Hoehn And Yahr Scale Research Articles

A Case Report of Two Patients with Idiopathic Parkinson’s Disease Treated with Korean Medicine Treatment and Temporomandibular Joint Balancing Therapy

Parkinson’s disease (PD) is a chronic degenerative disorder of the central nervous system. It has no cure, but current treatments can relieve symptoms and maintain quality of life. As PD progresses, controlling its symptoms becomes difficult. Here, we present the treatment of two patients with idiopathic PD using traditional Korean medicine (TKM) and temporomandibular joint balancing therapy (TBT). We measured the progress of the two patients using the unified PD rating scale (UPDRS) and the Hoehn and Yahr (HY) scale. Combined treatment of TKM and TBT decreased the total UPDRS score from 52 to 26 after 21 days in case 1, while it decreased the total UPDRS score from 91 to 65 after 20 days in case 2. In both patients, the HY scale score was maintained at 3, and no adverse events were observed. Thus, the combined treatment of TKM and TBT can produce a treatment response in PD patients.

Motor and process skills of people with parkinson's disease compared to healthy older adults. A cross-sectional study.

Both Parkinson's disease (PD) and the process of ageing are associated with functional limitations. The aim of this study was to determine the differences in motor and process skills between individuals with PD and healthy older adults, as well as to observe how disease progression affects motor and process skills performance in PD patients. A cross-sectional study was conducted. The Assessment of Motor and Process Skills (AMPS) measure was employed in order to analyze the differences in the motor and process skills of daily tasks in people with PD and healthy older adults age- and sex-matched. Part III of the Unified Parkinson Disease Rating Scale (UPDRS), the Hoehn and Yahr (HY) scale and the Schwab & England scale was administered to determine the severity of the disease. Seventy participants (49 patients with PD and 21 healthy older adults) were recruited for this study. Our results showed that even at moderate stages of the disease, both motor and process skills were found deteriorated in PD patients more than older healthy older adults (p < 0.001). As PD progresses, motor and process skills present significantly deterioration. PD leads to a greater deterioration in motor and process skills compared to healthy older adults. As disease stages advance according to the HY scale, performance in motor and process skills deteriorates significantly between moderate and advanced PD stages. According to the AMPS scale, PD patients show no impairment of processing skills up to HY IV, but motor impairment at HY stages II, III and IV.

MRI Assessment of Intrinsic Neural Timescale and Gray Matter Volume in Parkinson's Disease.

Numerous studies have indicated altered temporal features of the brain function in Parkinson's disease (PD), and the autocorrelation magnitude of intrinsic neural signals, called intrinsic neural timescales, were often applied to estimate how long neural information stored in local brain areas. However, it is unclear whether PD patients at different disease stages exhibit abnormal timescales accompanied with abnormal gray matter volume (GMV). To assess the intrinsic timescale and GMV in PD. Prospective. 74 idiopathic PD patients (44 early stage (PD-ES) and 30 late stage (PD-LS), as determined by the Hoehn and Yahr (HY) severity classification scale), and 73 healthy controls (HC). 3.0 T MRI scanner; magnetization prepared rapid acquisition gradient echo and echo planar imaging sequences. The timescales were estimated by using the autocorrelation magnitude of neural signals. Voxel-based morphometry was performed to calculate GMV in the whole brain. Severity of motor symptoms and cognitive impairments were assessed using the unified PD rating scale, the HY scale, the Montreal cognitive assessment, and the mini-mental state examination. Analysis of variance; two-sample t-test; Spearman rank correlation analysis; Mann-Whitney U test; Kruskal-Wallis' H test. A P value <0.05 was considered statistically significant. The PD group had significantly abnormal intrinsic timescales in the sensorimotor, visual, and cognitive-related areas, which correlated with the symptom severity (ρ = -0.265, P = 0.022) and GMV (ρ = 0.254, P = 0.029). Compared to the HC group, the PD-ES group had significantly longer timescales in anterior cortical regions, whereas the PD-LS group had significantly shorter timescales in posterior cortical regions. This study suggested that PD patients have abnormal timescales in multisystem and distinct patterns of timescales and GMV in cerebral cortex at different disease stages. This may provide new insights for the neural substrate of PD. 2 TECHNICAL EFFICACY STAGE: 1.

