Journal of Parkinson's Disease - Volume 8, issue 1

Authors: Mantri, Sneha | Fullard, Michelle E. | Duda, John E. | Morley, James F.

Article Type: Research Article

Abstract: Background: Physical activity and exercise improve outcomes in Parkinson disease (PD), however little is known about activity levels in early PD patients. Objective and Methods: We examined self-reported activity scores and examined associations with clinical characteristics in 383 PD subjects and 175 healthy controls from the Parkinson Progression Markers Initiative (PPMI). Results: Activity scores were 8% lower for PD subjects than HC (162.6±86.2 vs 175.0±78.5, p  = 0.10). Higher scores were associated with younger age and male sex. Only 47% of PD subjects and 44% of HC reported activity consistent with standard recommendations for adults. …Conclusions: Our findings highlight the need to encourage exercise even in early PD. Show more

Keywords: Disease progression, Parkinson disease, Parkinson Progression Markers Initiative, physical activity

DOI: 10.3233/JPD-171218

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 107-111, 2018

Authors: Ortelli, Paola | Ferrazzoli, Davide | Bera, Rossana | Caremani, Luca | Giladi, Nir | Maestri, Roberto | Frazzitta, Giuseppe

Article Type: Research Article

Abstract: Background: Parkinsonian patients in advanced stages of disease suffer from many motor and non-motor symptoms, whose responsiveness to dopamine replacement therapy and deep brain stimulation is poor. It is necessary to find complementary strategies in order to improve the clinical conditions of patients in advanced Parkinson’s disease (PD) stages. Objective: We aimed to understand whether an inpatient, motor-cognitive, multidisciplinary, aerobic, intensive and goal-based rehabilitation treatment (MIRT), specifically designed for PD, is effective for patients in advanced stages of disease. Methods: 638 Parkinsonian patients, hospitalized to undergo a 4-week MIRT, were retrospectively identified. According to the Hoehn …& Yahr (H&Y) scale, 496 were in H&Y stage 3 and 142 in H&Y stage 4-5. Outcome measures included: Unified Parkinson’s Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Six Minute Walk Test (6MWT), and Parkinson’s Disease Disability Scale (PDDS). Results: At baseline all measures, except UPDRS IV, significantly worsened passing from H&Y stage 3 to H&Y stage 4-5 (p ≤0.002 all). After rehabilitation all outcome measures significantly improved in both groups of patients (p  < 0.0001 all). Comparing the amount of improvement in the two groups, significant differences were observed only for the changes in BBS and TUG (both p  < 0.0001 after adjustment), with a better improvement in the H&Y stage 4-5 group. Conclusions: A multidisciplinary, motor-cognitive, intensive and goal-based rehabilitation treatment, such as MIRT, could be an effective complementary treatment in PD patients in advanced stages of disease. Show more

Keywords: Advanced stages of disease, multidisciplinary treatment, Parkinson’s disease, rehabilitation

DOI: 10.3233/JPD-171247

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 113-119, 2018

Authors: Bouça-Machado, Raquel | Maetzler, Walter | Ferreira, Joaquim J.

Article Type: Review Article

Abstract: Although yet poorly defined and often misused, the concept of functional mobility has been used in research studies as a more global and ecological outcome of patients’ health status. Functional mobility is a person’s physiological ability to move independently and safely in a variety of environments in order to accomplish functional activities or tasks and to participate in the activities of daily living, at home, work and in the community. Parkinson’s disease (PD) has a direct impact on patients’ motor control and on mobility in general. Even with optimal medical management, the progression of PD is associated with mounting impairments …at different levels of body function, causing marked limitations in a wide variety of activities, as well as a severe disability and loss of autonomy. Despite this, for everyday functioning PD patients need to have a good functional mobility that allow them to get around effortlessly in a reasonable amount of time to access to the same environments as others. This paper reviewed the concept of functional mobility applied to PD. This was done through an International Classification of Functioning and Disability (ICF) perspective. Recommendations to address the known factors that contribute to a poor functional mobility were outlined while suggestions for clinical practice and research were made. Show more

Keywords: Functional mobility, international classification of functioning, disability and health, Parkinson’s disease

DOI: 10.3233/JPD-171233

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 121-130, 2018

Authors: van den Heuvel, Lieneke | Lim, Andrew S. | Visanji, Naomi P. | Huang, Jana | Ghate, Taneera | Mestre, Tiago A. | AlDakheel, Amaal | Connolly, Barbara S. | Gasca-Salas, Carmen | Kern, Drew S. | Jain, Jennifer | Slow, Elizabeth J. | Pondal, Margarita | Faust-Socher, Achinoam | Rogaeva, Ekaterina | Tomlinson, George | Lang, Anthony E. | Marras, Connie

Article Type: Research Article

Abstract: Background: With recent advances in the search for disease-modifying therapies for Parkinson’s disease (PD) the importance of identifying prodromal markers becomes greater. Non-manifesting LRRK2 mutation carriers (NMC) are at risk for developing PD, and provide a population in which to identify possible markers. Objective: The aim of this study was to test the hypothesis that NMC have differences in daily activity, fragmentation of sleep, arm swing asymmetry, and movement variability during walking, detectable by actigraphy, as compared to matched control subjects. Methods: Eleven NMC, fourteen PD patients (4 LRRK2 -PD, 10 idiopathic PD (iPD)), and …twenty-nine controls wore wristbands containing an accelerometer for seven days, and performed a daily walking task. Outcome measures included daily activity, fragmentation of activity, fragmentation of sleep, arm swing asymmetry during walking, and intra-individual variability. Results: Compared to healthy controls, both NMC and LRRK2 /iPD showed higher intra-individual variability in activity during walking compared to healthy controls. Individuals with LRRK2 -PD/iPD, but not NMC, tend to have lower activity levels, more arm swing asymmetry and less increase of arm swing with transition from slow to faster walking speed compared to healthy controls. Conclusion: Higher intra-individual variability of gait-associated movements might be a useful biomarker of prodromal PD. These results encourage replication in a larger sample and longitudinal analysis is warranted. Show more

