Authors: Yoo, Sang-Won | Kim, Joong-Seok | Oh, Yoon-Sang | Ryu, Dong-Woo | Lee, Kwang-Soo
Article Type: Research Article
Abstract: Background: Trouble concentrating during orthostasis is one symptom of orthostatic hypotension (OH), but it is often ignored in clinical practice because OH incorporates many nonspecific symptoms. Blunted cognition during orthostasis may affect various aspects of the clinical status of patients with Parkinson’s disease (PD), but its impact on drug-naïve, early PD patients is not clear. Objective: This study investigated the association between trouble concentrating during orthostasis and orthostatic blood pressure changes and the influence of trouble concentrating during orthostasis on other non-motor symptoms and health-related quality of life in de novo PD. Methods: A total of 124 patients with early …PD were enrolled and received a structured clinical interview, physical examination, and validated questionnaires to evaluate motor and non-motor symptoms and quality of life. Disturbed concentration was evaluated with question 5 of the Orthostatic Hypotension Questionnaire system assessment (part I). Supine blood pressure and blood pressure change during tilt table testing were recorded, and any association was analyzed. Results: Among the study population, 76 (61.3%) patients had trouble concentrating. Patients with blunted concentration had a steeper decrease in blood pressure during orthostasis. The score for trouble concentrating was positively associated with non-motor symptoms and quality of life scores. Conclusions: Trouble concentrating when standing was a frequent finding in early, drug-naïve PD patients. It was positively associated with non-motor burden, mood and quality of life in patients with PD. OH was correlated with the incidence of trouble concentrating. Such findings complicate treatment but provide valuable information for managing early PD. Show more
Keywords: Orthostatic hypotension, Parkinson’s disease, quality of life, trouble concentrating
DOI: 10.3233/JPD-191578
Citation: Journal of Parkinson's Disease, vol. 9, no. 2, pp. 405-411, 2019
Authors: Yoo, Sang-Won | Ha, Seunggyun | Yoon, Hyukjin | Yoo, Ji-Yeon | Lee, Kwang-Soo | Kim, Joong-Seok
Article Type: Research Article
Abstract: Background: Orthostatic hypotension (OH) may antedate Parkinson’s disease (PD) or be found in early stages of the disease. OH may induce a PD brain to chronic hypotensive insults. 18 F-Florbetaben (18 F-FBB) tracer has a high first-pass influx rate and can be used with positron emission tomography (PET) as a surrogate marker for early- and late-phase evaluation of cerebral perfusion and cerebral amyloidosis, respectively. Objective: In this study, we evaluated whether 18 F-FBB uptake in the early- and late-phases of PD was related to OH. This study manipulated the imaging modality to illustrate the physiology of cerebral flow with OH …in PD (PD + OH). Methods: A group of 73 early-stage PD patients was evaluated with a head-up tilt-test and 18 F-FBB PET imaging. The cognitive status was assessed by a comprehensive battery of neuropsychological tests. PET images were normalized, and both early- and late-phase standardized uptake value ratios (SUVRs) of pre-specified regions were obtained. The associations between regional SUVRs and OH and cognitive status were analyzed. Results: Twenty (27.4%) participants had OH. Thirteen (17.8%) patients were interpreted as having amyloid pathology based on regional 18 F-FBB uptake. Early-phase SUVRs were higher in specific brain regions of PD + OH patients than those without OH. However, late-phase SUVRs did not differ between the groups. The early-phase SUVRs were not influenced by amyloid burden or by interaction between amyloid and orthostatic hypotension. Cognitive functions were not disparate when PD + OH patients were contrasted with non-OH patients in this study. Conclusion: Cerebral blood flow was elevated in patients with early PD + OH. This finding suggests augmented cerebral perfusion in PD + OH might be a compensatory regulation in response to chronic OH. Show more
Keywords: Parkinson’s disease, orthostatic hypotension, cerebral perfusion, cerebral autoregulation, 18F-Florbetaben (FBB), positron emission tomography
DOI: 10.3233/JPD-212596
Citation: Journal of Parkinson's Disease, vol. 11, no. 3, pp. 1335-1344, 2021
Authors: Song, In-Uk | Kim, Joong-Seok | Chung, Sung-Woo | Lee, Kwang-Soo | Oh, Jin-Kyoung | Chung, Yong-An
Article Type: Research Article
