Determinants and impact of alexithymia on quality of life in Parkinson's disease.

INTRODUCTION: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease. METHODS: Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model. RESULTS: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL. CONCLUSIONS: Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.

Determinants and impact of alexithymia on quality of life in Parkinson’s disease / Determinantes e impacto de la alexitimia en la calidad de vida en la enfermedad de Parkinson

Introduction: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty iden-tifying and describing feelings. Although associated with other non-motor symptoms, mainlyneuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson’sDisease (PwP). The objective of the study is to identify determinants of alexithymia and itsassociation with quality of life (QoL) in Parkinson’s disease. Methods: Subjects with Parkinson’s disease were recruited. The following instruments wereapplied: Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS),Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymiascale (TAS-20) and Parkinson’s Disease Questionnaire (PDQ-8). Matched healthy controls werescreened using TAS-20. Clinical and demographical variables were compared between alex-ithymic and non-alexithymic. Regression models were used to find determinants of alexithymia.Impact of alexithymia on QoL was estimated with a linear regression model.Results: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p < 0.001).Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well asTAS-20 score. Alexithymia was an independent determinant of QoL. Conclusions: Alexithymia is a prevalent independent non-motor symptom in PwP with impacton QoL. Low education level and urinary symptoms are important determinants of alexithymia.(AU)

Introducción: La alexitimia es un rasgo neuropsiquiátrico conceptualizado como la dificul-tad para identificar y describir sentimientos. Aunque está asociado con otros síntomas nomotores, principalmente neuropsiquiátricos, sigue siendo una característica independiente delas personas con enfermedad de Parkinson (PcP). El objetivo del estudio es identificar losdeterminantes de la alexitimia y su asociación con la calidad de vida en la enfermedad deParkinson. Métodos: Se reclutaron sujetos con enfermedad de Parkinson. Se aplicaron los siguientesinstrumentos: escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornosdel Movimiento (MDS-UPDRS), escala de síntomas no motores (NMSS), evaluación cognitiva deMontreal (MoCA), escala de alexitimia de Toronto (TAS-20) y cuestionario de la enfermedadde Parkinson (PDQ-8). Se incluyeron controles sanos pareados, los cuales se evaluaron usandola TAS-20. Las variables clínicas y demográficas se compararon entre pacientes alexitímicos yno alexitímicos. Se utilizaron modelos de regresión para estimar los predictores de alexitimia.El impacto de este rasgo neuropsiquiátrico en la calidad de vida se estimó con un modelo deregresión lineal. Resultados: Se incluyeron 98 pacientes. El 56,1% de PcP y el 28,8% de los controles fueronalexitímicos (p < 0,001). El nivel educativo (OR 0,86) y la puntuación urinaria del NMSS (OR1,09) determinaron la alexitimia, así como la puntuación del TAS-20. La alexitimia fue undeterminante independiente de calidad de vida. Conclusiones: La alexitimia es un síntoma independiente no motor prevalente con impactoen la calidad de vida. El bajo nivel educativo y los síntomas urinarios son determinantesimportantes de esta condición. (AU)

Determinants and impact of alexithymia on quality of life in Parkinson's disease.

INTRODUCTION: Alexithymia is a neuropsychiatric symptom conceptualized as difficulty identifying and describing feelings. Although associated with other non-motor symptoms, mainly neuropsychiatric, alexithymia may present as an isolated symptom in persons with Parkinson's Disease (PwP). The objective of the study is to identify determinants of alexithymia and its association with quality of life (QoL) in Parkinson's disease. METHODS: Subjects with Parkinson's disease were recruited. The following instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Toronto alexithymia scale (TAS-20) and Parkinson's Disease Questionnaire (PDQ-8). Matched healthy controls were screened using TAS-20. Clinical and demographical variables were compared between alexithymic and non-alexithymic. Regression models were used to find determinants of alexithymia. Impact of alexithymia on QoL was estimated with a linear regression model. RESULTS: 98 patients were included. 56.1% PwP and 28.8% controls were alexithymic (p<0.001). Education level (OR 0.86) and NMSS urinary score (OR 1.09) determined alexithymia as well as TAS-20 score. Alexithymia was an independent determinant of QoL. CONCLUSIONS: Alexithymia is a prevalent independent non-motor symptom in PwP with impact on QoL. Low education level and urinary symptoms are important determinants of alexithymia.

