Journal of Parkinson's Disease - Volume 6, issue 1

Authors: Jones, Corinne A. | Ciucci, Michelle R.

Article Type: Research Article

Abstract: Background: Parkinson disease (PD) has detrimental effects on swallowing function. Treatment options are largely behavioral; thus, patients would benefit from an earlier start to therapy. Early swallowing changes in PD are not well-known, so patients do not typically receive swallowing treatment until later in the progression of PD. Objective: We used predictive modeling to determine what quantitative swallowing variables best differentiate individuals with early to mid-stage PD from healthy controls. Methods: Participants included twenty-six individuals with early to mid-stage PD and 26 healthy, age- and sex-matched controls. Swallowing was evaluated by simultaneous high-resolution manometry and …videofluoroscopy as well as the Sydney Swallow Questionnaire (SSQ). Binomial logistic regression was performed on 4 sets of data: 1) high-resolution manometry only; 2) videofluoroscopy only; 3) SSQ only; and 4) all data combined. Results: A model from a combined data set had the highest accuracy in differentiating individuals with PD from controls. The model included maximum pressure in the velopharynx (soft palate), pressure variability in the velopharynx, and the SSQ item concerning difficulty with swallowing saliva. No significant models could be generated using the videofluoroscopy data. Conclusions: Individuals with PD show quantitative changes in pressure generation and are able to self-assess aspects of swallowing function in the early and mid-stages of PD, even in the absence of swallowing changes seen on videofluoroscopy. A multimodal approach for the assessment of swallowing may be more accurate for determining subtle swallowing changes that occur in the early stages of PD. Show more

Keywords: Parkinson disease, deglutition, high-resolution manometry, videofluoroscopy

DOI: 10.3233/JPD-150687

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 197-208, 2016

Authors: Murakami, Hidetomo | Momma, Yutaro | Nohara, Tetsuhito | Mori, Yukiko | Futamura, Akinori | Sugita, Toshihisa | Ishigaki, Seiichiro | Katoh, Hirotaka | Kezuka, Machiko | Ono, Kenjiro | Miller, Michael W. | Kawamura, Mitsuru

Article Type: Research Article

Abstract: Background: Dopaminergic drugs, the gold standard for motor symptoms, are known to affect cognitive function in Parkinson’s disease (PD) patients. Objective: We compared the effects of dopaminergic treatment on motor and cognitive function in drug-naïve patients. Methods: Dopaminergic medication (levodopa, dopamine agonist, selegiline) was given to 27 drug-naïve PD patients and increased to a dose optimal for improved motor symptoms. Patients were tested prior to, and 4–7 months after, drug initiation. Motor function was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS). Cognitive function was assessed using both the Japanese version of the Montreal …Cognitive Assessment (MoCA-J) and the Neurobehavioral Cognitive Status Examination (COGNISTAT-J). Improvements from baseline for both motor and cognitive assessment were compared. Results: Mean score of all motor assessments (UPDRS total score of Parts II and III, and sub-scores of tremor, rigidity, bradykinesia, gait, and postural instability) and certain cognitive assessments (MoCA-J total score and subscore of delayed recall) significantly improved with dopaminergic medication. Gait score improvement showed significant positive correlation with improvement in MoCA-J language domain and in language-comprehension subtests of COGNISTAT-J using Spearman’s correlation coefficients. Furthermore, multiple regression analysis showed gait score improvement significantly correlated with improvements in the subtests of language-comprehension in COGNISTAT-J. Conclusion: There is correlated improvement in both gait and language function in de novo PD patients in response to dopaminergic drugs. Gait and language dysfunction in these patients may share a common pathophysiology linked to dopamine deficits. Show more

Keywords: Parkinson’s disease, cognition, executive function, language, verbal fluency disorders, working memory, gait

DOI: 10.3233/JPD-150702

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 209-217, 2016

Authors: Martens, Heidi | Van Nuffelen, Gwen | Wouters, Kristien | De Bodt, Marc

Article Type: Research Article

Abstract: Background: Mapping adequacy of receptive prosodic abilities in speakers with hypokinetic dysarthria due to Parkinson’s disease (PD) is useful, because therapy of disturbed production of prosody relies on adequate reception of prosody. There is evidence for a deficit of reception of emotional prosody in PD. Objective: The present study aims at presenting a comprehensive picture of the reception of various communicative functions of prosody in hypokinetic dysarthria due to PD. Methods: We assessed perception (using a discrimination task) and comprehension (using an identification task) of five communicative functions of Dutch prosody (lexical stress, boundary marking, …focus, sentence mode, and emotional prosody) in a group of adults with hypokinetic dysarthria due to PD (n  = 22) and a gender and age matched group of unimpaired adults (n  = 22). We also investigated the relationship between age and global test score, and the effect of perception and comprehension subtest sequence on the global test score. Results: Between groups, no significant differences in receptive prosodic abilities were found. Within both groups, the comprehension subtest was significantly more difficult than the perception subtest, and there was a significant negative correlation between age and global test score. No subtest sequence effect could be demonstrated. Conclusions: Considering that the older speakers with hypokinetic dysarthria due to PD had receptive prosodic skills inferior to those of the younger speakers, notwithstanding apparently intact cognition and hearing, the findings suggest that age is a factor to be reckoned with in prosody assessment and management in this population. Show more

