Journal of Parkinson's Disease - Volume 9, issue 3

Authors: Kotagal, Vikas | Szpara, Ashley | Albin, Roger L. | Bohnen, Nicolaas I.

Article Type: Research Article

Abstract: Background/Objective: Fatigue is a common debilitating symptom in Parkinson’s disease (PD) of unclear etiology. Hypotension and blood pressure variability are common in PD though their relationship to other non-motor symptoms is less well understood. Methods: We conducted a cross-sectional study to explore differences in 24-hour ambulatory blood pressure measurements in PD subjects (n  = 35) with and without fatigue. Subjects underwent hourly systolic (SBP) and diastolic (DBP) blood pressure testing in their home environment. The presence of fatigue was assessed using the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part 1. We compared blood pressure measurements in …fatigued vs. non-fatigued PD subjects, assessed over 4 epochs: overnight, morning, midday, and evening. Results: PD subjects with symptoms of fatigue demonstrated lower mean DBP, compared to those without fatigue (67.8±4.8 mmHg vs. 75.6±9.4 t  = 2.57, p  = 0.014). These intergroup differences were most notable in the morning. The two groups did not differ in scoring on the Survey of Autonomic Symptoms or on an office-based blood assessment of SBP or DBP performed on the day of 24-hour monitor initiation. Conclusions: Fatigue in PD may be a clinical manifestation of low-grade systemic hypotension. Show more

Keywords: Autonomic symptoms, blood pressure, fatigue, hypotension, Parkinson’s disease

DOI: 10.3233/JPD-191579

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 575-581, 2019

Authors: Park, Ho Youn | Lee, Ju Hee | Lee, Soo Young | Yu, Dong Soo | Han, Kyung-Do | Park, Yong Gyu | Lee, Young Bok

Article Type: Research Article

Abstract: Background: Although several studies have reported a correlation between Behçet’s disease (BD) and Parkinson’s disease, this association has not yet been clarified. Objective: To determine the risk of Parkinson’s disease in patients with BD. Methods: BD patients (n  = 17,179; mean age, 51.12±8.09 years; male, 34.95%) without known previous diagnosis of Parkinson’s disease were selected from the Korean National Health Insurance Database between 2010 and 2013. An age- and gender-matched control population of individuals without BD was randomly sampled at a ratio of 3:1 (n  = 34,575). Both cohorts were followed for development of Parkinson’s disease until 2015. …Results: Among a total of 11,525 BD patients, 50 (0.43%) developed Parkinson’s disease, whereas only 51 among the 34,575 individuals in the non-BD group developed Parkinson’s (0.15%, P  < 0.0001). The incidence of Parkinson’s disease was significantly higher in BD patients than in controls. In addition, during the follow-up period, patients with BD were more likely to be diagnosed with Parkinson’s disease than those in the non-BD group. Conclusions: BD patients had a higher risk of Parkinson’s disease compared to non-BD controls. Physicians should carefully monitor patients with BD for potential development of Parkinson’s disease. Show more

Keywords: UC18ZESI0061, orcid.org/0000 0002 8642 2479, Behçet’s disease, hazard ratio, incidence, Parkinson’s disease

DOI: 10.3233/JPD-191622

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 583-589, 2019

Authors: Hauser, Robert A. | Kremens, Daniel E. | Elmer, Lawrence W. | Kreitzman, David L. | Walsh, Ryan R. | Johnson, Reed | Howard, Robert | Nguyen, Jack T. | Patni, Rajiv

Article Type: Research Article

Abstract: Background: Parkinson’s disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life. Objective: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes. Methods: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials—analyzed for 17 hours following wake-up—at baseline and week 12. Results: Diaries were evaluable for 162 patients. At baseline, 67% of …patients woke up OFF, with prevalence decreasing to 13% at 2 hours and then remaining relatively steady at ∼12% (range, 6–17%) across half-hour intervals thereafter. Troublesome dyskinesia prevalence rose steadily from 5% to 24% over the first 2 hours, then fluctuated between 20% and 44% through the rest of the waking day. At baseline, patients experienced a mean of 3.0 daily episodes of troublesome dyskinesia (average duration 2.0 hours each), and 2.2 daily episodes of OFF (average duration 1.1 hour each). At week 12, Gocovri-treated patients showed greater reductions than placebo in troublesome dyskinesia and OFF episodes per day (treatment difference: –1.0 episodes and –0.4 episodes, respectively) and average episode duration (treatment difference: –0.6 hours and –0.3 hours, respectively). Mean duration of individual episodes of ON without troublesome dyskinesia (Good ON) increased by 5.0 hours for Gocovri, compared with 2.0 hours for placebo. Patients taking Gocovri experienced 2.2 fewer transitions between states than patients taking placebo. Conclusions: Troublesome dyskinesia and OFF occurred in the morning and throughout the waking day. Gocovri-treated patients experienced fewer, shorter episodes of both troublesome dyskinesia and OFF, thereby increasing the duration of continuous Good ON episodes and reducing the frequency of transitions between motor states. Show more

Keywords: Amantadine, delayed-action preparations, double-blind method, dyskinesias, OFF, episodes, humans, levodopa, Parkinson disease, transitions, treatment

DOI: 10.3233/JPD-181565

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 591-600, 2019

Authors: Carroll, Camille | Kobylecki, Christopher | Silverdale, Monty | Thomas, Chris | on behalf of the PKG audit group

Article Type: Letter

DOI: 10.3233/JPD-191623

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 601-601, 2019

Authors: Bohnen, Nicolaas I. | Hu, Michele T.M.