Survey on the Impact of the COVID-19 Pandemic on Patients with Parkinson's Disease and Their Caregivers in Japan.

The coronavirus disease 2019 (COVID-19) pandemic changed the lives of patients with Parkinson's disease (PD) and their caregivers. This study aimed to investigate changes in patient behavior and PD symptoms and their effect on caregiver burden resulting from the COVID-19 pandemic in Japan. This nationwide, observational, cross-sectional survey included patients with self-reported PD and caregivers (members of the Japan Parkinson's Disease Association). The primary objective was to evaluate changes in behaviors, self-assessed PD symptoms, and caregiver burden from pre-COVID-19 (February 2020) to post-national state of emergency (August 2020 and February 2021). Responses from 1883 patients and 1382 caregivers from 7610 distributed surveys were analyzed. Mean (standard deviation) age of patients and caregivers was 71.6 (8.2) and 68.5 (11.4) years, respectively; 41.6% of patients had a Hoehn and Yahr (HY) scale of 3. Patients (>40.0%) reported decreased frequency of going out. Most patients (>70.0%) reported no change in treatment visit frequency, voluntary training, or rehabilitation and nursing care insurance services. Symptoms worsened for approximately 7-30% of patients; the proportion with HY scale 4-5 increased from pre-COVID-19 (25.2%) to February 2021 (40.1%). Aggravated symptoms included bradykinesia, walking, gait speed, depressed mood, fatigue, and apathy. Caregivers' burden increased because of patients' worsened symptoms and reduced time going out. Control measures during infectious disease epidemics should consider that patients' symptoms may worsen; therefore, patient and caregiver support is needed to reduce burden of care.

Prognostic factors of unilateral prelemniscal radiations radiofrequency lesions: A surgical technique for the treatment of Parkinson’s disease motor symptoms

ObjectiveA group of patients with Parkinson's disease (PD) were managed with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). The current study aims to evaluate prognostic factors that could influence clinical response. MethodsPatients previously diagnosed with PD managed with U-Raprl were included in the study, classifying them into two groups according to their percentage of clinical response (</≥ 50%) at 5 years of follow-up in relation to the part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III), analyzing the possible factors associated with their response (age, evolution of PD, Hoehn and Yahr scale (HYS), and levodopa dose). To show differences between groups before and after the intervention, a T-test was performed, and a Mann-Whitney U test was carried out to determine differences between the response groups, added to an effect size calculation using a Cohen's d (α = 0.05, and β = 0.20). ResultsThirty-four patients were included, where the most prevalent symptoms were tremor and rigidity, with 52.9% percentage of males, 59.3 ± 6.4 mean age, and 7.4 ± 2.1 of mean evolution of PD. Analysis shows differences between groups (p < 0.05) according to the HYS, UPDRS, and levodopa intake, after the intervention. The analysis of the groups according to their response showed differences between the HYS (p < 0.01, ∆ > 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). The qualitative analysis of the distribution regarding the responder group shows that those patients with an age under 58 years, an evolution fewer than 7 years, and a preoperative HYS score smaller than 2, showed a response ≥ 50% according to the UPDRS-III in all cases. ConclusionU-Raprl is a highly effective procedure with a 5-year persistence of improvement. The most relevant prognostic factors to consider for a clinical response according to UPDRS-III greater than 50% are age under 58 years, less than 7 years of PD evolution, and HYS less or equal to 3.

