Journal of Parkinson's Disease - Volume 13, issue 5

Authors: Albano, Luigi | Agosta, Federica | Basaia, Silvia | Cividini, Camilla | Stojkovic, Tanja | Sarasso, Elisabetta | Stankovic, Iva | Tomic, Aleksandra | Markovic, Vladana | Canu, Elisa | Stefanova, Elka | Mortini, Pietro | Kostic, Vladimir S. | Filippi, Massimo

Article Type: Research Article

Abstract: Background: The hypothesis that the effectiveness of deep brain stimulation (DBS) in Parkinson’s disease (PD) would be related to connectivity dysfunctions between the site of stimulation and other brain regions is growing. Objective: To investigate how the subthalamic nucleus (STN), the most frequently used DBS target for PD, is functionally linked to other brain regions in PD patients according to DBS eligibility. Methods: Clinical data and resting-state functional MRI were acquired from 60 PD patients and 60 age- and sex-matched healthy subjects within an ongoing longitudinal project. PD patients were divided into 19 patients eligible for …DBS and 41 non-candidates. Bilateral STN were selected as regions of interest and a seed-based functional MRI connectivity analysis was performed. Results: A decreased functional connectivity between STN and sensorimotor cortex in both PD patient groups compared to controls was found. Whereas an increased functional connectivity between STN and thalamus was found in PD patient groups relative to controls. Candidates for DBS showed a decreased functional connectivity between bilateral STN and bilateral sensorimotor areas relative to non-candidates. In patients eligible for DBS, a weaker STN functional connectivity with left supramarginal and angular gyri was related with a more severe rigidity and bradykinesia whereas a higher connectivity between STN and cerebellum/pons was related to poorer tremor score. Conclusion: Our results suggest that functional connectivity of STN varies among PD patients eligible or not for DBS. Future studies would confirm whether DBS modulates and restores functional connectivity between STN and sensorimotor areas in treated patients. Show more

Keywords: Parkinson’s disease, functional connectivity, deep brain stimulation, subthalamic nucleus

DOI: 10.3233/JPD-230005

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 797-809, 2023

Authors: Koros, Christos | Simitsi, Athina-Maria | Papagiannakis, Nikolaos | Bougea, Anastasia | Prentakis, Andreas | Papadimitriou, Dimitra | Pachi, Ioanna | Beratis, Ion | Stanitsa, Evangelia | Angelopoulou, Efthalia | Antonelou, Roubina | Bregianni, Marianna | Lourentzos, Konstantinos | Papageorgiou, Sokratis G. | Bonakis, Anastasios | Trapali, Xenia Geronicola | Stamelou, Maria | Stefanis, Leonidas

Article Type: Research Article

Abstract: Background: The role of blood uric acid as a biomarker in symptomatic motor PD has been increasingly established in the literature. Objective: Our present study assessed the role of serum uric acid as a putative biomarker in a prodromal PD cohort [REM Sleep Behavior disorder (RBD) and Hyposmia] followed longitudinally. Methods: Longitudinal 5-year serum uric acid measurement data of 39 RBD patients and 26 Hyposmia patients with an abnormal DATSCAN imaging were downloaded from the Parkinson’s Progression Markers Initiative database. These cohorts were compared with 423 de novo PD patients and 196 healthy controls enrolled in …the same study. Results: After adjusting for age, sex, body mass index, and concomitant disorders (hypertension/gout), baseline and longitudinal serum uric acid levels were higher in the RBD subgroup as compared to the established PD cohort (p  = 0.004 and p  = 0.001). (Baseline RBD 6.07±1.6 vs. Baseline PD 5.35±1.3 mg/dL and Year-5 RBD 5.7±1.3 vs. Year-5 PD 5.26±1.33). This was also true for longitudinal measurements in the Hyposmic subgroup (p  = 0.008) (Baseline Hyposmic 5.7±1.6 vs. PD 5.35±1.3 mg/dL and Year-5 Hyposmic 5.58±1.6 vs. PD 5.26±1.33). Conclusion: Our results indicate that serum uric acid levels are higher in prodromal PD subjects with ongoing dopaminergic degeneration compared to those with manifest PD. These data indicate that the well-established decrease in the levels of serum uric acid occurs with the transition from prodromal to clinical PD. Whether the higher levels of serum uric acid observed in prodromal PD may provide protection against conversion to full-blown clinical PD will require further study. Show more

Keywords: Prodromal Parkinson’s disease, uric acid, REM sleep behavior disorder, hyposmia

DOI: 10.3233/JPD-230007

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 811-818, 2023

Authors: Yilmaz, Rezzak | Wolke, Robin | Puls, Nina | Sorgun, Mine Hayriye | Deuschl, Günther | Berg, Daniela | Margraf, Nils G.

