Effects of Levodopa on quality of sleep and nocturnal movements in Parkinson's Disease.

BACKGROUND: Sleep disturbances are common in Parkinson's Disease (PD), with nocturnal akinesia being one of the most burdensome. Levodopa is frequently used in clinical routine to improve nocturnal akinesia, although evidence is not well proven. METHODS: We assessed associations of Levodopa intake with quality of sleep and perception of nocturnal akinesia in three PD cohorts, using the Parkinson's Disease Sleep Scale (PDSS-2) in two cohorts and a question on nocturnal immobility in one cohort. In one cohort also objective assessment of mobility during sleep was performed, using mobile health technology. RESULTS: In an independent analysis of all three cohorts (in total n = 1124 PD patients), patients taking Levodopa CR reported a significantly higher burden by nocturnal akinesia than patients without Levodopa. Higher Levodopa intake and MDS-UPDRS part IV scores (indicating motor fluctuations) predicted worse PDSS-2 and higher subjective nocturnal immobility scores, while disease duration and severity were not predictive. Levodopa intake was not associated with objectively changed mobility during sleep. CONCLUSION: Our results showed an association of higher Levodopa intake with perception of worse quality of sleep and nocturnal immobility in PD, indicating that Levodopa alone might not be suitable to improve subjective feeling of nocturnal akinesia in PD. In contrast, Levodopa intake was not relevantly associated with objectively measured mobility during sleep. PD patients with motor fluctuations may be particularly affected by subjective perception of nocturnal mobility. This study should motivate further pathophysiological and clinical investigations on the cause of perception of immobility during sleep in PD.

Cholinergic Pathway SNPs and Postural Control in 477 Older Adults.

Objective: To determine whether single nucleotide polymorphisms (SNPs) of the cholinergic system and quantitative parameters of postural control are associated in healthy older adults. This is a cross-sectional analysis from the TREND study. Methods: All participants performed a static postural control task for 30 s on a foam pad in semitandem stance and eyes closed. We analyzed mean power frequency (MPF), area, acceleration, jerk, and velocity from a mobile sensor worn at the lower back using a validated algorithm. Genotypes of four SNPs in genes involved in the cholinergic system (SLC5A7, CHAT, BCHE, CHRNA4) were extracted from the NeuroX chip. All participants present a normal neurological examination and a Minimental state examination score >24. Results: Four hundred and seventy seven participants were included. Mean age was 69 years, 41% were female. One SNP of the cholinergic pathway was significantly associated with a quantitative postural control parameter. The minor allele of rs6542746 in SLC5A7 was associated with lower MPF (4.04 vs. 4.22 Hz; p = 3.91 × 10-4). Moreover, the following associations showed trends toward significance: minor allele of rs6542746 in SLC5A7 with higher anteroposterior acceleration (318 vs. 287 mG; p = 0.005), and minor allele of rs3810950 in CHAT with higher mediolateral acceleration [1.77 vs. 1.65 log(mG); p = 0.03] and velocity [1.83 vs. 1.74 log(mm/s); p = 0.019]. Intraindividual occurrence of rs6542746 and rs3810950 minor alleles was dose-dependently related with lower MPF (p = 0.004). Conclusion: This observational study suggests an influence of SNPs of the cholinergic pathway on postural control in older adults.

Effect of Fear of Falling on Turning Performance in Parkinson's Disease in the Lab and at Home.