Optical coherence tomography in patients with Parkinson\u2019s disease

BackgroundThe changes in the different retinal layers in Parkinson’s disease (PD) patients can be easily assessed using optical coherence tomography (OCT). Our aim was to evaluate retinal structural changes in patients with PD using OCT. Structural measurements of the retinal nerve fiber layer (RNFL), macular and ganglion cell complex (GCC) thicknesses were obtained using spectral domain optical coherence tomography. Disease severity was assessed using Unified Parkinson Disease Rating Scale (UPDRS).ResultsRetinal nerve fiber layer parameters, except for the superonasal and inferonasal quadrants, were significantly reduced in PD patients compared to controls. All macular parameters and GCC thickness were also reduced in PD patients compared to controls. Hoehn and Yahr (HY) staging was inversely correlated with all macular parameters, GCC and temporal RNFL thicknesses. UPDRS score showed a significant negative correlation with macular volume, inferior and nasal parafoveal thicknesses, nasal and temporal RNFL thicknesses and GCC thickness. The disease duration was inversely correlated with macular volume, inferior and temporal parafoveal thicknesses and GCC thickness. Using the multivariate linear regression analysis, the HY scale was a significant predictor for both the average GCC thickness and the macular volume. The sensitivity and specificity of average GCC thickness and macular volume to detect disease severity were 58.8%, 86.7%, 64.7% and 86.7%, respectively.ConclusionParkinson’s disease causes axonal damage in the RNFL along with retinal thinning that can be detected using SD-OCT. Patients with greater axonal damage tend to have longer duration of the disease and more severe PD symptoms.

PND41 Direct Medical Costs of Parkinson's Disease in JAPAN

Parkinson’s disease (PD) is a chronic neurodegenerative disorder that affects 150,000 people in Japan. The objective of this study was to evaluate the direct medical costs of PD in Japan based on real-world data. We performed a retrospective descriptive study using the administrative claims data from more than 400 hospitals provided by Medical Data Vision Co., Ltd. Patients who had at least one diagnosis of PD (ICD10 G20) were identified and PD-related outpatient and inpatient cost were summarized in relation to the Hoehn and Yahr (HY) severity scale. PD-related direct cost was defined as neurology outpatient visits and hospitalizations to manage PD, pneumonitis due to inhalation of food and vomit (J69.0), and fracture of femur (S72.0, S72.1). Between April 2008 and December 2018, 120,353 PD patients were identified, and 16% were diagnosed with the HY scale (1,405; 3,377; 8,107; 3,887; 2,590 for HY1 to HY5). Mean age was 74.6 ± 10.9, 46.5% were male, and the mean observation duration was 443 days. Mean monthly outpatient cost was increased by HY scale (JPY 22,762; 29,322; 45,804; 56,500; 57,164; 32,937 for HY1 to HY5 and overall, respectively). Anti-Parkinson drugs cost was 50% and 70% for HY1-2 and HY3-5, respectively. A total of 17,428 PD-related hospitalization events were identified, and incidence (0.20; 0.22; 0.57; 1.63; 2.57; 0.53 times per year) and duration (24.3; 22.9; 30.4; 36.4; 51.1; 36.3 days) were also increased by HY scale. The total cost of hospitalization related to PD by HY scale were JPY 985K; 940K; 1,176K; 1,398K; 1,727K; and for all PD patients was 1,379K, where two-thirds of costs were admission charges. Direct medical costs of PD in Japan were increased by the severity of disease.

Monitoring Parkinson's disease progression based on recorded speech with missing ordinal responses and replicated covariates