Factores asociados a la calidad de vida de sujetos con enfermedad de Parkinson y a la carga en el cuidador / Factors associated with the quality of life of subjects with Parkinson's disease and burden on their caregivers

Introducción: La enfermedad de Parkinson impacta en la calidad de vida del sujeto que la presenta, pero también ocasiona una carga para el cuidador. Los factores relacionados con estos efectos incluyen aspectos motores y no motores de la enfermedad, así como características inherentes al cuidador. Métodos: Se evaluó a sujetos con enfermedad de Parkinson mediante los siguientes instrumentos: cuestionario de calidad de vida PDQ-8, escala unificada de la enfermedad de Parkinson de la Sociedad de Trastornos del Movimiento parte i a iv (MDS-UPDRS) y estadio de Hoehn y Yahr (HY). A los cuidadores primarios, se les aplicó el inventario de carga del cuidador de Zarit. Adicionalmente, se registraron las principales variables demográficas y clínicas. Resultados: Se incluyó a 250 sujetos con enfermedad de Parkinson, de los cuales 201 contaban con un cuidador primario. En el análisis multivariado los factores predictores de una peor calidad de vida del sujeto con enfermedad de Parkinson fueron la puntuación de la MDS-UPDRS I (β = 0,39, p < 0,001), puntuación de la MDS-UPDRS II (β = 0,21, p < 0,001) y puntuación de la MDS-UPDRS III (β = 0,07, p = 0,004). En lo que respecta a la carga en el cuidador, la puntuación de la MDS-UPDRS II (β = 0,54, p = 0,007) fue el que más influyó. Conclusiones: El presente estudio muestra una relación entre la calidad de vida del sujeto con enfermedad de Parkinson y la percepción de carga del cuidador. No obstante, los factores que determinan cada una de estas parecen ser distintos

Introduction: Parkinson's disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor aspects of the disease, as well as traits inherent to the caregiver. Methods: We evaluated subjects with Parkinson's disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinson's disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded. Results: A total of 250 subjects with Parkinson's disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinson's disease were the MDS-UPDRS I score (β = .39, P < .001), MDS-UPDRS II score (β = .21, P < .001), and MDS-UPDRS III score (β = .07, P = .004). Regarding caregiver burden, the MDS-UPDRS II score (β = .54, P = .007) was the most influential factor. Conclusions: The present study shows a relationship between quality of life for the subject with Parkinson's disease and the caregiver's perceived burden. However, the factors that determine each situation appear to be distinct

Factors associated with the quality of life of subjects with Parkinson's disease and burden on their caregivers.

INTRODUCTION: Parkinson's disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor aspects of the disease, as well as traits inherent to the caregiver. METHODS: We evaluated subjects with Parkinson's disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinson's disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded. RESULTS: A total of 250 subjects with Parkinson's disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinson's disease were the MDS-UPDRS I score (ß=.39, P<.001), MDS-UPDRS II score (ß=.21, P<.001), and MDS-UPDRS III score (ß=.07, P=.004). Regarding caregiver burden, the MDS-UPDRS II score (ß=.54, P=.007) was the most influential factor. CONCLUSIONS: The present study shows a relationship between quality of life for the subject with Parkinson's disease and the caregiver's perceived burden. However, the factors that determine each situation appear to be distinct.

Clinical, imaging, and molecular findings in a sample of Mexican families with pantothenate kinase-associated neurodegeneration.

Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive disorder characterized by iron accumulation in the brain, because of mutations in the PANK2 gene. Phenotypic and genotypic characteristics of 11 patients from five Mexican families with PKAN disease are reported. Sequencing of PANK2 confirmed the diagnosis. The 11 patients had dysarthria associated with dystonia and Parkinsonism in six. Brain magnetic resonance imaging (MRI) showed the 'eye-of-the-tiger' sign in all patients. Three different mutations were identified, a novel one (p.A469P) and two (p.G219V and p.N404I) very rare. Homozygous sibs for the p.G219V mutation had a severe disease progression with early death. Dystonia predominated in the p.A469P/p.N404I compound heterozygous patients. Homozygous for p.N404I showed Parkinsonism, tics and personality and speech disorders. Early and late disease onset and variable expression was present in carriers of the different identified mutations. The 'eye-of-the-tiger' is an excellent neuroimaging hallmark to predict PANK2 mutations. We detected a 'cluster' of patients harboring the p.N404I mutation, strongly suggesting a founder effect for this mutation. This is the first familial clinical-genetic PKAN disease study accomplished in Mexico.

Relación entre el tipo y lado de inicio de la sintomatología motora con la frecuencia de síntomas no motores en la enfermedad de Parkinson / Relationship between the type and side of motor symptoms with the prevalence of non-motor symptoms in Parkinson's disease

Introducción: la relación de la lateralidad y asimetría de la enfermedad de Parkinson con la sintomatología de disfunción no motora ha sido abordada principalmente desde el punto de vista de las funciones cognitivas, y los escasos estudios que han involucrado otros síntomas han sido contradictorios. La asociación de los síntomas no motores con el tipo de inicio de la enfermedad no ha sido estudiada profundamente. Objetivo: analizar la asociación entre el lado de inicio de la sintomatología motora, así como del tipo de inicio termorígeno y rígido-bradicinético y la prevalencia de síntomas no motores. Pacientes y métodos: se incluyeron 232 pacientes con diagnóstico de enfermedad de Parkinson. Se documentó el tipo de inicio y el hemicuerpo afectado inicialmente. La presencia de síntomas no motores se determinó mediante la aplicación del cuestionario de síntomas no motores (NMSQuest). Resultados: al analizar el lado de inicio y la presencia de los síntomas no motores explorados se encontraron diferencias estadísticamente significativas en la frecuencia de alucinaciones (p=0,04) y del trastorno conductual del sueño (p<0,01) en los sujetos de inicio del lado derecho. En el caso del tipo de inicio no se encontraron diferencias con significación estadística. Conclusiones: los sujetos con inicio en el hemicuerpo derecho parecen tener un mayor riesgo de presentar tanto alucinaciones como trastorno conductual del sueño. El médico tratante debe buscar de forma intencionada estos síntomas en estos pacientes, y de esta manera otorgar un tratamiento adecuado que impacte en la calidad de vida de los mismos (AU)

Introduction: The relationship between laterality and asymmetry of Parkinson's disease and non-motor dysfunction has been studied mainly from the perspective of cognitive functions, and the few studies that have included other symptoms have mixed reports. The relationship between non-motor symptoms and the type of onset of the disease has not been studied in detail. Objective: to analyse the association between the side and type of motor onset and the prevalence of non-motor symptoms. Patients and methods: we included 232 patients diagnosed with Parkinson's disease. Type of onset and the side initially affected were documented. The presence of non-motor symptoms was determined by applying the non-motor symptom questionnaire (NMSQuest). Results: when analysing the side of onset and presence of each non-motor symptom explored, statistically significant differences were found in the frequency of hallucinations (P=0.04) and sleep behaviour disorder (P<0.01) in subjects with right side onset. The motor type of onset differences were not statistically significant. Conclusions: subjects with right side onset seem to have a higher risk of having hallucinations and sleep behaviour disorders. These symptoms should be intentionally sought in order to provide treatment and improve the patient's quality of life (AU)

Relationship between the type and side of motor symptoms with the prevalence of non-motor symptoms in Parkinson's disease.

