Peripheral neuropathy in Parkinson's disease.

Peripheral neuropathy (PN) is a common neurological problem defined as a dysfunction of sensory, motor, and autonomic nerves. The presence of peripheral neuropathy has recently been noticed in Parkinson's disease (PD) This comorbidity is concerning as it increases the burden on patients whose motor functions are previously compromised. A comprehensive computer-based literature review utilizing multiple peer-reviewed databases (e.g., Embase, PsycINFO, CINAHL, etc.) was conducted. There is evidence for the utility of robust diagnostic criteria to distinguish between large fiber neuropathy (LFN) and small fiber neuropathy (SFN). Some studies have established links between prolonged L-DOPA exposure and prevalence with increased levels of homocysteine (HCY) and methylmalonic acid (MMA) as pathological underlying mechanisms. PN in PD patients with relatively truncated exposure to L-DOPA therapy may have underlying mutations in the Parkin and MHTFR gene or separate mitochondrial disorders. Vitamin B12 and cobalamin deficiencies have also been implicated as drivers of PN. Accumulation of phosphorylated α-synuclein is another central feature in PN and deems urgent exploration via large cohort studies. Importantly, these underlying mechanisms have been linked to peripheral denervation. This review delves into the potential treatments for PN targeting B12 deficiencies and the use of COMT inhibitors along with other novel approaches. Avenues of research with powerful randomized controlled and long-term cohort studies exploring genetic mechanisms and novel treatment pathways is urgently required to alleviate the burden of disease exerted by PN on PD.

Parkinson's pain is more aching and interfering with social life in Caucasians compared to Indians.

Objectives: Although there have been numerous studies conducted to better understand Parkinson's disease (PD), the epidemiology of its debilitating non-motor symptoms across different ethnicities remains understudied. Herein we explore the relationship between depression, anxiety and pain in PD patients of Caucasian or Indian ethnicity (PD Caucasians and PD Indians). Patients and Methods: All patients and healthy age and gender matched controls were assessed via semi-structured interviews for anxiety, pain and depression using structured questionnaires. Results: PD Indians did not differ from PD Caucasians on anxiety or depression. However, PD Caucasians were more likely to report aching pain by 80 times and dull pain by 108 times compared to PD Indians. PD Indians were 82% less likely to have pain interfering with social activities, and 90% less likely to have pain interfering with relations with others compared to PD Caucasians. Conclusion: Although an Indo-Caucasian difference may not be detected from mood dysfunction, important differences may exist from the influence of pain interfering with several dimensions of life.

Negative impact of severity of pain on mood, social life and general activity in Parkinson's disease.

OBJECTIVE: Pain is an important non-motor symptom of Parkinson's disease (PD); however, it remains understudied. The purpose of previous studies on the relationship between PD and pain, has been to explore the cause, origin and types of pain. This case control study is designed for clinicians and rehabilitation specialists to effectively identify pain from the patient's point of view. Pain present in PD patients correlates with significant disruption to their daily lives, which was seen by analysing characteristics, frequency, severity and interference of pain. METHOD: A total of 100 PD patients and 100 control healthy individuals, consisting of 66 males and 34 females were evaluated during routine clinical assessment followed by a neurological exam. The Brief Pain Inventory (BPI) was used to measure chronic pain in terms of pain severity, pain interference and pain frequency between the two groups. RESULTS: It was determined that PD patients had significantly higher pain severity scores compared to controls (p < 0.05). PD patients with depressive symptoms had significantly higher pain severity and pain interference scores than controls without depressive symptoms. PD patients reported greater scores on Global BPI pain interference and all components of the pain interference subscale. DISCUSSION: PD and depression seem to be correlated with higher perceived pain, severity and interference. These findings have not been reported by other case control studies, and warrant further causal research into pain, depression and PD.

Decreased sleep quality in Parkinson's patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality.

OBJECTIVE: Pain, poor sleep quality, restless legs syndrome (RLS), and other symptoms are frequently reported by patients with Parkinson's disease (PD). However, the impact that pain severity and interference has on non-motor symptoms (NMS) has not been extensively studied. The objective of the present study is to explore the relationship between sleep quality in PD to pain and other NMS that affect quality of life. METHODS: The study included 100 PD patients and 100 age and gender-matched controls assessed for pain severity and pain interference using the Brief Pain Inventory and sleep quality using the Pittsburgh Sleep Quality Index. Participants were also evaluated for their subjective levels of anxiety and depression using the Hospital Anxiety and Depression Scale. RESULTS: PD patients with poor sleep quality had greater pain severity and pain interference than controls and PD patients with good or borderline sleep quality. PD patients with poor sleep quality also had the greatest case-ness and severity for depression and anxiety. However, RLS was not significantly correlated with depression, anxiety or pain. DISCUSSION: Poor sleep quality in PD patients is related to greater pain severity, pain interference, and more radiating and paresthestic pain that is independent of RLS. There is a higher prevalence of depression and anxiety in PD patients compared to controls, especially in PD patients with poor sleep quality. Our findings suggest a relationship between poor sleep quality in PD with pain, anxiety and depression. Prospective studies are warranted to investigate the causal relationship.

