males (75.5 vs 66.9%; p=0.001) was observed. Among women and men with dyslipidaemia concentrations of VWF decreased after FA supplementation (76.8% vs 69.6%; p=0.003 and 76.7% vs 67.8%; p=0.001 respectively). Among females and males with BMI ≥25 kg/m² concentrations of VWF decreased only in men (77.6% vs 66.5%; p=0.001). In female and male smokers supplementation of FA decreased VWF concentrations (82.5% vs 74.4%; p=0.012 and 76.6% vs 69.5%; p=0.036 respectively). DISCUSSION: The results of our study suggest that there is an effect of FA supplementation on VWF concentrations in subjects with atherosclerosis risk factors.

Association of COMT, MTHFR, and SLC19A1(RFC-1) polymorphisms with homocysteine blood levels and cognitive impairment in Parkinson's disease.

INTRODUCTION: Elevated plasma homocysteine (Hcy) concentration is an independent risk factor for cardiovascular disease, and its involvement in endothelial cell dysfunction is well established. However, the role of Hcy and folate in the pathogenesis of Parkinson's disease (PD) remains controversial. OBJECTIVES: The study was aimed at evaluating the relationships between Hcy, vitamin B12, and folic acid levels in the blood and cognitive status in PD patients with the genetic polymorphisms of MTHFR (rs1801133: C>T-677C>T, rs1801131: A>C-1298A>C), COMT (rs4680: A>G-Val158Met, rs6269: A>G, rs4633: C>T, rs4818: C>G), or SLC19A1 (rs1051266: G>A-80G>A). METHODS: A total of 502 participants (248 with PD and 254 age-matched and sex-matched controls) were included in the study. The Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging, and the Schwab-England scale were used to assess motor abilities and activity during daily life. Complex psychological examination with a battery of tests was used to classify patients into groups with (PDD) and without (nPDD) dementia. Blood samples were examined for Hcy, vitamin B12, and folic acid levels, as well as polymorphisms in genes related to Hcy metabolism, such as COMT, MTHFR, and SLC19A1(RFC-1). RESULTS: The frequency of homozygous COMT rs4680G and rs4633C allele carriers was significantly decreased in PD patients in comparison with the controls (P=0.015; odds ratio=0.60; 95% confidence interval 0.41-0.90 and P=0.020; odds ratio=0.619; 95% confidence interval 0.42-0.92, respectively). No significant differences in the distribution of MTHFR 677C>T, 1298A>C, and SLC19A1 80G>A alleles and genotypes between PD patients and the controls were found. Hcy levels were significantly increased in PD patients (18±7.8 µmol/l) as compared with the controls (14.0±9.6 µmol/l, P=10(-8)) and were significantly associated with the MTHFR 677C>T polymorphism both in PD patients and controls, in which T allele carriers were characterized by markedly elevated Hcy plasma concentrations. No association was observed between Hcy plasma level and COMT and SLC19A polymorphisms. The results of multivariate logistic regression analysis revealed age (P=0.0003) and Hcy plasma levels (P=0.07) as independent risk factors predisposing individuals to PD dementia. The studied polymorphisms were not associated with cognitive status in PD patients. CONCLUSION: The genetic factors studied were not associated with cognitive status in PD patients. Only age and Hcy plasma levels were found to be independent risk factors predisposing individuals to PD dementia. However, COMT: rs4680: A>G and rs4633: C>T polymorphisms were found to significantly affect PD risk, and the MTHFR 677C>T polymorphism helped determine plasma Hcy concentrations.

Rotigotine effects on early morning motor function and sleep in Parkinson's disease: a double-blind, randomized, placebo-controlled study (RECOVER).

In a multinational, double-blind, placebo-controlled trial (NCT00474058), 287 subjects with Parkinson's disease (PD) and unsatisfactory early-morning motor symptom control were randomized 2:1 to receive rotigotine (2-16 mg/24 hr [n = 190]) or placebo (n = 97). Treatment was titrated to optimal dose over 1-8 weeks with subsequent dose maintenance for 4 weeks. Early-morning motor function and nocturnal sleep disturbance were assessed as coprimary efficacy endpoints using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III (Motor Examination) measured in the early morning prior to any medication intake and the modified Parkinson's Disease Sleep Scale (PDSS-2) (mean change from baseline to end of maintenance [EOM], last observation carried forward). At EOM, mean UPDRS Part III score had decreased by -7.0 points with rotigotine (from a baseline of 29.6 [standard deviation (SD) 12.3] and by -3.9 points with placebo (baseline 32.0 [13.3]). Mean PDSS-2 total score had decreased by -5.9 points with rotigotine (from a baseline of 19.3 [SD 9.3]) and by -1.9 points with placebo (baseline 20.5 [10.4]). This represented a significantly greater improvement with rotigotine compared with placebo on both the UPDRS Part III (treatment difference: -3.55 [95% confidence interval (CI) -5.37, -1.73]; P = 0.0002) and PDSS-2 (treatment difference: -4.26 [95% CI -6.08, -2.45]; P < 0.0001). The most frequently reported adverse events were nausea (placebo, 9%; rotigotine, 21%), application site reactions (placebo, 4%; rotigotine, 15%), and dizziness (placebo, 6%; rotigotine 10%). Twenty-four-hour transdermal delivery of rotigotine to PD patients with early-morning motor dysfunction resulted in significant benefits in control of both motor function and nocturnal sleep disturbances.

