Magnetic resonance-guided focused ultrasound ventral intermediate thalamotomy for Tremor-Dominant Parkinson's disease: a systematic review and meta-analysis.

INTRODUCTION: Tremor-dominant Parkinson's Disease (TDPD) has a slower neurological decline compared to other phenotypes of the disease, but significantly impacts daily activities and is often less responsive to standard medications. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) lesioning of the Ventral Intermediate (VIM) nucleus of the thalamus may alleviate symptoms for these patients. METHODS: A systematic review and meta-analysis of English-language studies from PubMed, Cochrane, and Embase were conducted, assessing the efficacy and safety of MRgFUS VIM thalamotomy in TDPD patients. Tremor scores were evaluated using the Clinical Scale Rating for Tremor and the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRSIII). Neuropsychological outcomes were measured using the Parkinson Disease Questionnaire (PDQ) and the Montreal Cognitive Assessment. This analysis adhered to Cochrane and PRISMA guidelines. RESULTS: Thirteen studies with 211 patients were included. MDS-UPDRSIII scores showed significant improvement at 1, 6, and 12 months post-MRgFUS, respectively: (MD -8.92 points, 95% CI: -15.44 to -2.40, p < 0.01; MD -7.39 points, 95% CI: -11.47 to -3.30, p < 0.01; MD -10.66 points, 95% CI: -16.89 to -4.43, p < 0.01). PDQ scores at baseline compared to 6 months post-treatment also indicated a significant improvement (SMD - 0.86, 95% CI: -1.21 to -0.50, p < 0.01). Neurological adverse events were generally mild and transient, with gait instability and sensory deficits being the most common. CONCLUSION: This meta-analysis demonstrates significant improvements in tremor and neuropsychological outcomes following MRgFUS VIM thalamotomy in TDPD patients, with adverse events being typically mild and transient.

Association between cognitive performance and manual dexterity in patients with Parkinson's disease.

INTRODUCTION: Parkinson's disease (PD) is a progressive neurological condition resulting from the degeneration of dopaminergic neurons in the substantia nigra. Impaired manual dexterity and cognitive impairment are common symptoms and are often associated with recurrent adverse events in this population. OBJECTIVE: To verify the association between cognitive performance and manual dexterity in people with PD. METHODS: This is a cross-sectional observational study, with 29 participants, who underwent cognitive and manual dexterity assessments, and the following tools were used: Trail Making Test, box and block test (BBT), Learning Test of Rey and Nine Hole Peg Test. Descriptive statistics for clinical and demographic data were performed using mean and standard deviation, and data normality was assessed using the Shapiro-Wilk test. Spearman's nonparametric test was used to determine the correlation between variables. RESULTS: Our findings revealed significant associations between cognitive performance and manual dexterity. The nine-hole peg test positively correlated with TMT-Part A and Part B, establishing a relationship between manual dexterity and cognitive functions such as attention and mental flexibility. On the other hand, BBT showed an inverse relationship with TMT-Part B, indicating that longer time on this task was associated with lower manual dexterity. CONCLUSION: Fine manual dexterity had a significant correlation with visual search skills and motor speed, while gross motor dexterity had a negative correlation with cognitive skills. No significant results were demonstrated regarding the interaction between manual dexterity and memory.

Efficacy of subthalamic deep brain stimulation programming strategies for gait disorders in Parkinson's disease: a systematic review and meta-analysis.

Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.

[Vowel articulation and intelligibility of speech in Spanish speakers with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus]. / Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.

INTRODUCTION: Parkinson's disease (PD) can affect the intelligibility of speech. Although studies of vowel production are useful for measuring this impairment, they do not exist in Spanish speakers with the disease who have been treated with subthalamic nucleus deep brain stimulation (STN-DBS). STN-DBS is an effective treatment for the classic signs of PD, but with varied effects on speech. PATIENTS AND METHODS: Data from two individuals with PD treated with STN-DBS were studied: one (P1) had impairment and the other (P2) had stable speech intelligibility after STN-DBS implantation. The triangular vowel space area (tVSA) and the vowel articulation index (VAI) were measured and compared before the implantation surgery, and at three, six and nine months after surgery. These measurements were compared with measurements of speech intelligibility (percentage of words correctly identified and degree of intelligibility). RESULTS: Both participants presented variations in measurements of vowel articulation after surgery. In P1, the reduction in the tVSA, but not the post-surgical change in the VAI, was consistent with reduced speech intelligibility. However, in P2, both measurements (tVSA and VAI) reflected stable speech intelligibility after surgery. CONCLUSIONS: Reduced speech intelligibility in Spanish speakers with PD after STN-DBS implantation may be reflected in a reduced tVSA.