INTRODUCTION: the relationship between laterality and asymmetry of Parkinson's disease and non-motor dysfunction has been studied mainly from the perspective of cognitive functions, and the few studies that have included other symptoms have mixed reports. The relationship between non-motor symptoms and the type of onset of the disease has not been studied in detail. OBJECTIVE: to analyse the association between the side and type of motor onset and the prevalence of non-motor symptoms. PATIENTS AND METHODS: we included 232 patients diagnosed with Parkinson's disease. Type of onset and the side initially affected were documented. The presence of non-motor symptoms was determined by applying the non-motor symptom questionnaire (NMSQuest). RESULTS: when analysing the side of onset and presence of each non-motor symptom explored, statistically significant differences were found in the frequency of hallucinations (P=0.04) and sleep behaviour disorder (P<0.01) in subjects with right side onset. The motor type of onset differences were not statistically significant. CONCLUSIONS: subjects with right side onset seem to have a higher risk of having hallucinations and sleep behaviour disorders. These symptoms should be intentionally sought in order to provide treatment and improve the patient's quality of life.

[The clinical use of auto-antibodies in neurology]. / Uso clínico de autoanticuerpos en neurología.

INTRODUCTION: Auto-antibody determinations are very important in current clinical practice, not only in immunology or rheumatology but also in the neurosciences. These antibodies have both diagnostic and prognostic implications which, unfortunately, are often overused or are granted undue importance when it comes to interpreting them. On requesting their determination it is therefore necessary to know their indications, utility and application. AIM: To present a series of auto-antibodies that are relatively commonly used in neurology and which have primary and secondary effects on both the central and the peripheral nervous system, including the neuromuscular junction and muscle tissue. DEVELOPMENT: In this review we cover a series of different conditions, including diseases such as vasculitis, cerebrovascular disease, neurological paraneoplastic syndromes, dysimmune polyneuropathies and inflammatory myopathies. Special attention is given, when relevant, to the indications and, particularly, to the value and weight that should be granted to both positive and negative results. CONCLUSIONS: Appropriate interpretation and knowledge of the scope and limitations of auto-antibodies are essential, because otherwise they will lead to mistaken diagnoses and, consequently, erroneous treatment.

Uso clínico de autoanticuerpos en neurología / The clinical use of auto-antibodies in neurology

Las determinaciones de autoanticuerpos son de gran relevancia en la práctica clínica actual, no sóloen las áreas de inmunología o reumatología, sino también en las neurociencias. Estos anticuerpos poseen implicaciones tanto diagnósticas como pronósticas, que desafortunadamente se sobreutilizan con gran frecuencia o se les da un valor inapropiado en la interpretación; por lo anterior, es necesario al solicitarlos conocer sus indicaciones, utilidad y aplicación.Objetivo. Presentar una serie de autoanticuerpos de uso relativamente frecuente en neurología y que afectan tanto de manera primaria como secundaria al sistema nervioso central y periférico, incluidos también la placa neuromuscular y el músculo.Desarrollo. A lo largo de esta revisión se cubre una serie de entidades diversas, entre las que se incluyen enfermedades como vasculitis, enfermedad vascular cerebral, síndromes paraneoplásicos neurológicos, polineuropatías disinmunes y miopatías inflamatorias. Se hace hincapié, cuando es pertinente, en las indicaciones y, particularmente, en el valor y peso que a suresultado, tanto positivo como negativo, se le debe otorgar. Conclusiones. La interpretación adecuada y el conocimiento del alcance y limitaciones de los autoanticuerpos son indispensables, ya que de lo contrario conducirán a errores en el diagnósticoy, como consecuencia, en el tratamiento

Introduction. Auto-antibody determinations are very important in current clinical practice, not only in immunology or rheumatology but also in the neurosciences. These antibodies have both diagnostic and prognostic implications which, unfortunately, are often overused or are granted undue importance when it comes to interpreting them. On requesting their determination it is therefore necessary to know their indications, utility and application. Aim. To present a series of autoantibodies that are relatively commonly used in neurology and which have primary and secondary effects on both the central and the peripheral nervous system, including the neuromuscular junction and muscle tissue. Development. In this review we cover a series of different conditions, including diseases such as vasculitis, cerebrovascular disease, neurological paraneoplastic syndromes, dysimmune polyneuropathies and inflammatory myopathies. Special attention is given, when relevant, to the indications and, particularly, to the value and weight that should be granted to both positive and negative results.Conclusions. Appropriate interpretation and knowledge of the scope and limitations of auto-antibodies are essential, because otherwise they will lead to mistaken diagnoses and, consequently, erroneous treatment