Background: Parkinson's disease (PD) is a neurodegenerative movement disorder associated with gait and balance problems and a substantially increased risk of falling. Falls occur often during complex movements, such as turns. Both fear of falling (FOF) and previous falls are relevant risk factors for future falls. Based on recent studies indicating that lab-based and home assessment of similar movements show different results, we hypothesized that FOF and a positive fall history would influence the quantitative turning parameters differently in the laboratory and home. Methods: Fifty-five PD patients (43 underwent a standardized lab assessment; 40 were assessed over a mean of 12 days at home with approximately 10,000 turns per participant; and 28 contributed to both assessments) were classified regarding FOF and previous falls as "vigorous" (no FOF, negative fall history), "anxious" (FOF, negative fall history), "stoic" (no FOF, positive fall history) and "aware" (FOF, positive fall history). During the assessments, each participant wore a sensor on the lower back. Results: In the lab assessment, FOF was associated with a longer turning duration and lowered maximum and middle angular velocities of turns. In the home evaluations, a lack of FOF was associated with lowered maximum and average angular velocities of turns. Positive falls history was not significantly associated with turning parameters, neither in the lab nor in the home. Conclusion: FOF but not a positive fall history influences turning metrics in PD patients in both supervised and unsupervised environments, and this association is different between lab and home assessments. Our findings underline the relevance of comprehensive assessments including home-based data collection strategies for fall risk evaluation.

Molecular models of cesium and rubidium adsorption on weathered micaceous minerals.

Understanding the adsorption mechanisms of metal cations onto soils and sediments is of critical importance in the protection of the environment, especially for the case of radioactive materials including the fission product (137)Cs. Mechanism-based adsorption models for the long-term interaction of chemical and radionuclide species with clay minerals are needed to improve the accuracy of groundwater reaction and flow models, as well as related simulations for performance assessment of waste sites and repositories. Toward this goal, molecular simulation using geometry optimization and molecular dynamics methods have been used to investigate the adsorption behavior of Cs(+) and Rb(+) cations at frayed edge wedges (a proxy for frayed edge sites, FES) and in the interlayer region formed as a result of the transformation of muscovite to Al-hydroxy interlayered vermiculite (HIV) during weathering and pedogenesis. Frayed edge wedges, formed both on individual smectite and illite phases and on the mica-HIV intergrade, have previously been recognized as significant sinks for the strong adsorption of Cs(+) and Rb(+). Atomic density profiles, interlayer adsorption site maps, radial distribution functions, and adsorption enthalpies derived from the equilibrated structural models are used to evaluate the optimal adsorption configurations and thermodynamics for Cs- and Rb-endmembers, a 50:50 Cs-Rb composition for the aqueous interlayer of vermiculite, and for the interlayer wedge zone as mica is transformed to HIV (i.e., HIV-mica wedge). Adsorption enthalpies for both cations are significantly larger for the frayed edge wedges (as represented by the HIV-mica wedge model) compared to values for the vermiculite and mica interlayers. Cesium cation binds more strongly than Rb(+) in the vermiculite interlayer, while Rb(+) binds more strongly than Cs(+) in the HIV-mica wedge. In all cases, the derived adsorption enthalpies for both cations indicate a preference for the wedge environment where electrostatic interaction is enhanced due to the presence of layer charge and the increased size of interlayer at the wedge accommodating cations larger than K(+).

Enrichment of cesium and rubidium in weathered micaceous materials at the Savannah River Site, South Carolina.

The enrichment of Cs and Rb relative to Ba, Sr, and K in three soils representing a range of soil maturities was determined to investigate the long-term sorption behavior of these elements in upland soils of the Savannah River Site (SRS). Elemental mass fractions normalized to upper continental crust (UCC) decreased in the order Cs > Rb > Ba > K > Sr in the soil fine fractions. Only the UCC-normalized amount of Cs was greater than unity. The UCC-normalized amounts in strong-acid extracts decreased as Cs > Rb > Ba > K ≈ Sr. In all three soil cores, the trends of the UCC-normalized amounts of acid-extractable metals were similar to trends of cation-exchange capacity (CEC) calculated from synchrotron-X-ray diffractometry measurements of soil mineralogy. Consequently, the relative enrichment of Cs and Rb is largely controlled by selective sorption to micaceous minerals, including hydroxy-interlayered vermiculite, that dominate the CEC. Where high clay content had caused retention of soil solution, amounts of acid extractable K, Sr, and Ba were enhanced. The retention of natural Cs by these three soils, which developed over many thousands of years, is a strong indicator that radiocesium will likewise be retained in SRS soils.