Keywords: Parkinson’s disease, dysarthria, speech, perception, comprehension

DOI: 10.3233/JPD-150678

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 219-229, 2016

Authors: Jacobs, Marie L. | Dauvilliers, Yves | St. Louis, Erik K. | McCarter, Stuart J. | Romenets, Silvia Rios | Pelletier, Amélie | Cherif, Mahmoud | Gagnon, Jean-François | Postuma, Ronald B.

Article Type: Research Article

Abstract: Background: Numerous large-scale studies have found diverse risk factors for Parkinson’s disease (PD), including caffeine non-use, non-smoking, head injury, pesticide exposure, and family history. These studies assessed risk factors for PD overall; however, PD is a heterogeneous condition. One of the strongest identifiers of prognosis and disease subtype is the co-occurrence of rapid eye movement sleep behavior disorder (RBD). In previous studies, idiopathic RBD was associated with a different risk factor profile from PD and dementia with Lewy bodies, suggesting that the PD-RBD subtype may also have a different risk factor profile. Objective: To define risk …factors for PD in patients with or without associated RBD. Methods: In a questionnaire, we assessed risk factors for PD, including demographic, medical, environmental, and lifestyle variables of 189 PD patients with or without associated polysomnography-confirmed RBD. The risk profile of patients with vs. without RBD was assessed with logistic regression, adjusting for age, sex, and disease duration. Results: PD-RBD patients were more likely to have been a welder (OR = 3.11 (1.05–9.223), and to have been regular smokers (OR = 1.96 (1.04–3.68)). There were no differences in use of caffeine or alcohol, other occupations, pesticide exposure, rural living, or well water use. Patients with RBD had a higher prevalence of the combined family history of both dementia and parkinsonism (13.3% vs. 5.5% , OR = 3.28 (1.07–10.0). Conclusion: The RBD-specific subtype of PD may also have a different risk factor profile. Show more

Keywords: Parkinson’s disease, REM sleep behavior disorder, risk factors

DOI: 10.3233/JPD-150725

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 231-237, 2016

Authors: Canesi, Margherita | Rusconi, Maria Luisa | Moroni, Federica | Ranghetti, Alessandra | Cereda, Emanuele | Pezzoli, Gianni

Article Type: Research Article

Abstract: Background: An increase in artistic-like production in Parkinson’s disease (PD) has been associated with compulsive and repetitive behaviours after the introduction of dopaminergic treatment (DT). Recent data suggest that it could be due to the emergence of artistic-like skills triggered by DT. Objective: In order to evaluate whether artistic production and creative thinking are influenced by DT or linked to artistic-like skills, we characterize creativity features in PD and healthy controls (HC) including professional artists. Methods: Three groups of PD out-patients were included consecutively: professional artists (PD-A), patients with (PD-C) and without artistic-like production (PD-NC). …Twenty-four gender and age-matched HC were included: professional artists (HC-A) and non-artists (HC-NC). All patients were evaluated by means of a) a battery of neuropsychological tests and a semi-structured interview; b) the Abbreviated Torrance Test for Adults (ATTA) for creative thinking; c) the Minnesota Impulsive Disorders Interview (mMIDI) and a screening for impulse control disorders (ICDs) for compulsive behaviour. Results: ATTA total score was significantly higher in HC-A and PD-A than in the other groups. Although PD-NC showed the lowest ATTA total score the difference vs HC-NC was not significant. ATTA scores were not significantly correlated with DT dosage and duration. mMIDI tests were positive only in PD. There were no differences in ICDs among PD groups. Conclusions: Our results do not support a relationship between DT and the emergence of artistic creativity. We believe that DT may increase the drive to create and that further studies in “on” and “off” medication are needed to clarify this issue. Show more

Keywords: Creativity, professional artists, dopaminergic therapy, impulse control disorders, Parkinson phenotype

