Effect of bladder dysfunction on development of depression and anxiety in Parkinson's disease.

OBJECTIVES: Parkinson's disease (PD) often presents with movement disorder. However, besides motor complaints, there are many complaints such as anxiety, depression, urinary complaints and constipation. The aim of this study was to investigate whether neurogenic lower urinary dysfunction (NLUD), which is frequently seen in PD, has an effect on the development of anxiety and depression in these patients. MATERIALS AND METHODS: The study included 32 males (66.6%) and 16 females (33.3%); in total 48 subjects were registered. For the diagnosis and severity of PD, the UK Parkinson's Disease Society Brain Bank Criteria, Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn-Yahr scale were used. Urological evaluation was performed using history, physical examination, laboratory tests and standard forms such as IPSS and OAB-V8. RESULTS: There was no difference between the genders in terms of duration, severity and NLUD (p > 0.05). The incidence of anxiety and depression in PD patients was 62.8% and 72.1%, respectively. The prevalence of NLUD was 67.4% and depression and anxiety was found to increase (1.06 and 1.28 times, respectively) in relation to NLUD. In particular, there was a relationship between storage lower urinary tract symptoms and anxiety and depression development (p < 0.05). CONCLUSIONS: As expected, it was found that the incidence of NLUD, anxiety and depression was increased in PD. In addition, NLUD was found to be a risk factor for the development of anxiety and depression. Therefore, it is concluded that NLUD, which can potentially cause important complications, as well as motor complaints, should be closely monitored and treated in PD patients.

The correlation of non-motor symptoms and sleep on balance in Parkinson's disease patients with normal cognition and mild cognitive impairment.

BACKGROUND: Parkinson's disease (PD) is characterized by non-motor symptoms (NMS) as well as by motor symptoms. Together with the impairment of cognitive functions, NMS and sleep also affect motor symptoms negatively. The aim of our study is to examine the correlation of NMS and sleep on balance in PD patients with normal cognition (PD-NC) and with mild cognitive impairment (PD-MCI). METHODS: A total of 69 patients were included in our study. Using the Standardized Mini-Mental State Examination, participants were divided into 2 groups, PD-NC and PD-MCI. Patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), the Berg Balance Scale (BBS), the Tinetti Balance Assessment Tool (TBAT), the Non-Motor Symptoms Questionnaire (NMSQ), and the Parkinson's Disease Questionnaire (PDQ-39). RESULTS: PD-MCI patients had statistically significant worse motor symptoms and more balance disorder compared to PD-NC (UPDRS: p = 0.009; BBS: p = 0.010; TBAT: p = 0.004). PD-MCI patients had greater severity of non-motor symptoms and worse sleep quality than the PD-NC group (NMSQ-total: p = 0.02; NMSQ-sleep total: p = 0.01). The evaluation has shown that with a diagnosis of MCI, NMS, and sleeping problems were correlated, and the correlation was associated with impairment of the balance function. While being more pronounced in the PD-MCI group, quality of life was affected in both groups (p < 0.05). CONCLUSION: Our data demonstrate a negative effect on the balance function in patients with cognitive impairment suffering increased NMS and sleeping disorders. Treatment of these patients needs to concentrate on NMS and cognitive functions as much as on motor symptoms.

The Relationship Between Pain, and Freezing of Gait and Falls in Parkinson's Disease.

INTRODUCTION: To investigate the relationship between pain, freezing of gait (FOG) and falls in Parkinson's Disease (PD). METHODS: The study included 110 PD patients. The Unified PD Rating Scale (UPDRS) and Hoehn and Yahr Scale were used to evaluate disease severity. The patients self-reported occurrence of FOG and falls, and the FOG Questionnaire was administered to evaluate the severity of FOG. A visual analog scale (VAS) was used to measure the severity of pain and pain localization was self-reported by the patients. RESULTS: Fifty-eight of the patients had FOG and 43 experienced falls. Among the patients, 42 had no pain, whereas 35 had lower extremity pain. Higher UPDRS motor and FOG scores, and advanced-stage disease were noted in significantly more of the patients with FOG and falls. VAS scores were not affected by the presence of FOG or falls. There was a positive correlation between the severity of FOG and VAS score in the male patients (r=0.308; p=0.010). More patients with falls had lower extremity pain than those without falls (r=0.308; p=0.010). DISCUSSION: Patients with FOG and falls had more severe motor findings. Pain is correlated with both FOG and falls. Further investigations should be done to understand the mechanism of this relationship to prevent the motor complications in advanced PD.

