[Swimming disorders in Parkinson's disease]. / Narusheniya navykov plavaniya pri bolezni Parkinsona.

OBJECTIVE: To evaluate swimming disorders in patients with Parkinson's disease (PD). MATERIAL AND METHODS: During the pilot study, we examined 40 patients with PD, who were divided into two groups depending on the presence or absence of swimming disorders. The assessment on the Hoehn-Yahr scale in both groups ranged from 1 to 3. The severity of PD was assessed according to the unified Parkinson's disease scale of the International Society of Movement Disorders (MDS-UPDRS). The Montreal Cognitive Assessment Scale, the Hospital Scale of Anxiety and Depression, a new questionnaire of freezing when walking, a 6-minute walk test, the Eysenck Personality Questionnaire were administered. RESULTS: Of 40 patients with PD, 60% reported swimming disorders. No association was found between swimming disorders and the severity of motor symptoms of PD. At the same time, an increased level of anxiety was noted in the group of patients with swimming disorders. CONCLUSION: Further research is needed to study the mechanisms of the development of swimming disorders in PD.

[Unusual failure of swimming skills in patients with Parkinson's disease]. / Neozhidannaya utrata navykov plavaniya u patsientov s bolezn'yu Parkinsona.

The results of individual observations and several studies confirm the frequent complaints of patients with Parkinson's disease (PD) about difficulty or inability to swim. Difficulties moving the limbs, coordination and maintaining the horizontal position during swimming appear to be the main problems that prevent normal swimming. Further studies are needed to assess the frequency of swimming disorders in PD and the mechanisms of their development. Patients with PD must be educated about the potential risk of drowning and the need to evaluate and carefully monitor their swimming skills before going into deep water.

[Sleep disorders in patients with cervical dystonia]. / Narusheniya sna u patsientov s tservikal'noi distoniei.

AIM: To clarify the structure of sleep disorders in cervical dystonia and assess their relationship with anxiety and depressive disorders, as well as the impact on quality of life. MATERIAL AND METHODS: Twenty-five patients diagnosed with cervical dystonia (CD) were examined using neurological and psychometric methods (HADS, HAM-D, TAS, SCID-II, SF-36, PSQI). Polysomnographic study was performed using a Somnolab 2 system (Weinmann, Germany). RESULTS: Nineteen patients (76%) from the total sample showed increases in anxiety and depression. Sleep disorders were detected in all patients diagnosed with anxiety and depressive disorders. According to questionnaires, anxiety, depression, and sleep disturbances were significantly correlated with patients' quality of life. The most common sleep disorders were intrasomic disorders (waking up during sleep) (n=19; 76%), less common were presomnic (n=8; 32%) and postsomnic (n=11; 44%). Motor symptoms caused sleep disturbances only in 10 patients (40%). The specific features of sleep disorders in patients with CD detected by polysomnography are a decrease in the representation of delta-sleep, along with an increase in the phase of REM sleep, compared to physiological normal values. CONCLUSIONS: Sleep disturbances (mainly frequent waking during sleep) are widely represented in patients with cervical dystonia, are comorbid to anxiety and depressive disorders and significantly correlate with the poorer quality of life.

[An analysis of causes of death in patients with Parkinson's disease]. / Analiz prichin smerti u bol'nykh bolezn'iu Parkinsona.

AIM: To determine population mortality rate and reasons of death in Parkinson's disease (PD). MATERIAL AND METHODS: To analyze reasons of death, medical death certificates and postmortem records as well as official results of the Federal state statistics service were used. According to the register of Parkinson's disease (PD) patients during 2009-2012, the total mortality was 9.9%. The average age of patients died from the disease was 74.3 ± 2.4 years. The main reasons of death were PD (36.2%), circulatory illnesses (27.6%), respiratory diseases (12.1%), malignant neoplastic diseases (12.1%), other reasons (12.0%). Direct reasons of death in patients with PD were the complications of underlying disease in connection with the development of immobility and comorbidities. Timely correction of complications and comorbidities is a main strategy to extend life expectancy in patients with PD.

[Sleep disorders in the early stage of Parkinson's disease in untreated patients]. / Narusheniya sna na rannei stadii bolezni Parkinsona u patsientov, ne prinimayushchikh protivoparkinsonicheskie preparaty.

Disorders of sleep and wakefulness occur in about 60-98% of patients with Parkinson's disease (PD). The majority of research on the scale and nature of the disorders was performed in patients treated with antiparkinsonian drugs, and, therefore, the true picture of sleep disorders was interfering with side effects of therapy. The spectrum of these disorders in PD patients is broad and includes insomnia, parasomnia and hypersomnia. The main symptoms of insomnia are difficulty in maintaining sleep, associated with nocturia, rapid eye movement (REM) sleep behavior disorder (RBD), night cramps, akinesia and tremor. The frequency of hypersomnia in PD patients not receiving antiparkinsonian drugs was comparable to that in healthy people. In some studies, hypersomnia is considered as an independent phenomenon of PD, and not associated with the quality of night's sleep or concomitant therapy. Parasomnias in PD patients at the early stage are manifested primarily by REM-sleep behavior disorder (RBD), which has been proven to be a predictor of development of PD. According to our data, insomnia, hypersomnia and RBD were identified in patients who did not receive antiparkinsonian drugs. The polysomnographic study showed the development of RBD in 25% of patients. In the analysis of the anamnesis, it was noted that in 8 cases sleep disorders appeared several years before the first motor symptoms.

