Journal of Parkinson's Disease - Volume 2, issue 3

Authors: Lewis, Patrick A.

Article Type: Review Article

Abstract: James Parkinson occupies a unique position in the history of Parkinson's disease. As the man responsible for originally identifying and describing the disease that he called the Shaking Palsy, his name is familiar to anybody with a connection with the disease – patients, carers, clinicians and members of the general public alike. This review summarises the life and career of one of the most recognizable names in neurology.

Keywords: History of neurology, Parkinson's disease, James Parkinson

DOI: 10.3233/JPD-2012-012108

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 181-187, 2012

Authors: Manson, Alice | Stirpe, Paola | Schrag, Anette

Article Type: Review Article

Abstract: Levodopa-induced dyskinesias (LID) belong to the most common dose-limiting adverse effects of levodopa therapy. “Peak-dose” LID occur with the maximum effect of medication, ‘diphasic dyskinesias’ have a “beginning- and end-of-dose” pattern, and the, “off-period dyskinesia” occur during off-periods, most frequently in the early mornings and are typically dystonic in nature. The majority of patients will have developed dyskinesias after 10 years of treatment, and about 40–50% after 5 years. Occurrence of LID appears to be related to dose and duration of treatment with levodopa and severity and duration of disease. In addition, patients with younger age of onset have been …reported to have an earlier onset and higher rate of LID. The important aetiological role of non-physiological pulsatile stimulation of dopaminergic receptors is increasingly recognized and more continuous dopaminergic stimulation with the longer acting dopamine agonists has been shown to reduce and delay the onset of dyskinesias. LID may not have a significant effect on quality of life in patients with early disease or in very advanced disease stages. when often other problems arise, but in other patients they may be severely disabling. Treatment strategies to overcome LID include adjustment of timing, type and amount of dopaminergic medication, treatment with amantadine and, in treatment resistant cases, stereotactic surgery involving deep brain stimulation or lesioning procedures. A number of other pharmacological options are also being explored. Several methods for the assessment of LID are available to attempt accurate assessment of efficacy, although all of these have limitations, and further evidence on their utility if needed. Show more

Keywords: Dyskinesia, clinical features, epidemiology, treatment

DOI: 10.3233/JPD-2012-120103

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 189-198, 2012

Authors: McAuley, J.H. | Gregory, S.

Article Type: Research Article

Abstract: Background: Olfactory hallucinations are known to occur in idiopathic Parkinson's disease (IPD) but are much less well-described than visual hallucinations. Objective: To report the prevalence, clinical features, response to treatment and prognosis of olfactory hallucinations in IPD. Methods: 205 consecutively reviewed IPD patients and 205 non-IPD control patients attending the local hospital were surveyed for the presence of olfactory hallucinations by specific questioning; the IPD patients were followed up for at least three years. Results: Of 188 patients who had a clinical course remaining consistent with IPD, four were initially found to have olfactory hallucinations, yielding a prevalence of 2.1% …(95% confidence interval 0.4–5.4%). Two further patients developed such hallucinations later during the study. Olfactory hallucinations were not always accompanied by other hallucination modalities. The patients had a long duration of disease treated with dopaminergic medication, loss of sense of smell typical for IPD, no dementia or features suggestive of non-idiopathic PD after three years follow-up, a lack of insight into their hallucinations with consequent failure to report them spontaneously, and a good and lasting response to modest doses of atypical antipsychotics. Conclusions: This study confirms the significant prevalence of olfactory hallucinations, describes their clinical features and indicates that they may occur in isolation and not predict other psychotic or dementing features. The nuisance that such hallucinations cause, their ease of treatment and their failure to be volunteered as a symptom means that specific questioning for their presence should be included in routine assessment of patients with IPD. Show more

Keywords: Parkinson's disease, smell, olfaction, hallucinations, prevalence

DOI: 10.3233/JPD-2012-012086

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 199-205, 2012

Authors: Sage, Michael D. | Bryden, Pamela J. | Roy, Eric A. | Almeida, Quincy J.