Monitoring Parkinson's Disease (PD) progression is an important task to improve the life quality of the affected people. This task can be performed by extracting features from voice recordings and applying specifically designed statistical models, leading to systems that improve the ability of monitoring the progression of PD in an objective, remote, non-invasive, fast, and economically sustainable way. An experiment has been conducted with 36 subjects to study the progression of the PD over 4 years by using the Hoehn and Yahr (HY) scale and features extracted from the phonation of the vowel/a/. The collected dataset had many missing data, which should be addressed jointly with the non-decreasing nature of the disease and the within-subject variability due to the use of replicated features. In order to handle these issues, a Hidden Markov model for longitudinal data was designed and implemented by using a data augmentation scheme based on different latent variables. Markov chain Monte Carlo methods were used to generate from the posterior distribution. The proposed approach has been tested on simulated data, providing good accuracy rates in the context of a multiclass problem. It also has been applied to the real data obtained from the conducted experiment, providing imputed and predicted HY stages compatible with the progression of PD. The conducted experiment and the proposed approach contribute to fill a gap in the scientific literature on experiments and methodologies for tracking PD progression based on acoustic features and the HY scale. This would help to derive an expert system that can be integrated into the protocols of neurology units in hospital centers.

Salivary alpha-synuclein (total and oligomeric form): potential biomarkers in Parkinson\u2019s disease

BackgroundParkinson’s disease (PD) is one of the most common degenerative diseases of the central nervous system (CNS). Alpha-synuclein (A-syn) plays a critical role in the pathogenesis of PD. The close relation between the salivary glands and the CNS could render the A-syn secretions in the saliva useful biomarkers for PD.Aim of the workTo study the salivary A-syn levels in a cohort of PD Egyptian patients and to correlate these A-syn levels with the patients’ clinical data and disease severity.Patients and methodsTwenty-five PD patients and 15 age- and sex-matched healthy subjects, as a control group, were enrolled. Evaluation of PD patients was performed using the Unified Parkinson’s Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale (HYS). Samples of the saliva were analyzed using the enzyme-linked immunosorbent assay (ELISA) technique for the specific anti A-syn total and anti A-syn oligomer (A-synolig).ResultsThere was a statistically significant increase in A-synolig level and A-synolig/A-syn total ratio and a decrease in A-syn total level among PD patients. A statistically significant increase in A-synolig level was detected among patients having bradykinesia and rigidity as predominant symptoms. Also, there was a statistically significant positive correlation between A-synolig level and the disease duration. No statistically significant correlation was found between A-syn concentrations and disease severity.ConclusionSalivary A-syn total and A-synolig can be used as potential biomarkers for PD diagnosis.

Validation Turkish version of the simple screening vehicle for early diagnosis of advanced Parkinson’s disease in daily practice: The CDEPA questionnaire

We aimed was to modify to validate a simple screening tool, the CDEPA questionnaire (“Cuestionario De Enfermedad de Parkinson Avanzada” [Questionnaire for Advanced Parkinson’s Disease (APD)]), for the identification of APD in daily practice and to analyse the validity and reliability of the questionnaire. One hundred and twenty consecutive patients with Advanced Parkinson’s Disease (45% were women, mean age was 69.3 ± 11.6 years) included in the study and stratified according to the Hoehn and Yahr (HY) scale. Permission regarding the translation and validation of the CDEPA questionnaire was obtained. The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living, motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia. PD was categorized as advanced in 45 (37.5%) patients when using the gold standard and in 75 (62.5%) patients when the CDEPA questionnaire was used. The CDEPA questionnaire and the gold standard agreed moderately (P < 0.001). The CDEPA classified APD with a sensitivity of 98%; specificity of 58%; total accuracy of 74.6%; and area under the curve of 78.5%. The internal consistency determined by Cronbach's alpha indicated an extremely good correlation (0.978). Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Global Impression–Severity Scale, and Patient Global Impression–Severity Scale). These findings suggest, Turkish version of the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD.