Abstract: Cognitive dysfunction is a common feature of Parkinson's disease (PD). Recent research has focused on the detection and management of subjective memory impairment (SMI) as the stage that precedes mild cognitive impairment (MCI). Nevertheless, few clinical studies have biomarkers of SMI in PD. Therefore, this study was designed to investigate differences in perfusion brain SPECT between PD with SMI (PD+SMI) and PD without SMI (PD-SMI) to identify a potential prodromal biomarker of progression to dementia in patients with PD. In this study, 30 PD patients with SMI and 24 PD patients without SMI have been recruited. All subjects underwent perfusion …brain SPECT and neuropsychological testing. Brain SPECT images were analyzed by using the SPM program and comparing between patients with PD+SMI and PD-SMI. The PD+SMI and PD-SMI groups did not differ in any neuropsychological tests, except for MMSE. Despite a significant difference in MMSE scores, all scores of both groups were in the normal range. Brain SPECT analysis of PD+SMI patients showed hypoperfusion in the frontal and inferior temporal regions, anterior cingulate and thalamus compared with PD-SMI patients. This pilot study investigated the role of decreased brain perfusion SPECT findings in PD+SMI patients compared with PD-SMI patients as a predictive biomarker of pre-dementia as the stage that precedes MCI in PD. Larger, prospective studies are warranted for further investigation of the pathophysiology of neuronal systems during cognitive decline. Show more
Keywords: Parkinson's disease, subjective memory impairment, perfusion SPECT
DOI: 10.3233/BME-141164
Citation: Bio-Medical Materials and Engineering, vol. 24, no. 6, pp. 3405-3410, 2014
Authors: Yoo, Sang-Won | Oh, Yoon-Sang | Yoo, Ji-Yeon | Ryu, Dong-Woo | Lee, Kwang-Soo | Shin, Na-Young | Kim, Joong-Seok
Article Type: Research Article
Abstract: Background: Cognitive impairment and cardiovascular dysautonomia are two major non-motor features of Parkinson’s disease (PD). They have been investigated separately and extensively, but their interactive outcomes have rarely been studied. Objective: The purpose of this study was to examine the association between central atrophy and cognition and to assess the influence of cardiovascular lability on this association in PD patients. Methods: Out of 151 early PD patients, 47 subjects were ultimately enrolled according to our selection criteria. Their cognitive status was examined by comprehensive neuropsychological tests assessing five domains of cognition. Supine and orthostatic blood pressures were recorded during head-up …tilt tests, and orthostatic mean arterial pressure change was calculated. Every patient underwent brain magnetic resonance imaging, and intercaudate nucleus ratio was obtained as a central atrophy surrogate marker. The associations and interactions between central atrophy, cognition, and blood pressure variability were analyzed. Results: Among 47 subjects, 20 (42.6%) had orthostatic hypotension. Attention/working memory, executive function, and delayed recall were inversely associated with central atrophy (r = –0.332, p = 0.028; r = –0.314, p = 0.038; r = –0.399, p = 0.024; respectively). In a multiple regression model, only attention/working memory was independently associated with central atrophy when modulated by orthostatic mean arterial pressure change (p < 0.05). Conclusion: This study revealed that cardiovascular dysautonomia interacted with the inverse association between cerebral atrophy and cognition, and it reinforced its relationship. Interaction between these two non-motor features should be kept in mind in clinical practice, particularly in PD patients with co-morbid vascular factors. Show more
Keywords: Parkinson’s disease, subcortical atrophy, cardiovascular dysautonomia, cognition
DOI: 10.3233/JPD-191748
Citation: Journal of Parkinson's Disease, vol. 10, no. 1, pp. 153-160, 2020
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: Oh, Yoon-Sang | Yoo, Sang-Won | Lyoo, Chul Hyoung | Yoo, Ji-Yeon | Yoon, Hyukjin | Ha, Seunggyun | Lee, Kwang-Soo | Kim, Joong-Seok
Article Type: Research Article
Abstract: Background: Co-occurrence of β-amyloid (Aβ) pathology has been reported in Parkinson’s disease (PD), and Aβ deposition in the brain may contribute to cognitive decline in patients with PD. Whether striatal dopamine uptake and cognitive status differ with amyloid deposition has been reported in only a few studies. Objective: The purpose of this study was to investigate the association among striatal dopaminergic availability, Aβ-positivity, and motor and cognitive status in early and non-demented PD. Methods: A total of 98 newly-diagnosed, non-medicated, and non-demented patients with PD were included in this study. Cognitive status was assessed using neuropsychological testing. Patients with mild …cognitive impairment (MCI) were stratified into two groups: amnestic MCI (aMCI) and non-amnestic MCI (naMCI). Patient motor status was examined using the Unified Parkinson’s Disease Rating Scale (UPDRS) and positron emission tomography (PET) with 18 F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane (18 F-FP-CIT). All patients also underwent 18 F-florbetaben (18 F-FBB) PET and were divided based on the results into Aβ-positive and Aβ-negative groups. Results: Eighteen patients had Aβ-positivity in 18 F-FBB PET and 67 had MCI. Sixteen of 18 with Aβ-positive patients had MCI. The Aβ-positive group had higher frequency of MCI, especially amnestic-type, and lower dopaminergic activities in the left ventral striatum, but not with UPDRS motor score. Conclusion: Amyloid pathology was associated with MCI, especially amnestic-subtype, in early and non-demented PD patients and with low dopaminergic activities in the left ventral striatum. This finding suggests that PD patients with Aβ-positivity have AD-related cognitive pathophysiology in PD and associated impaired dopaminergic availability in the ventral striatum can affect the pathophysiology in various ways. Show more