TITLE: Articulación de las vocales e inteligibilidad del habla en hispanohablantes con enfermedad de Parkinson tratados con estimulación cerebral profunda del núcleo subtalámico.Introducción. La enfermedad de Parkinson (EP) puede alterar la inteligibilidad del habla. Aunque los estudios de la producción de las vocales son útiles para medir esta afectación, no existen en hispanohablantes con la enfermedad que hayan sido tratados con estimulación cerebral profunda del núcleo subtalámico (STN-DBS). La STN-DBS es un tratamiento efectivo para los signos clásicos de la EP, pero con variados efectos en el habla. Pacientes y métodos. Se estudiaron los datos de dos personas con EP tratadas con STN-DBS: uno (P1) con deterioro y el otro (P2) con estabilidad de la inteligibilidad del habla después de la implantación de la STN-DBS. Se calcularon y compararon medidas de espacio vocálico acústico triangular (tVSA) e índice de articulación de las vocales (VAI) antes de la cirugía de implantación y a los tres, seis y nueve meses de la intervención. Estas medidas se contrastaron con medidas de inteligibilidad del habla (porcentaje de palabras correctamente identificadas y grado de inteligibilidad). Resultados. Ambos participantes mostraron variación de las medidas de articulación de las vocales después de la cirugía. En P1, la reducción del tVSA, pero no el cambio posquirúrgico del VAI, correspondió con disminución de la inteligibilidad del habla. Por el contrario, en P2, el comportamiento de ambas medidas (tVSA y VAI) reflejó la estabilidad de la inteligibilidad del habla después de la cirugía. Conclusiones. La reducción de la inteligibilidad del habla en hispanohablantes con EP después de la implantación de la STN-DBS puede reflejarse en la reducción del tVSA.

Relationship between oral status, swallowing function, and nutritional risk in older people with and without Parkinson's disease. / Relação entre estado oral, função de deglutição e risco nutricional entre idosos com e sem doença de Parkinson.

PURPOSE: To compare oral status, swallowing function (through instrumental and SLH assessment), and nutritional risk between dysphagic individuals with and without Parkinson's disease. METHOD: This is a cross-sectional retrospective study based on data collected from medical records. It included 54 dysphagic older adults, divided into two groups according to the diagnosis of Parkinson's disease. The study collected data on the speech-language-hearing assessment of postural control, tongue mobility and strength, maximum phonation time (MPT), and cough efficiency. Oral status was assessed using the number of teeth and the Eichner Index. The level of oral intake and pharyngeal signs of dysphagia were analyzed with four food consistencies, according to the International Dysphagia Diet Standardization Initiative classification, using fiberoptic endoscopic evaluation of swallowing, for comparison between groups. The severity of pharyngeal residues was analyzed and classified with the Yale Pharyngeal Residue Severity Rating Scale, and the nutritional risk was screened with the Malnutrition Screening Tool. RESULTS: The group of older adults with Parkinson's disease was significantly different from the other group in that they had fewer teeth, unstable postural control, reduced tongue strength, reduced MPT, weak spontaneous coughing, pharyngeal signs, less oral intake, and nutritional risk. CONCLUSION: Dysphagic older people with Parkinson's disease had different oral status, swallowing function, and nutritional risk from those without the diagnosis.