Article Type: Research Article

Abstract: Background: Camptocormia (CC) is the forward-bending of the spine of more than 30 degrees that can be found in Parkinson’s disease (PD) as a disabling complication. Detection of changes in paraspinal lumbar musculature in CC is of value for choosing treatment strategies. Objective: To investigate whether these changes can be detected using muscle ultrasonography (mUSG). Methods: Age and sex-matched groups comprised 17 PD patients with CC (seven acute, PD-aCC; 10 chronic PD-cCC), 19 PD patients with no CC, and 18 healthy controls (HC). Lumbar paravertebral muscles (LPM) on both sides were assessed using mUSG by two …different raters blinded to the group assignment. Groups were compared with regard to the linear measurements of the muscle thickness as well as semi-quantitative and quantitative (grayscale) analyses of muscle echogenicity using a univariate general linear model. Results: All assessments showed substantial interrater reliability. The PD-cCC group had significantly thinner LPM compared to groups with no CC (PD and HC). Groups of PD-aCC and PD-cCC differed from the groups of no CC in quantitative and semi-quantitative analyses of LPM echogenicity, respectively. Conclusion: Assessment of LPM in PD patients with CC can be reliably performed using mUSG. Also, mUSG may be used as a screening tool to detect CC-related changes in thickness and echogenicity of the LPM in patients with PD. Show more

Keywords: Parkinson’s disease, camptocormia, posture

DOI: 10.3233/JPD-230037

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 819-827, 2023

Authors: Stopic, Vasilija | Jost, Stefanie T. | Baldermann, Juan Carlos | Petry-Schmelzer, Jan Niklas | Fink, Gereon R. | Dembek, Till A. | Dafsari, Haidar S. | Kessler, Josef | Barbe, Michael T. | Sauerbier, Anna

Article Type: Research Article

Abstract: Background: Stigma is significant in Parkinson’s disease (PD). However, no specific tool is available to assess stigma in PD comprehensively. Objective: This pilot study aimed to develop and test a stigma questionnaire specific to PD patients (PDStigmaQuest). Methods: Based on a literature review, clinical experience, expert consensus, and patients’ feedback, we developed the preliminary, patient-completed PDStigmaQuest in German language. It included 28 items covering five stigma domains: uncomfortableness, anticipated stigma, hiding, experienced stigma, and internalized stigma. In this pilot study, 81 participants (PD patients, healthy controls, caregivers, and health professionals) were included to investigate the acceptability, …feasibility, comprehensibility, and psychometric properties of the PDStigmaQuest. Results: The PDStigmaQuest showed 0.3% missing data points for PD patients and 0.4% for controls, suggesting high data quality. Moderate floor effects, but no ceiling effects were found. In the item analysis, most items met the standard criteria of item difficulty, item variance, and item-total correlation. Cronbach’s alpha was > 0.7 for four of five domains. PD patients’ domain scores were significantly higher than healthy controls’ for uncomfortableness, anticipated stigma, and internalized stigma. Feedback to the questionnaire was predominantly positive. Conclusion: Our results indicate that the PDStigmaQuest is a feasible, comprehensive, and relevant tool to assess stigma in PD and helps to understand the construct of stigma in PD further. Based on our results, the preliminary version of the PDStigmaQuest was modified and is currently validated in a larger population of PD patients for use in clinical and research settings. Show more

Keywords: Stigma, quality of life, pilot study, questionnaire development

DOI: 10.3233/JPD-230071

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 829-839, 2023

Authors: Oftedal, Linn | Maple-Grødem, Jodi | Tysnes, Ole-Bjørn | Alves, Guido | Lange, Johannes

Article Type: Short Communication

Abstract: Seed amplification assays (SAA) are the first credible molecular assay for Parkinson’s disease (PD). However, the value of SAA to support the clinicians’ initial diagnosis of PD is not clear. In our study, we analyzed cerebrospinal fluid samples from 121 PD patients recruited through population screening methods and taken within a median delay of 38 days from diagnosis and 51 normal controls without neurodegenerative disease. SAA yielded a sensitivity of 82.6% (95% CI, 74.7% – 88.9%) and specificity of 88.2% (95% CI, 76.1% – 95.6%). These results highlight the potential of SAA to support the initial diagnosis of PD in …clinical practice and research. Show more

Keywords: Seed amplification assay, alpha-synuclein, biomarker, cerebrospinal fluid, Parkinson’s disease, diagnosis

DOI: 10.3233/JPD-230065

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 841-844, 2023

Authors: Ineichen, Christian | Vogel-Baumann, Heide | Sitzler, Matthias | Deuschl, Günther | Baumann, Christian R.

Article Type: Article Commentary

Abstract: In a retrospective analysis, we recently reported findings on the detrimental motor effects of interrupted physiotherapy following the COVID-19 pandemic in parkinsonian patients. Using an extended follow-up period, we investigated the beneficial effect of reinstated physiotherapy on patients’ disease severity and reversal of interruption-induced motor deterioration. Compared to before the COVID-19 outbreak, we observed persistence of motor disease worsening despite full resumption of state-of-the-art physical therapy suggesting that motor deterioration after discontinuation of physical therapy could not be compensated for. Therefore, and considering possible future crises, establishing means to safeguard continuation of physical therapy and to foster remote provision of …care should be major goals. Show more

Keywords: Parkinson’s disease, COVID-19, confinement, motor disease severity, MDS-UPDRS part III

DOI: 10.3233/JPD-230061

Citation: Journal of Parkinson's Disease, vol. 13, no. 5, pp. 845-848, 2023