Effect of depressive symptoms on quality of life in middle-aged and elderly patients with Parkinson's disease: a 4-year follow-up study

Objective To analyze the impact of depressive symptoms on quality of life in patients with Parkinson's disease(PD)based on middle- and long-term follow-up study, and to explore predictors for the reduced quality of life in PD patients. Methods Clinical data of 80 PD patients were searched from the electronic database in our research center.Patients who had complete general information and the following data of unified Parkinson's disease rating scale(UPDRS), Hoehn and Yahr scale(HY), mini-mental state examination(MMSE), Hamilton depression rating scale(HAMD), Hamilton rating scale for anxiety(HAMA), the 39-item Parkinson's disease questionnaire(PDQ-39), etc.after one-year follow-up were included in this study.The differences in quality of life were analyzed and compared among the non-depression group(n=38), depression remission group(n=22)and depression group(n=20). A follow-up visit was conducted after four years.The disease progression and decline in quality of life were compared between the depression and non-depression groups according to the baseline value of the Hamilton Depression Rating Scale.According to the change in PDQ-39 value, cluster analysis was used to reclassify patients into fast-decline group and slow-decline group.Logistic regression analysis was used to determine independent risk factors for the decline of quality of life. Results At the end of 1 year follow-up, the quality of life was decreased in the depression group as compared with the baseline(P=0.017), and the score of PDQ-39 was higher in the depression group than in the non-depression group and depression remission group.At the end of 4-year follow-up, UPDRS total score, UPDRSⅢ score, HY stage and PDQ-39 score were increased as compared with the baseline, the quality of life decreased more significantly, and the disease progressed faster in the depression group than the other two groups(P<0.05). The differences in the disease course, total score of UPDRS, HY stage and HAMD score were statistically significant between the fast-decline group and slow-decline group(P=0.001, 0.039, 0.003 and <0.001, respectively). Logistic regression analysis showed that disease course(OR=1.254, P=0.020), and baseline HAMD score(OR=1.450, P=0.003)were the independent risk factors for the decline of quality of life. Conclusions The quality of life of PD patients is worse in the depression group than in the depression remission group and non-depression group.In PD patients with depressive symptoms, the illness progression is faster, and the quality of life is decreased more significantly.The disease course and depression can predict the decline of quality of life in PD patients. Key words: Parkinson's disease; Depression; Quality of life; Follow-up studies

Feasible Classified Models for Parkinson Disease from 99mTc-TRODAT-1 SPECT Imaging.

The neuroimaging techniques such as dopaminergic imaging using Single Photon Emission Computed Tomography (SPECT) with 99mTc-TRODAT-1 have been employed to detect the stages of Parkinson’s disease (PD). In this retrospective study, a total of 202 99mTc-TRODAT-1 SPECT imaging were collected. All of the PD patient cases were separated into mild (HYS Stage 1 to Stage 3) and severe (HYS Stage 4 and Stage 5) PD, according to the Hoehn and Yahr Scale (HYS) standard. A three-dimensional method was used to estimate six features of activity distribution and striatal activity volume in the images. These features were skewness, kurtosis, Cyhelsky’s skewness coefficient, Pearson’s median skewness, dopamine transporter activity volume, and dopamine transporter activity maximum. Finally, the data were modeled using logistic regression (LR) and support vector machine (SVM) for PD classification. The results showed that SVM classifier method produced a higher accuracy than LR. The sensitivity, specificity, PPV, NPV, accuracy, and AUC with SVM method were 0.82, 1.00, 0.84, 0.67, 0.83, and 0.85, respectively. Additionally, the Kappa value was shown to reach 0.68. This claimed that the SVM-based model could provide further reference for PD stage classification in medical diagnosis. In the future, more healthy cases will be expected to clarify the false positive rate in this classification model.

Nocturnal blood pressure changes in Parkinson's disease: correlation with autonomic dysfunction and vitamin D levels.