OBJETIVO: Comparar o estado oral, a função de deglutição por meio da avaliação instrumental, fonoaudiológica e do risco nutricional entre indivíduos disfágicos com e sem doença de Parkinson. MÉTODO: Trata-se de um estudo transversal e retrospectivo com base na coleta de dados dos prontuários. Foram incluídos 54 idosos disfágicos divididos em dois grupos, de acordo com a presença do diagnóstico de doença de Parkinson. Foram coletados dados com relação à avaliação fonoaudiológica de controle postural, mobilidade e força de língua, Tempo Máximo de Fonação (TMF) e eficiência da tosse. O estado oral foi avaliado por meio do número de dentes e o Índice de Eichner. Foram analisados o nível de ingestão oral e os sinais faríngeos de disfagia em quatro consistências alimentares, de acordo com a classificação International Dysphagia Diet Standardisation Initiative (IDDSI), por meio da videoendoscopia da deglutição, para comparação entre os grupos. Para análise e classificação da gravidade dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), enquanto que, para rastrear o risco nutricional foi utilizado o Malnutrition Screening Tool (MST). RESULTADOS: O grupo de idosos com doença de Parkinson apresentou diferença significativa em menor número de dentes, controle postural instável, força de língua reduzida, TMF reduzido, tosse espontânea fraca, sinais faríngeos, nível de ingestão oral menor e em risco nutricional, em comparação ao outro grupo. CONCLUSÃO: Os idosos disfágicos com doença de Parkinson apresentaram diferenças no estado oral, na função de deglutição e no risco nutricional em comparação àqueles sem o diagnóstico.

[Relationship between severity of hypomimia and basic emotion recognition in Parkinson's disease]. / Relación entre la gravedad de la hipomimia y el reconocimiento de emociones básicas en la enfermedad de Parkinson.

INTRODUCTION: Parkinson's disease is characterised by the presence of motor symptoms including hypomimia, and by non-motor symptoms including alterations in facial recognition of basic emotions. Few studies have investigated this alteration and its relationship to the severity of hypomimia. OBJECTIVE: The objective is to study the relationship between hypomimia and the facial recognition of basic emotions in subjects with Parkinson's disease. SUBJECTS AND METHODS: Twenty-three patients and 29 controls were evaluated with the test battery for basic emotion facial recognition. The patients were divided into two subgroups according to the intensity of their hypomimia. RESULTS: The comparison in battery test performance between the minimal/mild hypomimia and moderate/severe hypomimia groups was statistically significant in favour of the former group. CONCLUSIONS: This finding shows a close relationship between expression and facial recognition of emotions, which could be explained through the mechanism of motor simulation.

TITLE: Relación entre la gravedad de la hipomimia y el reconocimiento de emociones básicas en la enfermedad de Parkinson.Introducción. La enfermedad de Parkinson se caracteriza por la presencia de síntomas motores, entre los que es significativa la presencia de hipomimia, y por síntomas no motores, en los que se destaca la alteración en el reconocimiento facial de emociones básicas. Son pocos los estudios que investiguen dicha alteración relacionada con la gravedad de la hipomimia. Objetivo. El objetivo es estudiar la relación entre la hipomimia y el reconocimiento facial de emociones básicas en sujetos con enfermedad de Parkinson. Sujetos y métodos. Se evaluó a 23 pacientes y 29 controles con la batería de reconocimiento facial de emociones básicas. El grupo de pacientes se dividió en dos subgrupos según la intensidad de la hipomimia. Resultados. La comparación en el rendimiento de las pruebas de la batería entre el grupo de hipomimia mínima/leve e hipomimia moderada/grave resultó estadísticamente significativa a favor del primer grupo. Conclusiones. Este hallazgo evidencia una estrecha relación entre la expresión y el reconocimiento facial de emociones, que podría explicarse a través del mecanismo de simulación motora.

Posterior insula repetitive transcranial magnetic stimulation for chronic pain in patients with Parkinson disease - pain type matters: A double-blinded randomized sham-controlled trial.