[Clinical evaluation of Parkinson's disease progression]. / Klinicheskaia otsenka progressirovaniia bolezni Parkinsona.

Objective. We conducted a prospective study on the dynamics of clinical progression of motor and non-motor impairments in PD from 2009 to 2012. Material and methods. We examined 136 patients with Parkinson's disease, 77 men and 59 women, mean age 63.2±10.4 years, disease duration 7.5±3.8 years, including 50 (36.8%) patients at the mild stage of disease, 67 (49.3%) patients at the moderate stage and 19 (13.9%) patients at the advanced stage. Evaluation of progression was carried out annually using part III UPDRS: an annual increase of 9 scores or more indicated the fast progression; from 5 to 8 scores - moderate progression; up to 4 scores - slow progression. Results. Eighty-five patients (62.5%) had slow progression, 39 patients (27.1%) had moderate progression and 12 patients (10.4%) had fast progression. Conclusion. Older age, severity of axial movement disorders, cognitive impairment and motor fluctuations, orthostatic hypotension and psychotic disorders (hallucinations) predicted the fast progression.

[Methods of rehabilitation in Parkinson's disease]. / Metody reabilitatsii pri bolezni Parkinsona.

The review of literature addresses the problems of rehabilitation in Parkinson's disease (PD). In the last decade, evidence of effectiveness of training balance and gait for increasing mobility and activities of daily living in PD patients has been demonstrated. In addition, the data on the possible impact of the training on launching and strengthening of mechanisms of neuroprotection and neuroplasticity in PD has been proved. All this facts indicate the importance of rehabilitation in PD in the early stage of the disease. However, despite a large number of studies, there are many open questions in the choice of a rehabilitation program with the use of different methodology, duration and frequency of training, performance assessment. Follow-up studies are warranted to develop common practical guidelines for the rehabilitation of patients with PD.

[Characteristics of cognitive and behavioral disturbances in patients with semantic dementia with a prevalent atrophy of the right- or left hemisphere].

Semantic dementia (SD) is one of the main clinical forms of frontotemporal degeneration. The authors describe clinical and neuropsychological characteristics of two patients with SD with the atrophy of frontal regions of temporal lobes of the right and left hemispheres. The disturbance of the semantic structure of speech caused by the lesion of the left hemisphere and the prevalence of prosopagnosia and behavioral disturbances related to the atrophy of the right hemisphere have been identified.

Efficacy and safety of memantine in Lewy body dementia.

Lewy body dementia (LBD) is a progressive brain disease manifest as dementia and parkinsonism, along with psychotic and autonomic disorders. Although studies in recent years have demonstrated the positive effects of cholinesterase inhibitors in LBD, the search for therapeutic agents with other mechanisms of action remains relevant. An open, controlled, 16-week study was performed with the aim of evaluating the efficacy and safety of memantine in patients with clinically diagnosed LBD (criteria of McKeith et al., 1999). The study included 23 patients (mean age 69.2 +/- 5.9 years), who were divided into two groups: 14 patients received memantine at a dose of 20 mg/day and nine patients constituted the control group. Efficacy was evaluated using a battery of quantitative neurospychological tests, clinical scales for assessment of fluctuations in mental states, scales for assessment of behavioral and psychotic disorders, and the general clinical impression scale. The results demonstrated that memantine had positive effects on the patients' general status and cognitive functions (increases on the mini mental state examination by 1.5 points), mainly because of improvements in attention and control functions. There were also reductions in the severity of fluctuations in mental state, aggressivity, lack of spontaneity, and disinhibition. The severity of psychotic and motor disorders did not change significantly. Tolerance of the agent was good, only two patients withdrawing from the study because of episodes of confusion during the dose titration period.

[The clinical-pharmacoeconomic study of efficacy of stalevo in the treatment of Parkinson's disease with motor fluctuations].

An open randomized study of pharmacoeconomic efficacy of stalevo in patients with Parkinson's disease with motor fluctuations was conducted. The results of the study revealed that the drug substantially reduced motor deficit, increased the "on"-period, decreased the duration and severity of the "off" period, improved the daily activity and quality of life of patients compared to standard therapy with an additional dosage of levodopa/DDC inhibitor. Despite the increase in cost, the use of stalevo in the treatment of Parkinson's disease with motor fluctuations is cost-effective in long-term (already after two years) management of patients.

[Efficacy and safety of memantine in dementia with Lewy bodies].