Nocturnal blood pressure (BP) changes are an indicator of autonomic dysfunction. We aim to investigate the correlation between nocturnal blood pressure (BP) variability, vitamin D levels and Parkinson's disease severity (PD) in this study. Thirty-five patients with PD participated in the study. Disease severity was evaluated by United Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (HYS). Equivalent levodopa dose was calculated and 25-hydroxyvitamin D levels were measured. The Non-Motor Symptom Questionnaire (NMSQ) was applied to all patients. Ambulatory BP monitoring for 24h was established. Patients were divided into three groups according to nocturnal BP results: dippers (normal finding-a decline in mean nighttime BP of more than 10%); non-dippers (pathological-a decline in mean nighttime BP of less than 10%); reverse dippers (pathological-an increase in mean nighttime BP) .The mean score of the NMSQ was higher in the group with HYS > 2 (p = 0.050). Four patients were dipper, 17 patients were non-dipper and 16 patients were reverse dipper. There was no significant difference between the three groups in terms of age, gender, disease duration, age of the disease onset, disease stage, disease duration, dopamine agonist usage, levodopa equivalent dose, vitamin D level and NMSQ scores. NMSQ scores are high in advanced PD. Ambulatory BP monitoring is useful in detecting autonomic dysfunction. The number of patients with non-dipping and reverse dipping is high in PD, independent from PD severity, drug dose, vitamin D and the other NMS symptoms.

Validation of a simple screening tool for early diagnosis of advanced Parkinson\u2019s disease in daily practice: the CDEPA questionnaire

Early clinical diagnosis of advanced Parkinson’s disease (APD) may be difficult. This study aimed to validate a simple screening tool, the CDEPA questionnaire (“Cuestionario De Enfermedad de Parkinson Avanzada” [Questionnaire for Advanced Parkinson’s Disease]), for the identification of APD in daily practice. The study included 173 consecutively selected patients with PD (40% were women, mean age was 68.4 ± 10.5 years), stratified according to the Hoehn and Yahr (HY) scale. The CDEPA questionnaire defined APD as the presence of severe disability requiring help for activities of daily living (ADL), motor fluctuations with limitation or inability to perform ADL, severe dysphagia, recurrent falls, or dementia. The diagnostic performance of the questionnaire was assessed against the gold standard criterion based on clinical judgment. PD was categorized as advanced in 65 (38%) patients when using the gold standard and in 109 (63%) patients when the CDEPA questionnaire was used. The CDEPA questionnaire and the gold standard agreed moderately (kappa statistic of 0.48, P < 0.001). The CDEPA classified APD with a sensitivity of 97%; specificity of 57%; total accuracy of 72.3%; and area under the curve (for a binary classifier) of 77.2%. Significant differences were found between the groups created by the CDEPA in several usual PD evaluations (HY Scale, SCOPA Motor Scale, Non-motor Symptoms Scale for PD, Clinical Impression of Severity Index for PD, Clinical Global Impression–Severity Scale, and Patient Global Impression–Severity Scale). CDEPA showed satisfactory inter-rater agreement (kappa = 0.88) and test–retest concordance (kappa 0.83). In conclusion, the CDEPA questionnaire is a valid, reliable, and useful instrument for easily screening APD.

Relationship between cognitive function and motor impairment severity in Parkinson's disease

Cognitive impairment is among the most frequent non-motor symptoms in Parkinson's disease (PD). To clear the characteristics of cognitive impairment in patient with PD may be critical for the planning of effective rehabilitation interventions. However, a few studies have sought to investigate relationship between cognitive impairment and motor functions. The purpose of this study was to compare cognitive impairment of PD patients in relation to the motor impairment severity according to Hoehn and Yahr (HY) stages. The subjects of this study were 78 patients with PD (33 males and 45 females). The Cognitive function was assessed using the Wechsler Adult Intelligent Scale-III (WAIS-III) and Wechsler Memory Scale-Revised (WMS-R). The HY scale was used to evaluate the motor impairment severity as I (no disability, n = 11), II (mild, n = 34), III (moderate, n = 26), or IV–V (severe, n = 7). The Kruskal–Wallis test was used to compare the cognitive impairment the between HY groups. The difference in performance intelligence quotient (PIQ) of WAIS-III (I: 105.6 ± 8.6, II: 94.9 ± 17.7, III: 91.5 ± 14.3, IV–V: 82.9 ± 8.2) and general memory quotient (GMQ) of WMS-R (I: 105.5 ± 14.4, II: 91.8 ± 15.6, III: 90.0 ± 18.2, IV–V: 86.1 ± 13.0) between groups were significant, scores of IV-V stage were lowest. There were statistically significant differences in processing speed index and verbal memory quotient among the groups. The difference in other measurements was not significant the between groups. Our present findings indicated that the cognitive impairment was observed in deterioration of the motor impairment in PD patients. Specifically, in the factor scale level, the low processing speed index and the low verbal memory quotient reduced each of the PIQ and GMQ in the lowest HY group patients. Therefore, we suggest that a careful assessment of cognitive impairments, especially processing speed and verbal memory, is important in identifying appropriate interventions for PD with severe stage.

