ABSTRACT
BACKGROUND: The postural tachycardia syndrome (POTS) is a condition of the autonomic nervous system with symptoms of orthostatic intolerance. In POTS patients, orthostatic stress leads to an overshoot of heart rate increase without a fall in blood pressure. The purpose of this study is to distinguish between anxiety disorders and anxiety as a concomitant phenomenon of orthostatic stress. METHODS: 50 patients fulfilling the diagnostic criteria (orthostatic symptoms, heart rate increase of > 30 bpm or up to > 120 bpm by testing with tilt-table) were included. The study design included a thorough medical history as well as standardised questionnaires about anxiety. RESULTS: The average heart rate increase was 36 bpm after ten minutes of standing and 42 bpm after maximal standing time (max. 45 minutes). POTS patients scored significantly higher than a comparison group in a range of anxiety disorders by using anxiety questionnaires like "Beck Angst-Inventar" (BAI) and trait test of "State-Traits-Angstinventar" which include autonomic items. When questionnaires were used that exclude autonomic items (anxiety sensitivity index: ASI; Interaktions-Angst-Fragebogen: IAF) there was no difference. CONCLUSION: POTS patients do not exhibit signals of anxiety disorders more often than control groups, provided that questionnaires without autonomic items are used.
Subject(s)
Anxiety/psychology , Postural Orthostatic Tachycardia Syndrome/psychology , Adolescent , Adult , Aged , Anxiety/etiology , Blood Pressure/physiology , Child , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Neuropsychological Tests , Panic , Postural Orthostatic Tachycardia Syndrome/complications , Posture/physiology , Surveys and Questionnaires , Tachycardia/physiopathologyABSTRACT
In addition to the motor symptoms of Morbus Parkinson, a number of cognitive and emotional changes take place. The diagnosis of these concomitant symptoms has received increasing attention in research and clinical practice. Global rating scales offer economical advantages but generally do not satisfy the requirements of psychometric criteria, and they do not suffice in light of the multidimensional symptoms of the disease. Based on recent research results, recommendations from the CAPSIT protocol (Core Assessment Program for Surgical Interventional Therapies) for diagnosis of neurosurgically treated Parkinson's patients, and the restraints of everyday clinical work, we propose a standardized neuropsychological diagnostic routine. It includes diagnostic methods that are in use internationally and so timesaving and easily accessible that they can be considered suitable for routine diagnostics. Data comparison among various treatment centers can thus take place more easily. We have included only methods that differentiate well and whose test criteria offer a basis for thorough consultation as well as planning and evaluation of multidimensional therapy.
Subject(s)
Dementia/diagnosis , Neuropsychological Tests , Parkinson Disease/diagnosis , Dementia/psychology , Humans , Parkinson Disease/psychology , Quality of LifeABSTRACT
Some 114 patients with idiopathic Parkinson's disease (not demented, no tremor dominance; mean age: 67.0 years; mean duration of illness: 6.1 years) were subjected to the manual dexterity test "MLS" ("Motorische Leistungs Serie"). A retest was carried out 24 h later with no change in medication. Thus, adequate conditions were present for testing the stability of dimensions of manual dexterity. In addition, data from the initial measurement were normalized (T norms). The correlations of the values from both measurements (retest reliability) underscore the constancy of manual dexterity functions. Subtest show adequate stability of measurement so that they can be used for diagnosing dexterity disturbances in individual patients. Charts listing normal values and critical differences allow intra- and interindividual comparisons. It is thus possible to make statistically sound predictions for individual patients concerning the effectiveness of therapy or progression of illness with respect to manual dexterity. In addition, differences on the left and right sides can be tested for statistic significance.
Subject(s)
Motor Skills/physiology , Neurologic Examination , Parkinson Disease/diagnosis , Aged , Female , Functional Laterality/physiology , Humans , Male , Middle Aged , Parkinson Disease/physiopathology , Psychomotor Performance/physiology , Reaction Time/physiology , Reference Values , Sensitivity and Specificity , Serial Learning/physiologyABSTRACT
"Freezing" is a sudden, unforeseen state of immobility occurring independently of L-Dopa dosage timing and often presents in connection with walking, speech and hand movements. The immobility results from deficits in initiating or simultaneously and sequentially executing movements, in correcting inappropriate movements or planning movements. However, since the progression of motor activity is strongly dependent upon external stimuli, the patient can overcome the freezing phenomena with the aid of certain stimuli or subjective strategies. No consistent relationships have been found with respect to age, length of illness, L-dopa dosis or L-dopa treatment. Neurotransmitter models to explain the freezing phenomena are: a noradrenalin deficiency in locus coeruleus or alternately a dopamine deficiency in substantia nigra, pars compacta, which can possibly be coupled with a GABA deficiency in substantia nigra, pars reticulata. In addition to optimal drug therapy, patients require physiotherapeutical and ergotherapeutical assistance to develop subjectively effective strategies in counteracting freezing during everyday activities.
Subject(s)
Hypokinesia/diagnosis , Parkinson Disease/diagnosis , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Combined Modality Therapy , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Hypokinesia/physiopathology , Hypokinesia/rehabilitation , Levodopa/administration & dosage , Levodopa/adverse effects , Locus Coeruleus/physiopathology , Neurotransmitter Agents/physiology , Parkinson Disease/physiopathology , Parkinson Disease/rehabilitation , Physical Therapy Modalities , Substantia Nigra/physiopathologyABSTRACT
Disturbances in memory belong to the most frequent cognitive impairments in Parkinson patients. This review treats problematical aspects in the clinical diagnosis of these memory disturbances, which are particularly evident in free recall, immediate reproduction, the chronological sequencing of events and the initiation of meaningful strategies. These selective impairments are discussed within a theoretical frame of reference. Finally, considering the time demands and work loading in contemporary psychological practice, recommendations are given for economical and multidimensional routine diagnostic testing.