Article Type: Research Article

Abstract: Background: The Unified Parkinson's Disease Rating Scale (UPDRS) is the gold standard for assessing Parkinsonian symptoms, yet objective outcome measures are needed to complement the UPDRS in research and clinical practice. Objective: This study aimed to investigate the relationship between performance on the Grooved Pegboard Test (GP) and clinical assessment of Parkinson's motor symptoms with the UPDRS. Methods: A large sample of individuals with Parkinson's disease (n = 191) were assessed with the GP and UPDRS motor section. The GP was separated into a place (more representative of visuospatial accuracy) and remove phase (general representation of motor speed and bradykinesia). …Both tests were completed at peak anti-parkinsonian medication levels, and UPDRS subscores were calculated to represent upper-limb control, rigidity, bradykinesia, and tremor. A subsequent correlation analysis was completed. Results: The strongest relationships were between the GP place phase (both limbs) and total UPDRS motor score (affected: r = 0.604, less-affected: r = 0.587), upper-limb control (affected: r = 0.367, less-affected: r = 0.426), rigidity (affected: r = 0.479, less-affected: r = 0.457) and body bradykinesia (affected: r = 0.375, less-affected: r = 0.438). The GP remove phase had weak positive relationships with total UPDRS scores (affected: r = 0.31, less-affected r = 0.31) and body bradykinesia (r = 0.31). Conclusions: Clinical assessment of upper-limb control, rigidity and bradykinesia are well represented by the GP place phase. Interestingly, it appeared that GP performance of the more affected limb may be more representative of motor severity in the early stages of disease, while more research is needed to understand the utility of the GP in the advanced stages of disease. Show more

Keywords: Grooved Pegboard Test, Parkinson's disease, UPDRS, assessment

DOI: 10.3233/JPD-2012-012093

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 207-213, 2012

Authors: Charles, David | Tolleson, Christopher | Davis, Thomas L. | Gill, Chandler E. | Molinari, Anna L. | Bliton, Mark J. | Tramontana, Michael G. | Salomon, Ronald M. | Kao, Chris | Wang, Lily | Hedera, Peter | Phibbs, Fenna T. | Neimat, Joseph S. | Konrad, Peter E.

Article Type: Research Article

Abstract: Background: Deep brain stimulation provides significant symptomatic benefit for people with advanced Parkinson's disease whose symptoms are no longer adequately controlled with medication. Preliminary evidence suggests that subthalamic nucleus stimulation may also be efficacious in early Parkinson's disease, and results of animal studies suggest that it may spare dopaminergic neurons in the substantia nigra. Objective: We report the methodology and design of a novel Phase I clinical trial testing the safety and tolerability of deep brain stimulation in early Parkinson's disease and discuss previous failed attempts at neuroprotection. Methods: We recently conducted a prospective, randomized, parallel-group, single-blind pilot clinical trial …of deep brain stimulation in early Parkinson's disease. Subjects were randomized to receive either optimal drug therapy or deep brain stimulation plus optimal drug therapy. Follow-up visits occurred every six months for a period of two years and included week-long therapy washouts. Results: Thirty subjects with Hoehn & Yahr Stage II idiopathic Parkinson's disease were enrolled over a period of 32 months. Twenty-nine subjects completed all follow-up visits; one patient in the optimal drug therapy group withdrew from the study after baseline. Baseline characteristics for all thirty patients were not significantly different. Conclusions: This study demonstrates that it is possible to recruit and retain subjects in a clinical trial testing deep brain stimulation in early Parkinson's disease. The results of this trial will be used to support the design of a Phase III, multicenter trial investigating the efficacy of deep brain stimulation in early Parkinson's disease. Show more

Keywords: Parkinson's disease, deep brain stimulation, subthalamic nucleus, research design

DOI: 10.3233/JPD-2012-012095

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 215-223, 2012

Authors: Bronner, Gila | Hassin-Baer, Sharon

Article Type: Research Article

Abstract: Background: A range of impulse control disorders has been described in Parkinson's disease, including compulsive sexual behavior. Excessive sexual demands of parkinsonian men can lead to considerable tension within the couple. Thorough sexual interviews reveal that these cases may reflect various types of sexual dysfunctions that present as hypersexuality. Objective: This study aims to analyze cases of presumed and true compulsive male sexual behavior, and to propose a practical tool for clinicians, assisting them with the diagnosis and management of compulsive sexual behavior and other sexual dysfunctions in parkinsonian patients. Methods: We describe four male patients with Parkinson's disease from …the movement disorders clinic, which were referred to the sex therapist as suspected hypersexuality. Results: The sexual assessment revealed that only one of the cases involved true hypersexuality due to compulsive sexual behavior. The other three presented with erectile dysfunction, difficulties reaching orgasm (delayed ejaculation), and a gap in desire within the couple. Conclusions: Complaints about hypersexual behavior in patients with Parkinson's disease must be carefully evaluated, involving a multidisciplinary team. A comprehensive diagnostic and therapeutic algorithm is suggested. Show more