OBJECTIVES: Altered somatosensory processing in the posterior insula may play a role in chronic pain development and contribute to Parkinson disease (PD)-related pain. Posterior-superior insula (PSI) repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have analgesic effects among patients with some chronic pain conditions. This study aimed at assessing the efficacy of PSI-rTMS for treating PD-related pain. METHODS: This was a double-blinded, randomized, sham-controlled, parallel-arm trial (NCT03504748). People with PD (PwP)-related chronic pain underwent five daily PSI-rTMS sessions for a week, followed by once weekly maintenance stimulations for seven weeks. rTMS was delivered at 10 Hz and 80% of the resting motor threshold. The primary outcome was a ≥ 30% pain intensity reduction at 8 weeks compared to baseline. Functionality, mood, cognitive, motor status, and somatosensory thresholds were also assessed. RESULTS: Twenty-five patients were enrolled. Mean age was 55.2 ± 9.5 years-old, and 56% were female. Nociceptive pain accounted for 60%, and neuropathic and nociplastic for 20% each. No significant difference was found for 30% pain reduction response rates between active (42.7%) and sham groups (14.6%, p = 0.26). Secondary clinical outcomes and sensory thresholds also did not differ significantly. In a post hoc analysis, PwP with nociceptive pain sub-type experienced more pain relief after active (85.7%) compared to sham PSI-rTMS (25%, p = 0.032). CONCLUSION: Our preliminary results suggest that different types of PD-related pain may respond differently to treatment, and therefore people with PD may benefit from having PD-related pain well characterized in research trials and in clinical practice.

Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review.

OBJECTIVE: To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease. METHODS: Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library. RESULTS: Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases. CONCLUSION: More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.

Performance of a cost-effective olfactory test to evaluate hyposmia in Parkinson's disease patients.

BACKGROUND: Parkinson's disease (PD) causes motor and non-motor symptoms such as hyposmia, which is evaluated through olfactory tests in the clinical practice. OBJECTIVE: To assess the feasibility of using the modified Connecticut Chemosensory Clinical Research Center (mCCCRC) olfactory test and to compare its performance with the Sniffin' Sticks-12 (SS-12, Burghart Messtechnik GmbH, Wedel, Germany) test. METHODS: A transversal case-control study in which the patients were divided into the PD group (PDG) and the control group (CG). The cost and difficulty in handling substances to produce the mCCCRC test kits were evaluated. Sociodemographic characteristics, smoking habits, past coronavirus disease 2019 (COVID-19) infections, self-perception of odor sense, and cognition through the Montreal Cognitive Assessment (MoCA) were also evaluated. The PDG was scored by part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and the Hoehn and Yahr Scale (H&Y) scale. Correlations were assessed through the Spearman rank correlation coefficient test (ρ, or rho). RESULTS: The mCCCRC test was easily manufactured and handled at a cost ten times lower compared with the SS-12. The groups (PDG: n = 34; CG: n = 38) were similar in terms of age, sex, level of schooling, smoking habits, and history of COVID-19. The tests results showed moderate correlation (rho = 0.65; p < 0.0001). The CG presented better cognitive performance and scored better in both tests (p < 0.0001). There was a tendency for a negative correlation with age, but good correlation with the MoCA (p = 0.0029). The results of the PDG group showed no correlation with olfactory results and motor performance or disease duration. The self-perception of hyposmia was low in both groups. CONCLUSION: The mCCCRC is an easy-to-apply and inexpensive method that demonstrated a similar performance to that of the SS-12 in evaluating olfaction in PD patients and healthy controls.