Article Type: Review Article

Abstract: Sleep disturbances are common and a major source of disability in Parkinson’s disease (PD). Primary and secondary insomnia, rapid eye movement sleep behavior disorder (RDB), central sleep apnea, restless legs, and nocturnal akinesia are common sleep disturbances in PD. Prodromal presence of RBD is associated with a more severe motor and non-motor PD subtype implying a significant disease-modifying effect of this parasomnia. Other disease-modifying mechanisms of sleep disturbances in PD include impaired glymphatic clearance, endoplasmic reticulum stress, nocturnal brain deoxygenation and inflammatory processes among others. Impairments of neural circuit switching and imbalance between inhibitory and excitatory neuronal populations are likely …responsible for episodic sleep disturbances, in particular RBD. As neural circuits may predict patterns of α -synuclein propagation in the nervous system, impairments of such circuits are of high relevance for PD pathophysiology. Future research is needed to determine whether appropriate treatment for disturbed sleep might slow progression of PD. Show more

Keywords: Acetylcholine, α-synuclein, amyloid-β , GABA, glymphatic clearance, inflammation, neural circuits, sleep, tau

DOI: 10.3233/JPD-191627

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 603-614, 2019

Authors: Domingos, Josefa | Radder, Danique | Riggare, Sara | Godinho, Catarina | Dean, John | Graziano, Mariella | de Vries, Nienke M. | Ferreira, Joaquim | Bloem, Bastiaan R.

Article Type: Research Article

Abstract: Background: Persons with Parkinson’s disease (PD) benefit from continuous exercise through participation in community-based exercise programs. However, community programs often lack PD-specific knowledge needed to provide safe and adequately dosed exercise. Objective: To evaluate the acceptability and safety of a PD-specific boxing program in the community. Methods: We developed specific educational resources to facilitate the boxing instructors. We also organized an educational and practical workshop for patients (n  = 26) and instructors (n  = 10), and assessed: (a) participants’ satisfaction; (b) instructors’ appreciation of the educational resources; and (c) numbers of patients interested in participating in the boxing …program. After 18 months, patients and instructors completed a questionnaire evaluating: (a) participants’ satisfaction; (b) adverse events; (c) facilitators and barriers; and (d) proportion of participants at follow-up. Results: Twenty-six persons with PD (62% men) and 10 boxing instructors participated in the workshop. 81% of patients and 80% of instructors were very satisfied. Instructors found the educational materials “very helpful” (60%) or “helpful” (40%). Patients expressed a clear interest (54%) or possible interest (46%) in the program. We initiated classes with 10 participants. At 18-months follow-up, the program consisted of four boxing sessions/week, led by three instructors, with 40 participants. Seventeen patients responded to the questionnaire at follow-up. Participants were “very satisfied” (53%), “satisfied” (35%) and neither satisfied nor unsatisfied (12%) with the program. Adverse effects were mild (e.g., muscle aches). Transportation and physical disability were the main barriers for participation. Conclusions: The boxing program was well-received, with increasing numbers of participants at 18 months. The educational resources can support boxing instructors participating in current and future boxing classes being delivered in the community. Show more

Keywords: Boxing training, community exercise, Parkinson’s disease, physiotherapy

DOI: 10.3233/JPD-191616

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 615-623, 2019

Authors: Barbosa, Pedro | Kaski, Diego | Castro, Patricia | Lees, Andrew J. | Warner, Thomas T. | Djamshidian, Atbin

Article Type: Research Article

Abstract: Fifteen individuals with Parkinson’s disease (PD) and impulsive compulsive behaviours (PD+ICB) were compared to 15 PD patients without ICBs (PD-ICB) and 15 healthy controls (HC) on a pro-saccades and an anti-saccades task to assess if ICBs are associated with distinct saccadic abnormalities. PD+ICB made shorter saccades than HC and more direction errors in the anti-saccades task than PD-ICB and HC, suggesting that patients with ICBs have greater difficulty in suppressing automatic saccades towards a given target. Saccadic assessment has the potential to evolve into a marker to guide therapeutic decisions in patients at risk of developing ICBs.

Keywords: Parkinson’s disease, impulse control disorders, impulsive compulsive behaviours, eye movements, saccades

DOI: 10.3233/JPD-181460

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 625-630, 2019

Authors: Zarkali, Angeliki | Lees, Andrew J. | Weil, Rimona S.

Article Type: Short Communication

Abstract:  Visual hallucinations are a common and often distressing feature of Parkinson’s disease; they are ephemeral and capricious, making them difficult to study but tend to be more prominent in dim illumination. Flickering stimuli can induce simple hallucinations even in healthy individuals. We tested a stroboscope and an equivalent full-screen flickering stimulus in 16 participants: 7 patients with Parkinson’s and habitual visual hallucinations, 6 Parkinson’s patients without hallucinations and 3 controls. Both flicker sources induced varied geometrical hallucinations in 4 participants (25%) and complex hallucinations in 1 but neither induced typical Parkinson’s-associated hallucinations.

Keywords: Parkinson’s disease, visual hallucinations, stroboscopic light, hallucination state

DOI: 10.3233/JPD-191635

Citation: Journal of Parkinson's Disease, vol. 9, no. 3, pp. 631-635, 2019