Keywords: Sexual dysfunction, hypersexuality, hypersexual behavior, compulsive sexual behavior, erectile dysfunction, Parkinson's disease, diagnosis

DOI: 10.3233/JPD-2012-012098

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 225-234, 2012

Authors: Hohler, Anna D. | Amariei, Diana Elena | Katz, Douglas I. | DePiero, T. Joy | Allen, Valerie B. | Boyle, Suzanne | Phenix, Heidi Alison | DeAngelis, Tara Ashley | Geibel, Carrie Denise | Smith, Karla M. | Saint-Hilaire, Marie | Ellis, Terry

Article Type: Research Article

Abstract: Background: Patients with idiopathic Parkinson's disease (PD) or atypical Parkinsonism (AP) often present with orthostatic hypotension (OH) as a result of the dysautonomia associated with the disease or as a side effect of the dopaminergic medications used to treat it. Our recent study suggested that OH negatively impacts gross motor, balance, and cognitive functions in patients with PD. Objective: To determine if correcting the orthostatic hypotension (OH) of patients with PD or AP improves their gross motor, balance, and cognitive functions. Methods: Forty patients with PD or AP were assessed before and after correcting their OH using a staged approach …with a goal of SBP >80 when standing and SBP <180 when laying. Step 1 of treatment included reducing antihypertensive medications, as possible, maintaining hydration with 1500cc/day, decreasing dietary salt, wearing high compression stockings, and keeping the head of bed elevated at 30 degrees when supine. If SBP <80 with standing after step 1, then treatment was started with fludrocortisone and/or midodrine. Results: Patients' OH was managed as part of a rehabilitation program. Tests such as the Motor and Cognitive Functional Independence Measures, Berg Balance Scale, Two Minute Walking test, and the Finger Tapping test showed significant improvements (p < 0.05) in their gross motor, walking, balance and cognitive function with our OH management plan. No significant differences between admission and discharge were found in the Timed Up and Go test. Conclusion: Our data suggest that monitoring and correcting the OH of patients with PD or AP improves their gross motor, balance, and cognitive function. Show more

Keywords: Parkinson's disease, Parkinsonism, orthostatic hypotension, motor function, cognitive function

DOI: 10.3233/JPD-2012-012101

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 235-240, 2012

Authors: Speelman, Arlène D. | Groothuis, Jan T. | van Nimwegen, Marlies | van der Scheer, Ellis S. | Borm, George F. | Bloem, Bastiaan R. | Hopman, Maria T.E. | Munneke, Marten

Article Type: Research Article

Abstract: Background: Patients with Parkinson's disease (PD) are physically less active than controls, and autonomic dysfunction may contribute to this sedentary lifestyle. Specifically, an altered cardiovascular response to physical effort may restrict physical activities. Objective: To assess the cardiovascular responses to a submaximal exercise test in PD patients and controls, 546 sedentary PD patients and 29 sedentary healthy controls performed the Åstrand-Rhyming submaximal cycle exercise test. Methods: Average heart rate was used to estimate maximal oxygen consumption (VO2 max). Variables that may affect submaximal activity in PD patients, including disease severity, fatigue, and level of physical activity in daily life, were …recorded. Results: Fewer PD patients (46%) completed the submaximal exercise test successfully than the controls (86%). The estimated VO2 max of patients with a successful test was 34% lower than the controls (p < 0.001). Multivariate regression analyses revealed that higher body weight, lower systolic blood pressure, lower resting heart rate, and lower maximal workload were associated with an increased risk of an inadequate heart rate increase during submaximal exercise (R2 = 27%). PD patients with a successful submaximal exercise test had lower estimated VO2 max values than controls. Conclusions: Importantly, half of the PD patients had an inadequate heart rate increase during submaximal exercise, which was likely caused by cardiac sympathetic denervation leading to autonomic dysfunction. PD patients should therefore be screened to identify their limitations in exercise performance. Caution should be applied when prescribing beta blockers, as they might limit physical activities further. Show more

Keywords: Parkinson's disease, exercise test, physical fitness, autonomic dysfunction

DOI: 10.3233/JPD-2012-012111

Citation: Journal of Parkinson's Disease, vol. 2, no. 3, pp. 241-247, 2012