Dementia with Lewy bodies (DLB) is a progressive disease of the nervous system manifested with dementia, parkinsonism, psychotic and autonomic disturbances. To estimate efficacy and safety of memantine in patients with clinically diagnosed DLB (according to criteria of McKeith et al., 1999), an open controlled 16-week trial was carried out in 23 patients, mean age 69,2+/-5,9 years. Patients were divided into 2 groups: 14 patients who received memantine in dosage 20 mg/d and 9 patients of a control group. A battery of neuropsychological tests, clinical assessment using fluctuation scales, scales for assessment of behavioral and psychotic disturbances, the General Clinical Impression scale were used. Memantine significantly improved cognitive dysfunction throughout the study (the mean MMSE scorer were increased by 1,5 points compared to the baseline) especially due to the improvement of attention and executive functions. The reduction of fluctuations of mental status, aggressiveness, aspontaneity, disinhibition was also observed. There were no significant changes of Parkinsonian and psychotic symptoms severity. Good tolerability of memantine is noted: only 2 patients were withdrawn from the study because of episodes of confusion on the titration phase of the trial.

[Stalevo (levodopa/carbidopa/entacapon)--a new generation drug in the treatment of Parkinson's disease].

Based on literature data on the usage of Dopa medications in the treatment of Parkinson's disease (PD), a characteristic of a new complex drug stalevo, which includes levodopa, carbidopa and entacapon (catechol-O-methyltransferase inhibitor), is presented. The authors studied 15 patients with PD, aged 55.6+/-8.7 years, illness duration 7.7+/-3.1 years, who received stalevo during 6 weeks and revealed that stalevo reduced significantly the intensity of main PD symptoms, especially hypotension and rigidity as well as motor fluctuations, and improved general movement and daily activity of patients thus ameliorating their quality of life. The drug is well-tolerable.

[Comparative study of Parkinson's disease and dementia with Lewy bodies]. / Sravnitel'noe issledovanie bolezni Parkinsona i dementsii s tel'tsami Lewy.

Comparative investigation of motor and neuropsychological functions was conducted in 17 patients with clinically established diagnosis of dementia with Lewy bodies (DLB), 21 patients with Parkinson's disease (PD) without dementia and 26 patients with dementia (PDD). No significant differences were found in overall severity of parkinsonian features. However, comparing to PD, patients with DLB rarely had resting tremor, bilateral parkinsonism onset and good response to levadopa medication but more frequently exhibited gaze up palsy and myoclonus. Patients with PDD had more prominent akinesia, rigidity and axial disturbances, as compared to the PD patients without dementia, but there were no significant differences in these variables between patients with DLB and PDD. Comparing to PDD patients, those with DLB poorly performed on the tests measuring attention, verbal fluency and visual-spatial functions. Behavioral disturbances (especially apathy, aspontaneity, euphoria, obsessive-compulsive syndrome, dysinhibition, environment dependence) were severer in the patients with DLB and PDD, but no significant differences were found between these two groups. All the patients with DLB, 14 patients with PDD (53.8%) and 2 patients without dementia (7.4%) had psychotic disorders, which emerged later and were less pronounced in the patients with DLB compared to PDD patients. However, no significant differences were found in motor and neuropsychological impairment between DLB and PDD with psychotic disorders. The results may indicate a typological similarity of clinical manifestations of DLB and PDD that suggest nosologic proximity of these conditions included to synucleinopathies group.

[Clinical and electromyographical analysis of peculiarities of parkinsonian syndrome in multiple system atrophy and Parkinson's disease]. / Kliniko-élektromiograficheskii analiz osobennostei parkinsonicheskogo sindroma pri mul'tisistemnoi atrofii i bolezni Parkinsona.

Because differential diagnosis between Parkinson's disease (PD) and multiple system atrophy (MSA) may be difficult due to overlapping of clinical features, especially at the early stage of the diseases, a search for additional clinical and instrumental markers increasing reliability of etiological diagnosis appears actual. The article presents the results of comprehensive comparison of parkinsonian signs and spectral electromyography (sEMG) data in 18 patients with MSA, diagnosed clinically according to criteria of Gilman et al (1998), and in 21 PD patients. Though no between-group differences in total expression of parkinsonian signs evaluated with The Unified Parkinson's Disease Rating Scale, part III, were found, MSA patients demonstrated progressive motor deficits, severer hypokinesia in the distal regions of the extremities, more pronounced impairment of axial movements, postural instability and gait disturbances but milder resting tremor, as compared to the PD patients (p < 0.05). Besides, the MSA patients were more frequently resistant to levodopa and had axial drug-induced dyskinesia (p < 0.05). An analysis of sEMG data revealed that MSA patients had a more prominent peak in 10-17 Hz frequency band (for arm muscles) and in Hz 7-14 (for leg muscles) as well as higher amplitudes peak frequencies (p < 0.05) positively correlated to hypokinesia severity. The results may be useful for differential diagnosis between PD and MSA.