DOI: 10.3233/JPD-150681

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 239-246, 2016

Authors: Bhattacharjee, Sandipan | Goldstone, Lisa | Warholak, Terri

Article Type: Research Article

Abstract: Background: Elderly individuals with Parkinson’s disease (PD) generally suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the author’s knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States (US). Objective: Therefore, the primary objective of this study was to examine the prevalence, patterns and predictors of psychotropic polypharmacy among elderly individuals with PD in the (US). Methods: A retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice …Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥65 years) individuals with PD. Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy. Results: Approximately 93,648 and 37,439 elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28%, whereas, it was 21.36% in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%) and home health (40.98%) residents with PD. Multiple logistic regression analyses revealed that specific comorbidities were significantly associated with psychotropic polypharmacy among elderly nursing home residents with PD. Conclusions: These findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy. Show more

Keywords: Parkinson’s disease, nursing homes, home health Care, psychotropic drugs, elderly

DOI: 10.3233/JPD-150646

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 247-255, 2016

Authors: Weintraut, Rita | Karádi, Kázmér | Lucza, Tivadar | Kovács, Márton | Makkos, Attila | Janszky, József | Kovács, Norbert

Article Type: Research Article

Abstract: Background: Apathy is a syndrome characterized primarily by lack of motivation which may be associated with cognitive, affective and behavioral changes. Although the Lille Apathy Scale (LARS) has been extensively utilized in PD for detecting apathy and testing the effectiveness of specific therapeutic interventions, the highly variable cut-off values (between –11 and –22 points) ensures the applicability of the LARS degree of difficulty as a superb screening tool. Objective: The aim of this study is to determine more reliable threshold values based on the neuropsychiatric status of patients. Methods: Depression was assessed utilizing the Montgomery-Asberg …Depression Rating Scale and neurocognitive status by Addenbrooke’s Cognitive Examination. The presence of apathy was assessed by the proposed diagnostic criteria of Drijgers et al, and graded by both LARS and the ‘Apathy’ item of MDS-UPDRS. Results: Based on multivariate regression analysis, we revealed the neurocognitive status, severity of depression, and also gender while applying dosage of dopamine agonists to determine the degree of patient apathy. Based on whether or not depression and neurocognitive disorders were indeed present, we established four different threshold values for the LARS: patients with normal cognition and without depression: –22.5; patients with normal cognition and with depression: –18.5; patients with NCD and without depression: –19.5; patients with NCD and with depression: –14.5. Conclusions: The LARS and the ‘Apathy’ item of MDS-UPDRS were confirmed to be potentially operational, beneficial and easy-to-assess instruments for detecting apathy syndrome in PD. However, there is no universal threshold value for the LARS suitable in all types of Parkinson’s patients. Show more

Keywords: Apathy, scale, threshold value, Parkinson’s disease, validation

DOI: 10.3233/JPD-150726

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 257-265, 2016

Authors: Rieu, Isabelle | Houeto, Jean Luc | Pereira, Bruno | De Chazeron, Ingrid | Bichon, Amélie | Chéreau, Isabelle | Ulla, Miguel | Brefel-Courbon, Christine | Ory-Magne, Fabienne | Dujardin, Kathy | Tison, François | Krack, Paul | Durif, Franck

Article Type: Research Article

Abstract: Background: Mood symptoms negatively affect quality of life of Parkinson’s disease (PD); however little is known about the impact of behavioral disorders such as impulse control disorders, and non-motor fluctuations on quality of life. Objective: To assess the impact of mood and behavioral disorders on quality of life in PD. Methods: 136 (84% male) PD were included (mean age: 61±8y; mean duration of disease: 8.8±5.4y). Mood symptoms, behavioral disorders and non-motor fluctuations were detected and quantified using the recently validated “Ardouin Scale of Behavior in Parkinson’s Disease”. Motor symptoms were assessed using UPDRS and quality …of life with the “39-item Parkinson’s Disease Questionnaire”. Results: Both motor and non-motor factors significantly affected the quality of life of PD patients. Multivariate regression of the relationship between items of the quality of life questionnaire and the Ardouin Scale showed that alteration of patients’ quality of life was strongly correlated with the presence of mood symptoms (such as depression, anxiety ...) and with non-motor fluctuations (especially in the OFF period). A significant correlation was also found between the number of symptoms and their severity, and the quality of life deterioration. Some behavioral disorders (compulsive buying / eating behavior) also negatively affected patient’s quality of life to a lesser extent. Alternatively, excess in motivation and hobbyism behaviors had a positive impact on mobility and emotional well-being dimensions respectively of quality of life. Conclusions: This study shows the main impact of mood symptoms and non-motor fluctuations on worsening quality of life in PD. Show more

Keywords: Parkinson’s disease, quality of life, impulse control disorders, mood disorders

DOI: 10.3233/JPD-150747

Citation: Journal of Parkinson's Disease, vol. 6, no. 1, pp. 267-277, 2016