[Autonomic disorders in Parkinson's disease]. / Zaburzenia autonomiczne w chorobie Parkinsona.

INTRODUCTION: Autonomic disorders (AD) are one of non-motor symptoms in Parkinson's disease (PD). The aim of this study was to assess the frequency of AD in PD patients and their relationship with age, gender, disease duration, treatment duration, L-dopa dose, and disease severity. MATERIAL AND METHODS: 101 patients with PD were recruited. Anamnesis was recorded with a focus on orthostatic hypotension, sialorrhea, dysphagia, nausea/vomiting, loss of appetite, weight loss, constipation, nycturia, urgency, pollakiuria, difficulties in starting miction, urinary incontinence, erectile dysfunction, sweating, heat/cold intolerance, and seborrhea. Mann-Whitney test and Pearson's chi2 test were used for statistical analysis. RESULTS: The study group comprised 53 men and 48 women, aged 42-84 years, mean age 67.69 years. The disease duration was 1-25 years, mean 6.5 years, L-dopa treatment duration was 1-20 years, mean 6.04 years, L-dopa dose was 300-2000 mg/24 h, mean 636 mg/24 h, UPDRS score was 8-103 pts, mean 36.38 pts. Orthostatic hypotension was found in approximately 16% of the patients. As regards gastrointestinal disorders, more than 40% of patients suffered from constipation, more than 32% from dysphagia, almost 28% from sialorrhea, approximately 11% from loss of appetite, 6.93% from weight loss, 2% from nausea/vomiting. The distribution of urogenital disorders was as follows: almost 85% of patients had erectile dysfunction, almost 57% nycturia, 24.78% urinary incontinence, approximately 22% pollakiuria, and almost 12% urgency and difficulties with erection. One-third of PD patients suffered from seborrhea, 16.83% from sweating, and almost 9% from heat/cold intolerance. CONCLUSIONS: The most frequent AD in PD were: erectile dysfunction, nycturia, constipation, dysphagia, and seborrhea. Age correlated with orthostatic hypotension, constipation, and urinary incontinence, and with erectile dysfunction in men. Women were predisposed to weight loss and sweating. Men were predisposed to difficulties in starting miction. Disease duration correlated with constipation, nycturia, and urinary incontinence; L-dopa treatment duration correlated with nausea/vomiting and constipation; L-dopa dose correlated with nausea/vomiting, constipation, urgency, and heat/cold intolerance; disease stage correlated with sialorrhea, constipation, sweating, and heat/cold intolerance.

Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) in the early stages of Alzheimer's disease.

Alzheimer's disease (AD) is one of the most common causes of dementia in the world. Patients with AD frequently complain of vision disturbances that do not manifest as changes in routine ophthalmological examination findings. The main causes of these disturbances are neuropathological changes in the visual cortex, although abnormalities in the retina and optic nerve cannot be excluded. Pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) tests are commonly used in ophthalmology to estimate bioelectrical function of the retina and optic nerve. The aim of this study was to determine whether retinal and optic nerve function, measured by PERG and PVEP tests, is changed in individuals in the early stages of AD with normal routine ophthalmological examination results. Standard PERG and PVEP tests were performed in 30 eyes of 30 patients with the early stages of AD. The results were compared to 30 eyes of 30 normal healthy controls. PERG and PVEP tests were recorded in accordance with the International Society for Clinical Electrophysiology of Vision (ISCEV) standards. Additionally, neural conduction was measured using retinocortical time (RCT)--the difference between P100-wave latency in PVEP and P50-wave implicit time in PERG. In PERG test, PVEP test, and RCT, statistically significant changes were detected. In PERG examination, increased implicit time of P50-wave (P < 0.03) and amplitudes reductions in P50- and N95-waves (P < 0.0001) were observed. In PVEP examination, increased latency of P100-wave (P < 0.0001) was found. A significant increase in RCT (P < 0.0001) was observed. The most prevalent features were amplitude reduction in N95-wave and increased latency of P100-wave which were seen in 56.7% (17/30) of the AD eyes. In patients with the early stages of AD and normal routine ophthalmological examination results, dysfunction of the retinal ganglion cells as well as of the optic nerve is present, as detected by PERG and PVEP tests. These dysfunctions, at least partially, explain the cause of visual disturbances observed in patients with the early stages of AD.

