The progression of non-motor symptoms in Parkinson's disease and their contribution to motor disability and quality of life.

Non-motor symptoms are gaining relevance in Parkinson's disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1-10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I-II mild; III moderate; IV-V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.

Influence of anatomical factors on the feasibility and safety of carotid stenting in a series of 154 consecutive procedures.

OBJECTIVE: The present study assessed the impact of unfavourable vascular anatomy on the feasibility and safety of carotid angioplasty and stenting (CAS). METHODS: Between 2000 and 2005, 154 CAS procedures (46% in symptomatics) were performed in 138 consecutive patients (mean age 72 +/- 7 years, 63% males), followed for a median period of 16 months by a neurologist performing clinical and duplex scan examination. The impact on outcome of tortuous supra-aortic vessels, tortuous internal carotid artery (ICA), calcified stenosis and contralateral ICA occlusion were assessed. RESULTS: The feasibility was 100%. The 1-month rate of death and disabling stroke was 2.6% (1.2% in the asymptomatic group and 4.2% in symptomatic group, P = 0.33). The 1-month rate of any stroke and death was 4.5%. During follow-up, a further seven events occurred (one ipsilateral major stroke, one ipsilateral minor stroke and five deaths). There was no difference in occurrence of any event during follow-up between asymptomatic and symptomatic group (8.4% versus 9.6%, P = 0.78). At least one unfavourable vascular anatomy condition was present in 48% of cases, two conditions in 16% and three in 3%. No statistically significant association was found between unfavourable vascular anatomy and outcome. Intra-stent restenosis was registered by duplex scan in five cases (3.2%); it was associated with occurrence of minor stroke during follow-up (P = 0.032). CONCLUSIONS: CAS as first choice procedure is feasible, safe and effective, despite hostile vascular anatomy may be encountered in some patients. Unfavourable anatomic conditions appear to have a scarce impact on outcome.