ANTECEDENTES: A doença de Parkinson (DP) cursa com sintomas motores e não motores como a hiposmia, que é avaliada por diferentes testes olfativos na prática clínica. OBJETIVO: Avaliar a viabilidade do teste olfatório Connecticut Chemosensory Clinical Research Center modificado (mCCCRC) e compará-la à do teste Sniffin' Sticks-12 (SS-12, Burghart Messtechnik GmbH, Wedel, Alemanha). MéTODOS: Estudo transversal de caso-controle em que os pacientes foram divididos no grupo DP (GDP) e no grupo controle (GC). O custo e as dificuldades no manuseio das substâncias necessárias para a produção dos kits do teste mCCCRC foram avaliados. Características sociodemográficas, tabagismo, histórico de infecção por doença do coronavírus 2019 (coronavírus disease 2019, COVID-19, em inglês), autopercepção do olfato e cognição pelo Montreal Cognitive Assessment (MoCA) também foram avaliados. O GDP foi avaliado pela parte III da Unified Parkinson's Disease Rating Scale (UPDRS-III) e pela escala de Hoehn and Yahr (H&Y). As correlações utilizaram o teste do coeficiente de correlação de postos de Spearman (ρ, ou rho). RESULTADOS: O mCCCRC foi facilmente poroduzido e manipulado com custo dez vezes inferior ao do SS-12. Os grupos (GDP: n = 34; GC: n = 38) eram similares em termos de idade, sexo, escolaridade, tabagismo e histórico de COVID-19. Os resultados obtidos em ambos os testes mostraram excelente correlação (rho = 0.65; p < 0.0001). O GC teve um desempenho cognitivo melhor e pontuou melhor nos dois testes (p < 0.0001). Houve uma tendência a uma correlação negativa com a idade, mas boa correlação com a pontuação no MoCA (p = 0.0029). Os resultados olfativos do GDP não mostraram correlação com desempenho motor ou duração da doença. A autopercepção de hiposmia foi baixa em ambos os grupos. CONCLUSãO: O mCCCRC é um teste de fácil aplicação, baixo custo, e apresentou um desempenho semelhante ao do SS-12 na avaliação olfativa de pacientes com DP e controles saudáveis.

Osteoporosis in Parkinson's disease and the role of lean body mass: a cross-sectional study in a Brazilian tertiary center.

Background: Parkinson's disease (PD) is the second most common neurodegenerative illness and has the highest increase rate in recent years. There is growing evidence to suggest that PD is linked to higher osteoporosis rates and risk of fractures. Objective: This study aims to estimate the prevalence and factors associated with osteoporosis as defined by the National Osteoporosis Foundation (NOF) and World Health Organization in patients with mild to moderate PD. Methods: We performed a cross-sectional study at a tertiary public hospital in Fortaleza, Brazil, dating from May 2021 until April 2022. The study sample was comprised of patients with mild to moderate PD who were at least 40 years old and who had the ability to walk and stand unassisted. Bone Mineral Density (BMD) of both the hip (neck of the femur) and the lumbar spine were obtained via properly calibrated Dual Energy X-ray Absorptiometry (DXA) scanning. The FRAX (Fracture Risk Assessment Tool) score was used to determine a person's 10-year risk of major osteoporotic fracture. The Revised European Working Group on Sarcopenia in Older People (EWGSOP 2) was used as a basis to confirm a sarcopenia diagnosis with the following parameters: low muscle strength gauged by handgrip strength and low muscle quantity by DXA. Physical performance was carefully evaluated by using the Short Physical Performance Battery test. Osteoporosis and osteopenia were diagnosed following the NOF guidelines and WHO recommendations. Results: We evaluated 107 patients in total, of whom 45 (42%) were women. The group's mean age was 68 ± 9 years, and the mean disease time span was 9.9 ± 6.0 years and mean motor UPDRS was 43 ± 15. We found that 42.1% and 34.6% of the sample had osteopenia and osteoporosis following NOF criteria, respectively, and 43% and 33.6% following the WHO recommendations. Lower lean appendicular mass was associated to osteopenia and osteoporosis in multinomial logistic regression analysis in both diagnostic criteria. Conclusion: Our findings provide additional evidence for the protective role of lean mass against osteoporosis in patients with PD.

Physical Exercise for Treating the Anxiety and Depression Symptoms of Parkinson's Disease: Systematic Review and Meta-Analysis.

BACKGROUND: Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD. METHODS: Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate. RESULTS: Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety. CONCLUSION: Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.

Trans-Spinal Theta Burst Magnetic Stimulation in Parkinson's Disease and Gait Disorders.

BACKGROUND: Gait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment. OBJECTIVES: To investigate the efficacy of intermittent θ burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders. METHODS: This was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition. RESULTS: Thirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group). DISCUSSION: TsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. © 2024 International Parkinson and Movement Disorder Society.

The Impact of Motor, Non-Motor, and Social Aspects on the Sexual Health of Men Living with Parkinson's Disease.