Disability from pain directly correlated with depression in Parkinson's disease.

OBJECTIVE: Parkinson's disease (PD) is a progressively debilitating disorder resulting in reduced quality of life (QoL). Along with the motor symptoms of PD, non-motor symptoms of PD such as pain, restless leg syndrome (RLS) depression also occur. These exacerbate the worsening QoL and must be promptly diagnosed and treated. The objective of this study was to determine the relationship between pain severity, walking, general activity and work (WAW) and rapid eye movements (REM) dimensions of pain interference, and disability with depression and RLS in PD. PATIENTS & METHODS: 120 patients with PD and 120 controls were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS-D). Pain severity and interference was measured using Brief Pain Inventory (BPI). REM and WAW dimensions of pain were also measured. The Pain Disability Index (PDI) was used to assess the disabling effects from chronic pain. RESULTS: The study found a statistically significant direct correlation between the BPI, PDI and PD. A significant direct correlation was also found for depression and pain in PD. No association as found between RLS and PD; RLS was not a confounding factor. CONCLUSIONS: Based on these findings, we conclude that pain interference, severity of pain and disability from pain is directly correlated with depression in PD. We also discern that these symptoms of PD are not independent of each other. We cannot establish a causal relationship between any of these variables. Prompt recognition and treatment of pain and depression is valuable in preserving the quality of life in PD.

Increased likelihood of anxiety and poor sleep quality in Parkinson's disease patients with pain.

BACKGROUND: Pain is a bothersome non-motor symptom in patients with Parkinson's disease (PD), but the relationships between PD, presence of pain, different pain characteristics, and other non-motor symptoms such as mood and sleep disturbances are unclear. OBJECTIVE: To investigate the relationship between PD and pain as well as specific subtypes of pain with anxiety, depression and sleep quality. METHODS: This cross-sectional case-control study included two groups of PD patients; one with (n=37) and one without pain (n=37). Healthy controls with (n=37) and without pain (n=37) were recruited and matched to the PD groups for age and gender. All participants completed questionnaires regarding pain, mood and sleep. RESULTS: PD patients with pain showed significantly higher anxiety severity and poorer sleep quality than PD patients without pain. Compared to controls with pain, PD patients with pain had more anxiety, depression and worsened sleep quality. PD patients with pain were more likely to report akathisic, tension and sharp pain compared to controls with pain, but these three pain characteristics did not correlate with each other. There were no differences in depression, anxiety, or sleep between PD patients with akathisic, tension and sharp pain and those without. CONCLUSION: Pain in PD seems to be linked with specific pain characteristics (akathisic, tension and sharp pain) as well as heightened anxiety and worsened sleep quality. Integrative approach treatments which address pain in PD may also improve anxiety and sleep quality.

Restless leg syndrome: a risk factor of higher prevalence of anxiety and depression in Parkinson's disease patients.

BACKGROUND: Many studies have assessed the relationship of depression and anxiety with Parkinson's disease (PD), as well as examining restless leg syndrome (RLS) with depression and anxiety. Nonetheless, there has not been an extensive effort to show how the prevalence of RLS affects both depression and anxiety in PD patients. The objective of this study was to examine how the prevalence of RLS in PD patients affects the prevalence and severity of depression and anxiety and how they compare with each other. This study is the first of its kind that examines the effects of the combination of the two neurological conditions with depression and anxiety as well as comparing their prevalence and severity to each other. METHODS: The study included 27 PD patients who also suffered from RLS, 27 PD patients not suffering from RLS, and 27 gender-matched healthy individuals. All were evaluated for caseness and severity of both anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); HADS-A and HADS-D, respectively. RESULTS: PD patients with RLS reported having the highest prevalence of both anxiety and depression. The least reported cases for both anxiety and depression were in the control group. In comparison, the results for severity of anxiety and depression within the three groups showed that PD patients with and without RLS had significantly higher severity scores for both anxiety and depression than the control group, but the scores did not significantly differ between the two PD patient groups. CONCLUSION: The presence of RLS in PD patients may increase the occurrence of both anxiety and depression, but the severity of the symptoms is not significant in the two groups of the PD patients.

Association of restless legs syndrome, pain, and mood disorders in Parkinson's disease.

PURPOSE/AIMS: The objectives of the study were to analyze the association between Parkinson's disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. METHODS: This study included 123 Parkinson's disease patients and 123 non-Parkinson's disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. RESULTS: Parkinson's disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinson's disease patients' comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinson's disease only, Parkinson's disease anxiety, and Parkinson's disease depression patients. CONCLUSIONS: Pain interference, pain severity, and pain disability is greater among Parkinson's disease patients with anxiety and depression, in comparison to Parkinson's disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

Ophthalmological Features of Machado-Joseph Disease.