Novel and improved stage estimation in Parkinson's disease using clinical scales and machine learning

The stage and severity of Parkinson's disease (PD) is an important factor to consider for taking effective therapeutic decisions. Although the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) provides an effective instrument evaluating the most pertinent features of PD, it does not allow PD staging. On the other hand, the Hoehn and Yahr (HY) scale which provides staging, does not evaluate many relevant features of PD. In this paper, we propose a novel and improved staging for PD using the MDS-UPDRS features and the HY scale, and developing prediction models to estimate the stage (normal, early or moderate) and severity of PD using machine learning techniques such as ordinal logistic regression (OLR), support vector machine (SVM), AdaBoost- and RUSBoost-based classifiers. Along with this, feature importance in PD is also estimated using Random forests. We observe that the predictive models of SVM, Adaboost-based ensemble, Random forests and probabilistic generative model performed well with the AdaBoost-based ensemble giving the highest accuracy of 97.46%. Body bradykinesia, tremor, facial expression (hypomimia), constancy of rest tremor and handwriting (micrographia) were observed to be the most important features in PD. It is inferred that MDS-UPDRS combined with classifiers can form effective tools to predict PD staging which can aid clinicians in the diagnostic process.

Validation of the Korean Version of the Scales for Outcomes in Parkinson's Disease-Sleep.

BackgroundSleep problems commonly occur in patients with Parkinson's disease (PD), and are associated with a lower quality of life. The aim of the current study was to translate the English version of the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-S) into the Korean version of SCOPA-S (K-SCOPA-S), and to evaluate its reliability and validity for use by Korean-speaking patients with PD.MethodsIn total, 136 patients with PD from 27 movement disorder centres of university-affiliated hospitals in Korea were enrolled in this study. They were assessed using SCOPA, Hoehn and Yahr Scale (HYS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Sleep Scale 2nd version (PDSS-2), Non-motor Symptoms Scale (NMSS), Montgomery Asberg Depression Scale (MADS), 39-item Parkinson's Disease Questionnaire (PDQ39), Neurogenic Orthostatic Hypotension Questionnaire (NOHQ), and Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ). The test-retest reliability was assessed over a time interval of 10–14 days.ResultsThe internal consistency (Cronbach's α-coefficients) of K-SCOPA-S was 0.88 for nighttime sleep (NS) and 0.75 for daytime sleepiness (DS). Test-retest reliability was 0.88 and 0.85 for the NS and DS, respectively. There was a moderate correlation between the NS sub-score and PDSS-2 total score. The NS and DS sub-scores of K-SCOPA-S were correlated with motor scale such as HYS, and non-motor scales such as UPDRS I, UPDRS II, MADS, NMSS, PDQ39, and NOHQ while the DS sub-score was with RBDQ.ConclusionThe K-SCOPA-S exhibited good reliability and validity for the assessment of sleep problems in the Korean patients with PD.

Assessment of mental health of carers according to patient stage of idiopathic Parkinson's disease.