Background: Sexual health (SH) is influenced by several biological, mental, and social factors that may be negatively impacted by Parkinson's disease (PD). Despite its prevalence and relevance for quality of life, the factors that affect SH in men with PD (MwPD) are still poorly understood. Objectives: To investigate the impact of motor, non-motor, and social aspects on the SH in MwPD. Methods: We conducted a cross-sectional study of 80 men (mean-age 53.55±10.8) in stages 1-3 of Hoehn and Yahr classification (H&Y), who reported having an active sex life in the last six months. The following data were collected for each person: 1) Demographic and clinical features; 2) global cognitive capacity (T-MoCA); 3) Non-Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part I); 4) Motor Aspects of Experiences of Daily Living (MDS-UPDRS, part II); 5) Fatigue (FSS); 6) Self-esteem (RSES); 7) Sleep disorder (PDSS); 8) Couple relationship quality (DAS); 9) Depressive signals (BDI); 10) Short-term sexual health by International Index of Erectile Function (IIFE); and 11) Long-term sexual health by Sexual Quotient-Male (SQ-M). Results: Our results showed that although several motor, non-motor, and social factors were correlated with SH, only motor disability levels in daily living predicted short-term SH and erectile dysfunction, while only depression predicted long-term SH in MwPD. Age, disease onset, and medication daily dosage were not correlated with SH. Conclusions: Our findings confirm that multidimensional factors can affect the SH of MwPD and emphasize that only a multi-professional team can offer proper care to improve SH in MwPD.

Association between fatigue and MDS-UPDRS in individuals with Parkinson's disease: cross-sectional study.

BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

Suicide attempt in a dopamine agonist withdrawal syndrome in Parkinson's disease.

Dopamine agonist withdrawal syndrome (DAWS) results from the reduction or suspension of dopamine agonist medications; it encompasses mainly psychiatric symptoms, including suicidal behaviors. In patients with Parkinson's disease (PD), the impact of DAWS can be significant in terms of distress and disability; however, we must take this syndrome into account as a threatening condition because suicidal behaviors could be developing in the context of DAWS. Here we present a brief case of DAWS affecting a young man with PD, whom abruptly discontinued DA treatment and developed psychiatric symptoms within two weeks which led to a suicidal attempt.

Sensitivity and specificity of the EAT-10 and SDQ-DP in identifying the risk of dysphagia in Parkinson's disease.

BACKGROUND: The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications. OBJECTIVE: To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD. METHODS: Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy. RESULTS: EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%. CONCLUSION: The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.

ANTECEDENTES: A identificação precoce de risco para disfagia nos pacientes com doença de Parkinson (DP) é fundamental para a prevenção de complicações nutricionais e pulmonares. OBJETIVO: Analisar a sensibilidade e especificidade dos questionários Swallowing Disturbance Questionnaire (SDQ-PD) e Eating Assessment Tool (EAT-10) para a identificação do risco de disfagia em pacientes com DP nos estágios iniciais e intermediários da doença. MéTODOS: Participaram 29 pacientes com DP. Foi realizado a aplicação dos questionários EAT-10 e SDQ-PD e o exame de videofluoroscopia da deglutição. Para a classificação da presença e gravidade da disfagia foi utilizada a escala Dysphagia Outcome and Severity Scale e, para identificação da presença de penetração/aspiração, a escala Penetration-Aspiration Scale (PAS). Na análise estatística, calcularam-se a sensibilidade e a especificidade dos questionários de risco EAT-10 e SDQ-DP e o valor preditivo positivo, o valor preditivo negativo e a acurácia. RESULTADOS: A análise do EAT-10 para identificar o risco de penetração/aspiração revelou sensibilidade de 71.42% e especificidade de 45.45%; para identificar a presença de disfagia, a sensibilidade foi de 47,61% e a especificidade de 12.5%. Em relação ao questionário SDQ-PD, para identificar risco de penetração/aspiração, a sensibilidade foi de 28.57% e a especificidade de 68.18% e, para identificar a presença de disfagia, a sensibilidade foi de 20% e a especificidade de 44.44%. CONCLUSãO: O questionário SDQ-PD revelou baixa sensibilidade e baixa especificidade para identificar presença de disfagia e/ou penetração/aspiração em pacientes com DP em estágios iniciais e intermediários para essa amostra. O EAT-10 revelou boa sensibilidade na indicação de risco de penetração/aspiração, apesar de baixa especificidade.