Machado-Joseph disease (MJD) or spinocerebellar ataxia type-3 (SCA3) is a rare and progressive neurodegenerative disorder, as well as the most frequently inherited spinocerebellar ataxia. It has extensive polymorphic features, described through a spectrum of neurological, and especially, ophthalmological manifestations. Besides the deterioration of the oculomotor systems, degeneration predominantly involves the cerebellar, pyramidal, extra-pyramidal, and peripheral motor systems. Few patients express Parkinsonian features as well. Through two separate cases, we present the major differences seen in the two patients, but also display their underlying similarities in the context of MJD; specifically, the ophthalmological features. The shared features include nystagmus in the horizontal direction, orbicularis oculi contractions, and bilateral esotropia. The findings indicate the importance of the inherent ophthalmological features expressed in MJD.

Impact of ethnicity on mood disorders in Parkinson's disease.

Anxiety and depression are common in Parkinson's disease (PD) patients, yet their prevalence and severity compared to individuals without PD requires more research. Moreover, it has never been compared across different ethnic groups. The objective of this study was to close that gap in the literature by exploring the caseness and severity of anxiety and depression in PD patients of different ethnicities compared to controls without PD. It was found that caseness and severity of anxiety and depression are higher in individuals with PD compared to controls. Furthermore, the caseness and severity of anxiety and depression do not vary significantly among ethnic groups. Finally, depression caseness was not predicted by age, gender, disease duration, restless legs syndrome prevalence, Hoehn and Yahr (H&Y) score nor Unified Parkinson's disease rating scale part III (UPDRS-III) score. Anxiety caseness was predicted by gender, with females 2.7 times more likely to have anxiety caseness than males. Overall, our study suggests that treatment plans should be individualized based on prevalence and severity of the two conditions in individuals with PD rather than generalize treatment for specific ethnic groups.

Prevalence of essential tremor in an idiopathic Parkinson's disease patient population.

Essential tremor (ET) and Parkinson's disease (PD) tremor differ in type, frequency and distribution. Despite being two separate disorders, there have been cases reported of comorbidity for ET-PD. Studies have reported an increase in the incidence of ET in relatives of patients with PD, yet the risk of developing PD in ET patients has not been thoroughly investigated. Our study set out to determine the incidence of precedent ET in PD patients. We conducted a retrospective chart review analysis of 332 idiopathic PD patients to determine how many of them had ET prior to the diagnosis of PD and the percentage of them who were also diagnosed with ET. Our results indicate that the prevalence of precedent ET among a population of idiopathic PD patients was not any higher than the prevalence of ET in a comparable general population. Our results support the notion that ET and PD are mutually independent disorders. Further studies are needed to understand the exact relationship between these two disorders.

Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.

Giant cell arteritis (GCA) or Temporal arteritis (TA) is an autoimmune disease and the most common type of vasculitis in the elderly. It causes inflammation of the medium and large arteries in the upper part of the body. GCA is an under-recognized cause of  head aches in the elderly, especially when it presents itself with atypical features, resulting in delayed or incorrect diagnosis. Since GCA is a treatable condition, an accurate diagnosis is crucial to prevent the most serious complication of CGA, permanent vision loss. The diagnosis can be further complicated as GCA may present with features of other painful neurological conditions. The present case is an 81-year-old woman diagnosed with GCA, who initially presented with features similar to tension-type headache. Due to overlapping features of these conditions, the diagnosis of GCA was delayed, resulting in irreversible vision loss. Although previous research highlights diagnostic dilemmas featuring GCA and other disease states, this case is exclusive in describing a unique dilemma where tension-type headache mimics GCA.

Is action tremor in Parkinson's disease related to resting tremor?

OBJECTIVE: Action tremor (AT) and resting tremor (RT) have been widely cited in many studies with Parkinson's disease (PD) patients, but studies looking at the association between the two tremor types are few and show inconsistent results. This study will look at the prevalence and association of AT and RT in a large sample of idiopathic PD patients, and will put the results into context with the literature. METHODS: A retrospective chart review analysis of 332 patients with idiopathic PD was performed. Prevalence rates of particular tremor types were noted. The presence of AT was analyzed relative to the presence and severity of RT. RESULTS: Nearly all individuals with AT also had RT. The concurrence of the two tremor types was found to be highly significant by statistical analysis (P < 0.0001). The severity of RT, measured by its laterality, may also be of importance, albeit to a much smaller extent if at all. Neither presence of tremor nor type of tremor present was influenced by patient gender, age, or Hoehn and Yahr stage of PD. CONCLUSIONS: The results indicate that AT has extensive presence in PD. This and its seemingly close relationship to RT suggest that AT may be considered a variant of RT, particularly in PD patients. The degree of association between RT and AT needs to be further analyzed in PD, as well as in essential tremor (ET) and ET-PD.