In this study the aim was to collect data to assess the mental health of carers for patients with diagnosis of idiopathic Parkinson's disease (IPD) according to disease stage and to examine precautions to reduce the patient and disease load on carers. The study included 144 patients with staging according to modified Hoehn and Yahr criteria and 144 patient relatives who provided care support for patients every day, for some or all of the day, and who were over the age of 18 years and accepted participation in the research. Our prospective and cross-sectional study performed detailed neurological examination of patients, and after completing the 'Personal Information Form' with the interviewer every patient, with idiopathic Parkinson's disease (IPD) according to 'UK Brain Bank' diagnostic criteria, had the 'Unified Parkinson's Disease Rating Scale (UPDRS)' and 'Modified Hoehn and Yahr scale (HYS)' applied. Carers first completed the 'Personal Information Form' and then had the 'Short Symptom Inventory (SSI)' applied. As the stage of disease increased, the points for all sub-scales of the Short Symptom Inventory increased. With the parallel increase in disease scores and UPDRS stage scores, the points obtained by carers on the SSI sub-scales increased. This data shows that with progressing disease stage, the load on the carer increases and mental health begins to be disrupted.

Effects of dopaminergic medication on decision-making under ambiguity in patients with early Parkinson's disease

Objective To investigate the effects of dopaminergic medication on decision-making under ambiguity in patients with early Parkinson's disease(PD). Methods Using Iowa Gambling Task (IGT) for 24 early non-medication idiopathic PD patients(Hoehn and Yahr Scale≤Ⅱlevel), 24 early idiopathic PD patients with regular dopaminergic medication and also for 24 healthy controls(HC) whose age, gender, and education match to PD patients to test their ability of decision-making under ambiguity. Results The results showed non-medication PD group showed impairments on digtal span and verbal fluency and decision-making task. There was significant difference in IGT task scores among the three groups(F=6.024, P=0.004). The total net scores of advantageous choices in IGT were significantly lower in non-medication PD group((-4.50±22.19) scores) than medication PD group((8.83±23.24)scores) and healthy group((15.92±15.77)scores). The difference of net scores in block1 to block5 between non-medication PD group and medication PD group was gradually increased, and the difference of net scores in block5 was significant(P 0.05). As the game processing, medication PD group gradually shifted their selections toward the advantageous choices. But non-medication group did not exhibit this shift pattern and the performance was much poorer. Meanwhile, the study also indicated the total net scores of advantageous choices for non-medication PD group was positive correlation to the MoCA scores (r=0.614, P=0.001). Conclusion The present study has shown that non-medication PD group has impairment in decision-making under ambiguity risk condition and prefer to choose risky options. when exogenous complement dopaminergic medication, the risk decision-making ability of medication PD group has been improved. Key words: Parkinson's disease; Decision-making under ambiguity; Cognition; Dopaminergic medication

Nintendo Wii assessment of Hoehn and Yahr score with Parkinson's disease tremor.

Diagnosis of Parkinson's Disease (PD) by analyzing the resting tremor were much studied by using different accelerometer based methods, however the quantitative assessment of Hoehn and Yahr Scale (HYS) score with a machine learning based system has not been previously addressed. In this study, we aimed to propose a system to automatically assess the HYS score of patients with PD. The system was evaluated and tested on a dataset containing 55 subjects where 35 of them were patients and 20 of them were healthy controls. The resting tremor data were gathered with the 3 axis accelerometer of the Nintendo Wii (Wiimote). The clinical disability of the PD was graded from 1 to 5 by the HYS and tremor was recorded twice from the more affected side in each patient and from the dominant extremity in each control for a 60 seconds period. The HYS scores were learned with Support Vector Machines (SVM) from the features of the tremor data. Thirty-two of the subjects with PD were classified correctly and 18 of the normal subjects were also classified correctly by our system. The system had average 0.89 accuracy rate (Range: 81-100% changing according to grading by HYS). We compared quantitative measurements of hand tremor in PD patients, with staging of PD based on accelerometer data gathered using the Wii sensor. Our results showed that the machine learning based system with simple features could be helpful for diagnosis of PD and estimate HYS score. We believed that this portable and easy-to-use Wii sensor measure might also be applicable in the continuous monitoring of the resting tremor with small modifications in routine clinical use.