The use of olfactory testing when diagnosing Parkinson's disease - a systematic review.

INTRODUCTION: The diagnosis of Parkinson's disease (PD) is typically based on the presence of motor symptoms, but in the early phase of the disease, the diagnostic process can be challenging. Examination of non-motor symptoms in patients suspected of PD has gained growing attention. Olfactory tests have shown promising results as ancillary diagnostic tests. The aim of this study was to investigate how olfactory tests may be used clinically in diagnostic process in PD. METHODS: A systematic search was conducted in PubMed for relevant literature on 8 March 2017. A total of 358 articles were found. Our screening process left 27 articles, which were included for further analysis. RESULTS: In all, 20 of the included studies analysed the diagnostic value of olfactory testing by comparing patients with PD to healthy controls. Sensitivities varied from 61% to 95% and specificities from 66% to 99%. Ten studies used olfactory tests to distinguish between PD and diseases that mimic PD. The sensitivities varied from 62% to 92% and the specificities from 65% and 96%. CONCLUSIONS: Olfactory test can be a valuable ancillary tool in the diagnostic process in PD. In a clinical setting, the identification part from Sniffin' Sticks 16 is the most usable because it may be conducted quickly and independently of disease duration and severity. Before using an olfactory test in a clinical setting, it is necessary to adjust the odours to the patient population, and to establish the optimal specificity-adjusted cut-off.

Cerebrospinal fluid levels of catecholamines and its metabolites in Parkinson's disease: effect of l-DOPA treatment and changes in levodopa-induced dyskinesia.

Levodopa (l-DOPA, l-3,4-dihydroxyphenylalanine) is the most effective drug in the symptomatic treatment of Parkinson's disease (PD), but chronic use initiates a maladaptive process leading to l-DOPA-induced dyskinesia (LID). Risk factors for early onset LID include younger age, more severe disease at baseline and higher daily l-DOPA dose, but biomarkers to predict the risk of motor complications are not yet available. Here, we investigated whether CSF levels of catecholamines and its metabolites are altered in PD patients with LID [PD-LID, n = 8)] as compared to non-dyskinetic PD patients receiving l-DOPA (PD-L, n = 6), or not receiving l-DOPA (PD-N, n = 7) as well as non-PD controls (n = 16). PD patients were clinically assessed using the Unified Parkinson's Disease Rating Scale and Unified Dyskinesia Rating Scale and CSF was collected after overnight fasting and 1-2 h after oral intake of l-DOPA or other anti-Parkinson medication. CSF catecholamines and its metabolites were analyzed by HPLC with electrochemical detection. We observed (i) decreased levels of dihydroxyphenylacetic acid (DOPAC) and homovanillic acid in PD patients not receiving l-DOPA (ii) higher dopamine (DA) levels in PD-LID as compared to controls (iii) higher DA/l-DOPA and lower DOPAC/DA ratio's in PD-LID as compared to PD-L and (iv) an age-dependent increase of DA and decrease of DOPAC/DA ratio in controls. These results suggest increased DA release from non-DA cells and deficient DA re-uptake in PD-LID. Monitoring DA and DOPAC in CSF of l-DOPA-treated PD patients may help identify patients at risk of developing LID.

Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study was set up to clarify whether this effort has resulted in a decreased proportion of patients with known AF experiencing an ischemic stroke. METHODS: Patients admitted to the Department of Neurology, Vejle Hospital, Denmark, with ischemic stroke from January 1997 to December 2012 were included in the study. RESULTS: A total of 4134 patients were included in the study. Overall, the yearly proportion of patients with known AF varied between 9% and 18%. No significant change was observed (P = .511). The proportion of patients with known AF treated with anticoagulants at the time of the stroke and the proportion of newly discovered AF were significantly increasing during the study period (P = .002 and P = .035, respectively). Subgroup analysis of the patients aged 65-75 years showed similar results. CONCLUSIONS: No significant reduction in the proportion of patients admitted with ischemic stroke and AF was observed. An explanation could be an increase in the prevalence of AF in the general population, leaving the proportion of patients admitted with ischemic stroke unchanged. Other risk factors have been sought reduced as well with the implementation of national guidelines regarding hypertension, hypercholesterolemia, and diabetes.