Keywords: Actigraphy, high risk Parkinson, LRRK2 mutation, non-manifestingLRRK2 carrier, Parkinson’s disease, variability of gait

DOI: 10.3233/JPD-171151

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 131-139, 2018

Authors: Conradt, Christian | Guo, Dianlin | Miclea, Anca | Nisslein, Thomas | Ismail, Chaim | Chatamra, Krai | Andersohn, Frank

Article Type: Research Article

Abstract: Background: The independent contribution of levodopa exposure and Parkinson’s disease (PD) to the risk of polyneuropathy is not established. Objective: This study investigated whether patients with newly diagnosed PD without previous exposure to antiparkinsonian drugs have higher prevalence of polyneuropathy than the general population. Methods: Using the UK General Practice Research Database, presence of polyneuropathy in the previous 3 years was assessed. Results: Of 5089 PD patients and 19,897 controls, polyneuropathy was confirmed in 15 PD patients (0.29% ) and 24 controls (0.12% ). Polyneuropathy prevalence was 2.4-fold higher in PD patients than controls. …Conclusions: In this observational study, PD patients had a higher prevalence of preexisting polyneuropathy that cannot be explained by adverse effects of antiparkinsonian drugs. Show more

Keywords: Polyneuropathy, Parkinson’s disease, observational study

DOI: 10.3233/JPD-161057

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 141-144, 2018

Authors: Lee, Yang-Hyun | Lee, Jee-Eun | Ryu, Dong-Woo | Oh, Yoon-Sang | Lee, Kwang-Soo | Hong, Sung-Hoo | Kim, Joong-Seok

Article Type: Research Article

Abstract: Background: Urinary dysfunction is relatively common, however, is often underestimated and diagnosed by subjective questionnaires in patients with Parkinsonism. Objective: To determine the correlation between subjective urinary dysfunction and post-void residual urine volume in patients with Parkinson’s disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), and to assess the relationship between clinical characteristics and subjective or objective urinary dysfunction. Methods: A total of 196 patients with de novo Parkinsonism without urological and gynecological disorders were included. For all subjects, data were collected on sonographic post-void residual urine volume and urinary symptoms. All patients …were also assessed on motor symptom severity, cognitive and affective measurements, other nonmotor symptoms, 39-item Parkinson’s Disease Questionnaire, and renal functions. Results: Seventeen out of 196 parkinsonian patients showed abnormal post-void residual urine volumes, with ≥100 ml. The MSA group showed significantly higher post-void residual urine volume compared to the PD and PSP groups. Symptoms of the sense of incomplete emptying, weak urine stream, and nocturia were strongly correlated with post-void residual urine volume. Post-void residual urine volume was positively related to autonomic symptoms, other non-motor symptoms, patient activities of daily living, and negatively related to renal function. Conclusion: Increased post-void residual urine volumes were observed in small portion of early drug-naïve Parkinsonian patients, especially in MSA. Post-void residual urine volume was significantly related to subjective urinary and other autonomic dysfunctions. Voiding dysfunction is associated with not only end organ damage, but also other nonmotor dysfunctions and patient activities of daily living. Show more

Keywords: Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy, urinary dysfunction, post-void residual urine

DOI: 10.3233/JPD-171254

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 145-152, 2018

Authors: Kotagal, Vikas | Albin, Roger L. | Müller, Martijn L.T.M | Bohnen, Nicolaas I.

Article Type: Research Article

Abstract: Background: Medical comorbidities, including cardiovascular risk factors such as hypertension and diabetes, influence disease progression in Parkinson disease (PD) and may be variably present in different clinical populations. Objective/Methods: We conducted a retrospective nested case-control study of 29 Veterans with PD and 29 non-Veteran PD controls. The groups were matched for age, gender, and disease duration. Both groups underwent clinical and imaging testing as part of their participation in a larger cross-sectional PD observational study at our research center. Veterans were recruited primarily from movement disorders neurology clinics at the Ann Arbor Veterans Affairs (VA) Health System. Non-Veterans …were recruited primarily from analogous clinics at the University of Michigan Health System. We explored differences in cardiovascular risks factor burden between the groups. Results: Veterans with PD showed higher scores on the simplified Framingham 10-year general cardiovascular disease risk calculator (FR score; 27.3% (11.5) vs. 20.7% (6.8); t  = –2.66, p  = 0.011) and fewer years of self-reported education (14.5 (2.5) vs. 16.7 (2.6); t  = 3.33, p  = 0.002). After adjusting for age, disease duration, education, and the use of antihypertensive medications, Veterans showed higher FR scores (t  = 2.95, p  = 0.005) and a higher intra-subject ratio of FR score to age-and-gender normalized FR score (t  = 2.49, p  = 0.016), representing an elevated component of modifiable cardiovascular risk factor burden. Conclusion: Cardiovascular comorbidities are common in Veterans with PD and may be more severe than in non-Veteran PD populations. These findings merit replication in other representative cohorts. Veterans may be a preferred population for clinical trials evaluating cardiovascular risk factor management on PD progression. Show more

Keywords: Accidental falls, hypertension, Parkinson disease, veterans, white matter

DOI: 10.3233/JPD-171271

Citation: Journal of Parkinson's Disease, vol. 8, no. 1, pp. 153-160, 2018