Keywords: Parkinson’s disease, mild cognitive impairment, dopamine transporter, amyloid, motor, positron emission tomography
DOI: 10.3233/JPD-202496
Citation: Journal of Parkinson's Disease, vol. 11, no. 2, pp. 605-613, 2021
Authors: Ryu, Dong-Woo | Lee, Si-Hoon | Oh, Yoon-Sang | An, Jae-Young | Park, Jeong-Wook | Song, In-Uk | Lee, Kwang-Soo | Kim, Joong-Seok
Article Type: Research Article
Abstract: Background: Recent genetic and epidemiological studies have shown that there is a link between essential tremor and Parkinson’s disease (PD). However, there is a lack of data about the clinical features of PD developed from essential tremor. Objective: To explore and describe the clinical characteristics of Parkinson’s disease developed from essential tremor (ET-PD). Methods: Twenty-five ET-PD patients and 124 IPD controls were enrolled according to each criterion. Motor and non-motor features and dopamine transporter uptake were compared between the two groups. Results: Rest and action tremors were more severe in ET-PD patients than in IPD patients. In addition, tremor disorder …of first-degree relatives occurred more frequently in the ET-PD group than in the IPD group. A comparison between cases with ET-PD and IPD was not significant for striatal dopamine transporter uptake. Among the non-motor features, sleep disorder frequency, especially rapid-eye-movement sleep behavioral disorder, were lower in patients with ET-PD than in those with IPD, and smell identification test scores were higher in patients with ET-PD than in those with IPD. The prevalence of other non-motor symptoms did not differ between the two groups. Conclusion: This is the first comparison of motor and non-motor features between ET-PD and IPD. ET-PD and IPD have different characteristic motor and non-motor features from the nosologic perspective. Show more
Keywords: Parkinson’s disease, essential tremor, non-motor symptoms, REM sleep behavior disorder, olfactory dysfunction
DOI: 10.3233/JPD-160992
Citation: Journal of Parkinson's Disease, vol. 7, no. 2, pp. 369-376, 2017
Authors: Ahn, Jong Hyeon | Kim, Minkyeong | Mun, Jun Kyu | Cho, Yoonsu | Kim, Ji Sun | Youn, Jinyoung | Kim, Joong-Seok | Cho, Jin Whan
Article Type: Research Article
Abstract: Background: Fatigue is a common and disabling non-motor symptom in Parkinson’s disease (PD). Autonomic dysfunction is suggested as the possible pathophysiology of fatigue, but it has not been investigated in drug-naïve PD patients. Objective: In the present study, the relationship between fatigue and autonomic dysfunction in drug-naïve PD patients was investigated. Methods: In the present study, 89 drug-naïve PD patients were analyzed. The Parkinson’s disease fatigue scale (PFS) was used to divide the patients into fatigue (mean PFS≥3.3) and non-fatigue groups (mean PFS < 3.3). The autonomic function test (AFT), Scale for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT), Unified Parkinson’s Disease Rating Scale …(UPDRS)-I, -II, -III, modified Hoehn and Yahr (H&Y) scale, Montreal Cognitive Assessment (MoCA), Parkinson’s Disease Questionnaire-39 (PDQ-39), Parkinson’s Disease Sleep Scale (PDSS), and Beck Depress Index (BDI) were performed in all the participants. The AFT results and clinical scales were compared using multiple logistic regression analysis. Results: The prevalence of fatigue was 23.6% (n = 21) in drug-naïve PD patients. Total SCOPA-AUT score was higher in the fatigue group than in the non-fatigue group. The fatigue group had lower inspiratory:expiratory (I:E) ratio and Valsalva ratio. The prevalence of abnormal sympathetic skin response and orthostatic hypotension (OH) was 19% and 38.1%, respectively, in the fatigue group. Regression model analysis revealed that SCOPA-AUT and OH were the most related factor of fatigue in drug-naïve PD patients. Conclusion: Autonomic dysfunction in drug-naïve PD patients was investigated using a subjective scale as well as objective tests. The results indicated that fatigue is associated with autonomic dysfunction, especially OH, in drug-naïve PD patients. Show more
Keywords: Fatigue, autonomic dysfunction, drug naïve, Parkinson’s disease
DOI: 10.3233/JPD-201919
Citation: Journal of Parkinson's Disease, vol. 10, no. 2, pp. 605-612, 2020