Does the progeny of premature ischemic stroke sufferers need intensive interest of physicians oriented toward primary prevention? A pilot study.

BACKGROUND: Few studies focus on the progeny of stroke patients with respect to the occurrence of other potential risk factors. METHODS: The study group covered 60 males and 62 females whose parents had suffered premature ischemic stroke (PIS); the control group comprised of 41 males and 47 females whose parents had no history of premature vascular event (mean age: 28.4 and 27.1 years, respectively). Examination of both the groups consisted of evaluation of their diet, measurement of arterial blood pressure and body mass index (BMI). Moreover, blood test was carried out and concentration of biochemical stroke risk factors was determined. RESULTS: The adult progeny of parents with a history of PIS followed a deficient, unbalanced, and nonvaried diet. Their average blood pressure and BMI reached higher values, compared with the results obtained in the control group (125.7±16.06 vs. 122.64±10.83 mmHg; 24.27±3.98 vs. 22.54±2.69 kg/m, respectively; P<0.05). The same applies to average concentrations of the triglycerides 1.22±0.76 vs. 1.06±0.54 mmol/l; total cholesterol (5.34±1.16 vs. 4.82±0.89 mmol/l), low-density lipoprotein-cholesterol (2.95±0.97 vs. 2.52±0.73 mmol/l), total homocysteine (11.22±4.22 vs. 10.18±2.45 µmol/l), and fibrinogen (2.91±0.68 vs. 2.78±0.6 g/l) (P<0.05). CONCLUSION: Adult children of PIS sufferers show different stroke risk factor profiles than the control group. It may indicate a need for preventive activities for this group in the future. Family occurrence of stroke requires further detailed studies on a larger cohort of patients from risk group.

Usefulness of the ALSAQ-5 scale in evaluation of quality of life in amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: The evaluation of quality of life (QoL) is one of the most important factors in complex care of patients. The aim of the study was to estimate the usefulness of the shortened QoL-evaluating scale ALSAQ-5 in patients with amyotrophic lateral sclerosis and to establish the relationship between QoL and age, sex, duration of the disease, education and treatment. MATERIAL AND METHODS: Forty-four patients (24 males and 20 females) aged between 34 and 81 years (mean 58.9) were studied. The QoL was evaluated with the ALSAQ-40 and ALSAQ-5 scales. Patients could score between 0 and 100 pts in both scales (higher score denotes worse QoL). Mann-Whitney U-test, Wilcoxon test, Kolmogorov-Smirnov test and Spearman rank correlation coefficient were used for statistical analysis. RESULTS: The QoL was worsened by limited physical mobi-lity (ALSAQ-40: 22.5-100 pts, mean 80.8; ALSAQ-5: 25-100 pts, mean 88.6), reduced daily living/independence (ALSAQ-40: 7.5-100 pts, mean 76.0; ALSAQ-5: 0-100 pts, mean 75), communication disturbances (ALSAQ-40: 17.9-100 pts, mean 75.2; ALSAQ-5: 0-100, mean 73.9), and emotional functioning (ALSAQ-40: 5-100 pts, mean 64.9; ALSAQ-5: 0-100, mean 73.9). Eating and drinking dysfunctions (ALSAQ-40: 0-100 pts, mean 66.3; ALSAQ-5: 0-100, mean 67) had a smaller influence on QoL. CONCLUSIONS: Initial analysis shows that ALSAQ-5 is a sensitive and reliable instrument for the estimation of QoL of patients with amyotrophic lateral sclerosis. As there are no statistical differences in QoL estimation using ALSAQ-40 and ALSAQ-5, ALSAQ-5 seems to be more useful in clinical practice.

Genetic and environmental factors for hyperhomocysteinaemia and its clinical implications in Parkinson's disease.