Effects of levodopa therapy on global left ventricular systolic function in patients with Parkinson disease.

OBJECTIVES: Since levodopa was identified as an efficient therapeutic option in Parkinson disease (PD), great success has been achieved in the course and treatment of the disease. However, L­dopa-related side effects limit the therapeutic use in some patients. The aim of this study was to evaluate the effects of L­dopa therapy on left ventricular global systolic function via speckle tracking method. METHODS: In this study, 55 patients with PD under L­dopa/dopa decarboxylase inhibitor therapy were compared with 30 age- and sex-matched control subjects. Conventional transthoracic echocardiography was performed in the left lateral position by two experienced operators in accordance with generally accepted guidelines. Left ventricular systolic function was analyzed by speckle tracking method using global longitudinal strain (GLS) and global circumferential strain (GCS) imaging. RESULTS: Adequate echocardiographic imaging for the evaluation of global longitudinal strain and global circumferential strain could be achieved in 55 of the patients. LVEF (left ventricular ejection fraction), GLS and GCS values were found to be similar between the patients with PD under L­dopa therapy and the control group (62 ± 3.5 % vs 61 ± 4 %, p < 0.05; -19.46 ± 2.3 vs -19.4 ± 3.2, p < 0.05; and -18.60 ± 3.5 vs -18.22 ± 3.2, p < 0.05 respectively.) CONCLUSION: Levodopa therapy has no unfavorable effect on left ventricular systolic function in patients with PD.

Evaluation of cardiovascular risk in patients with Parkinson disease under levodopa treatment.

BACKGROUND: Levodopa is the indispensable choice of medial therapy in patients with Parkinson disease (PD). Since L-dopa treatment was shown to increase serum homocysteine levels, a well-known risk factor for cardiovascular disorders, the patients with PD under L-dopa treatment will be at increased risk for future cardiovascular events. The objective of this study is to evaluate cardiovascular risk in patients with PD under levodopa treatment. METHODS: The study population consisted of 65 patients with idiopathic PD under L-dopa treatment. The control group included 32 age and gender matched individuals who had no cognitive decline. Echocardiographic measurements, serum homocysteine levels and elastic parameters of the aorta were compared between the patients with PD and controls. RESULTS: As an expected feature of L-dopa therapy, the Parkinson group had significantly higher homocystein levels (15.1 ± 3.9 µmol/L vs. 11.5 ± 3.2 µmol/L, P = 0.02). Aortic distensibility was significantly lower in the patients with PD when compared to controls (4.8 ± 1.5 dyn/cm(2) vs. 6.2 ± 1.9 dyn/cm(2), P = 0.016). Additionally, the patients with PD had higher aortic strain and aortic stiffness index (13.4% ± 6.4% vs. 7.4% ± 3.6%, P < 0.001 and 7.3 ± 1.5 vs. 4.9 ± 1.9, P < 0.001 respectively). Furthermore, serum homocysteine levels were found to be positively correlated with aortic stiffness index and there was a negative correlation between aortic distensibility and levels of serum homocysteine (r = 0.674, P < 0.001; r = -0.602, P < 0.001, respectively). CONCLUSIONS: The patients with PD under L-dopa treatment have increased aortic stiffness and impaired diastolic function compared to healthy individuals. Elevated serum homocysteine levels may be a possible pathophysiological mechanism.

Is there a difference between Parkinson disease patients and a control group in terms of urinary symptoms and quality of life?

BACKGROUND/AIM: The aim of this study is to research whether urinary symptoms and disruption of quality of life observed in Parkinson disease patients are different than those of their healthy peers. Additionally, whether these complaints were affected by characteristics such as age at onset of Parkinson disease, sex, disease duration, and severity was investigated. MATERIALS AND METHODS: This study comprised a total of 79 individuals, 39 Parkinson patients and a control group of 40 individuals. Parkinson diagnosis was provided by a neurology expert according to the UK Parkinson's Disease Society Brain Bank Criteria. All patients were evaluated by a urologist with the International Prostate Symptom Score (IPSS) and an overactive bladder (OAB) questionnaire. RESULTS: Compared with the control group, the Parkinson patient group had statistically significantly higher rates of urological complaints (P < 0.001), irritative symptoms (P < 0.001), voiding symptoms (P < 0.001), OAB score (P < 0.001), IPSS total score (P = 0.007), and treatment requirements (P < 0.001). CONCLUSION: Urologic complaints were observed more frequently in the Parkinson patient group compared to the control group. Another important result of this study is that in the Parkinson patient group there was no difference found between urologic complaints in terms of sex.