Assisted technology in Parkinson's disease gait: what's up?

BACKGROUND: Gait disturbances are prevalent and debilitating symptoms, diminishing mobility and quality of life for Parkinson's disease (PD) individuals. While traditional treatments offer partial relief, there is a growing interest in alternative interventions to address this challenge. Recently, a remarkable surge in assisted technology (AT) development was witnessed to aid individuals with PD. OBJECTIVE: To explore the burgeoning landscape of AT interventions tailored to alleviate PD-related gait impairments and describe current research related to such aim. METHODS: In this review, we searched on PubMed for papers published in English (2018-2023). Additionally, the abstract of each study was read to ensure inclusion. Four researchers searched independently, including studies according to our inclusion and exclusion criteria. RESULTS: We included studies that met all inclusion criteria. We identified key trends in assistive technology of gait parameters analysis in PD. These encompass wearable sensors, gait analysis, real-time feedback and cueing techniques, virtual reality, and robotics. CONCLUSION: This review provides a resource for guiding future research, informing clinical decisions, and fostering collaboration among researchers, clinicians, and policymakers. By delineating this rapidly evolving field's contours, it aims to inspire further innovation, ultimately improving the lives of PD patients through more effective and personalized interventions.

ANTECEDENTES: Os distúrbios da marcha são sintomas prevalentes e debilitantes, diminuindo muito a mobilidade e a qualidade de vida dos indivíduos com doença de Parkinson (DP). Embora os tratamentos tradicionais ofereçam alívio parcial, há um interesse crescente em intervenções alternativas para enfrentar esse desafio. Recentemente, um aumento notável no desenvolvimento de tecnologia assistida (TA) foi testemunhado para ajudar indivíduos com DP. OBJETIVO: Explorar o cenário crescente de intervenções de TA adaptadas para aliviar deficiências de marcha relacionadas à DP e descrever as pesquisas atuais para esse fim. MéTODOS: Nessa revisão, pesquisamos artigos em inglês publicados no PubMed de 2018 a 2023. Além disso, os resumos de cada trabalho foram lidos para assegurar a sua inclusão. Quatro pesquisadores buscaram independentemente os artigos de acordo com os critérios de inclusão e exclusão. RESULTADOS: Incluímos trabalhos que preencheram os critérios de inclusão. Identificamos as tendências em tecnologia assistiva na análise dos parâmetros da marcha em DP. Esses compreendem os sensores portáteis, análise da marcha, retroalimentação em tempo real e técnicas de pista, realidade virtual e robótica. CONCLUSãO: Essa revisão é um recurso para orientar pesquisas futuras, informar decisões clínicas e promover a colaboração entre pesquisadores, médicos e formuladores de políticas. Ao delinear os contornos deste campo em rápida evolução, pretende inspirar mais inovação, melhorando em última análise a vida dos pacientes com DP através de intervenções mais eficazes e personalizadas.

Pain characterization in patients with Parkinson's disease.

BACKGROUND: Patients with Parkinson's disease (PD) often report chronic pain, which is one of the most complex non-motor symptoms. Therefore, this study aims to review the literature on the characteristics of pain in patients with PD. METHODS: A systematic literature review was conducted following MOOSE recommendations. Observational studies reporting pain in patients with PD were included. No time restrictions were applied, but studies in Portuguese, Spanish, and English were considered. The search was performed in PubMed®, LILACS, and SciELO databases. RESULTS: Twenty-six articles of observational studies were identified, reporting an average pain prevalence of 67.36%, emphasizing the significance of this symptom in the PD population. Pain was reported in various body regions, including lower limbs, upper limbs, lumbar spine, cervical spine, and other joints. Pain classification varied, encompassing musculoskeletal pain, PD-related pain, neuropathic pain, and dystonic pain, among others. DISCUSSION: Pain in patients with PD is a prevalent and multifactorial condition, significantly impacting patients' quality of life. CONCLUSION: Heterogeneity in data across included studies was observed, highlighting the need for additional research to elucidate the underlying mechanisms of pain in patients with PD and develop effective therapeutic strategies to address this symptom and improve the quality of life for individuals living with the disease.