Elevated homocysteine (Hcy) plasma levels are caused by genetic and environmental factors. Polymorphisms of Hcy metabolizing enzyme genes may result in its plasma increase. Experimental and clinical studies have shown the possible role of hyperhomocysteinaemia in pathogenesis of Parkinson's disease (PD), Alzheimer's disease and vascular disorders. The results of clinical studies in PD generally do not support the theoretical hypotheses, and animal studies remain controversial. A major environmental factor responsible for Hcy increase in PD seems to be levodopa therapy. Its metabolism results in Hcy increase and may be reduced with folate and vitamins B6, B12 supplementation or inhibition of catechol-O-methyltransferase (COMT) activity. Therefore, the potential harmful role of Hcy may be diminished in PD patients with vascular comorbidities. Further studies are needed to establish the real role of Hcy for PD and other neurological disorders. The paper summarizes the current knowledge on the genetic and environmental factors responsible for Hcy increase in PD.

[Selected dietary atherosclerosis risk factors in offspring of patients with premature ischemic stroke]. / Wybrane zywieniowe czynniki ryzyka miazdzycy u potomstwa chorych z przebytym przedwczesnym niedokrwiennym udarem mózgu.

UNLABELLED: There are currently multiple reports which conclude that there is a correlation between cardiovascular risk factors, including wrong dietary habits, and occurrence of these factors in families. AIM OF THE STUDY: To evaluate daily intake of selected dietary items, which have influence on premature development of atherosclerosis, in adult offspring of patients who underwent premature ischemic stroke. MATERIAL AND METHODS: 54 patients were included in the study: 21 males, aged 21-38 years (average 25.8 yrs.) and 33 women aged 19-39 years (average 28.2 yrs.). All of them were examined including medical history, physical examination and fasting blood draw. Dietary habits were evaluated with the method of 24-hour history using a questionnaire developed by Institute of Food and Diet in Warsaw, Poland (Instytut Zywnosci i Zywienia). Intake of selected dietary components (dietary cholesterol, fiber, vitamins E, C, B6, B12 and folic acid) was assessed using a computer program "Dietician 2" ("Dietetyk 2") which had been developed by the Institute of Food and Diet. RESULTS: In males, compared to females, there was a significantly higher (p < 0.05) level of daily calorie intake (2400.8 +/- 716.2 vs 1583.1 +/- 584.3 kcal) as well as intake (expressed in percentage of daily allowance) of dietary cholesterol (106.8 +/- 46.2 vs 62.9 +/- 42.8), fiber (70.6 +/- 28.2 vs 52.0 +/- 22.2), vitamin E (98.4 +/- 49.8 vs 63.5 +/- 33.9), folate (53.9 +/- 23.1 vs 37.8 +/- 16.4) and vitamin B12 (99.0 +/- 58.3 vs 57.2 +/- 44.5). There were also significantly higher levels of the following parameters in 22 normal-weight females compared to 11 overweight/obese females: daily calorie intake (1735.2 +/- 613.2 vs 1278.9 +/- 387.7 kcal) as well as intake (expressed in percentage of daily allowance) of dietary cholesterol (73.9 +/- 44.8 vs 40.9 +/- 29.2), folate (42.3 +/- 17.0 vs 28.7 +/- 10.9) and vitamin B12 (68.2 +/- 48.0 vs 35.1 +/- 26.4). CONCLUSIONS: The examined offspring (especially daughters) of a parent with premature ischemic stroke ate insufficient, unbalanced and monotonous diet, which impaired their nutrition. This should motivate family physicians to put greater interest in primary prevention in this group of patients. Overweight and obese women were put at even greater risk because such diet was added to other atherosclerosis risk factors, i.e. family history of premature ischemic stroke and increased body mass.

Assessment of rest tremor in Parkinson's disease.

BACKGROUND AND PURPOSE: Rest tremor is the most frequent sign of Parkinson's disease (PD) after bradykinesia, occurring with various severity in about 75% of patients. An objective assessment of rest tremor is difficult. The aim of the study was to analyze rest tremor in PD with the three-dimensional gauging system CMS 10; more specifically, the impact of levodopa treatment on rest tremor, the influence of clinical factors, and the correlation between rest tremor and clinical scales were assessed. MATERIAL AND METHODS: Ninety-five patients with PD (mean age 67.6 years) and 30 healthy people in a control group (mean age 59.3 years) were examined. Clinical scales (UPDRS, Hoehn and Yahr, Schwab and England, as well as Webster scale) were used to assess severity of PD. The assessment of rest tremor was performed within the more and less affected upper limb with the three-dimensional gauging system CMS 10 (Zebris GmbH) before and 1-2 hours after levodopa intake. Frequency (Hz), amplitude (deg), velocity (deg/ms) and acceleration (deg/s2) of the tremor were evaluated. Results were compared with averaged results for left and right upper limb in the control group. RESULTS: The method used in this study objectively showed asymmetry in rest tremor. After levodopa intake, all evaluated parameters of rest tremor were decreased (mainly the amplitude and frequency, and to a lesser degree, velocity and acceleration). The motor part of UPDRS showed the best correlation with rest tremor. CONCLUSIONS: The three-dimensional measuring system CMS 10 is useful in the objective assessment of rest tremor in PD. Rest tremor in PD is under the influence of PD form, the intake of levodopa dose, the amount of levodopa, gender and level of education.

Neurological syndromes in systemic lupus erythematosus and their association with antiphospholipid syndrome.

BACKGROUND AND PURPOSE: In patients with systemic lupus erythematosus (SLE), severe neurological syndromes indicating central, peripheral or autonomic nervous system involvement are frequently seen. Antiphospholipid syndrome (APS) increases the risk of nervous system involvement. The aim of the study was to assess neurological manifestations occurring in patients with SLE and to evaluate their association with APS. MATERIAL AND METHODS: One hundred thirty-seven patients (123 women and 14 men) with SLE were studied. Fifty out of 137 patients (43 women and 7 men) were diagnosed with APS. All patients underwent full neurological examination and diagnostics. Neurological syndromes were classified according to the standardized American College of Rheumatology (ACR) nomenclature. RESULTS: Neurological syndromes were found in 89 cases out of 137 admitted SLE patients (64.96%). Headache was present in 52 patients (37.96%), polyneuropathy in 17 (12.41%), cerebrovascular disease in 13 (9.49%), seizures in 10 (7.3%), cranial neuropathy in 5 (3.65%), demyelinating syndrome in 5 (3.65%), mononeuropathy in 3 (2.19%), movement disorder in 3 (2.19%), and aseptic meningitis in 2 patients (1.46%). Our study indicated that 78% of patients with APS showed nervous system involvement as compared with 57.47% of SLE patients without APS (p=0.01). CONCLUSIONS: Neurological syndromes occurring most frequently in SLE patients include headache, polyneuropathy and cerebrovascular diseases. Antiphospholipid syndrome increases the risk of nervous system involvement. We found that APS was strongly associated with neurological manifestations and in particular with cerebrovascular diseases and seizures.

The role of NAT2 gene polymorphism in aetiology of the most frequent neurodegenerative diseases with dementia.

BACKGROUND AND PURPOSE: The role of N-acetyltransferase gene (NAT2) polymorphism in the aetiology of Alzheimer's disease (AD) and Parkinson's disease (PD) is an interesting issue; it is suggested that the slow acetylator genotype favours the damage of central nervous system cells by environmental toxins. The aims of the study were: 1) to determine the genotype of NAT2 in patients with sporadic PD with dementia and in patients with sporadic AD; 2) to evaluate the relationship between the genotype of NAT2 and the age at the onset of the disease, the extent of dementia, and the dose and side effects of L-dopa (in PD patients only); 3) to evaluate the predispositions to PD and AD. MATERIAL AND METHODS: Fifty two PD patients with dementia aged 51-82 years (mean: 70.35) and 53 AD patients aged 58-84 years (mean: 72.58) were recruited. The control group consisted of 90 healthy subjects aged 65-86 years (mean: 72.11). Four standardized instruments for evaluation of dementia in PD patients were used. Clinical scales for PD evaluation were used. Each AD patient satisfied the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria for probable AD. Methods of molecular biology were used for genetic studies. RESULTS: The NAT2*5/NAT2*5 genotype was more frequent in PD patients with dementia; the NAT2*4/NAT2*5 genotype was more frequent and the NAT2*4/NAT2*6 genotype was less frequent in AD patients. No relationship was found between genotypes and NAT2 alleles and the age at onset, severity of dementia or with the dose and side effects of L-dopa (in PD patients). CONCLUSIONS: The analysis of NAT2 polymorphism does not seem to be useful in predicting the risk of PD with dementia or AD.

[Dopamine agonists--pharmacological similarities and differences]. / Agonisci dopaminy--farmakologiczne podobienstwa i róznice.

Parkinson's disease (PD) is a chronic and progressive neurological disorder characterized by selective degeneration of dopaminergic neurons in the substantia nigra pars compacta. Considerable advances made in defining the aetiology, pathogenesis and pathology of PD have resulted in the development and rapid expansion of the treatment. Dopamine receptor agonists play increasingly important roles in antiparkinsonian therapy. Pharmacological and pharmacokinetic properties of these agents are briefly reviewed and followed by a detailed summary of available literature concerning controlled trials in Parkinson's disease.