Hoehn-Yahr Stage Research Articles

Using ‘dead or dependent’ as an outcome measure in clinical trials in Parkinson's disease

BackgroundSimple, robust, sensitive and clinically meaningful outcome measures are required for neuroprotective trials in Parkinson's disease (PD). We explored the feasibility of a composite binary outcome measure, ‘dead or dependent’,...

The difference in putamen volume between MSA and PD: evidence from a meta-analysis.

The accurate and non-invasive tool for differential diagnosis between multiple system atrophy (MSA) and Parkinson's disease (PD) is needed at the early stage of disease for clinical trials of disease modifying therapy. PET is helpful, but the availability is limited. MRI is considered to be more available and potential method instead of PET. We aimed to investigate the effect of MSA and PD on putamen volume using a meta-analysis approach. A computer literature search yielded 6 eligible studies. Putamen volume was expressed as the standardized mean difference between MSA and PD patients. Moreover, subgroup analyses planed to be performed in order to identify factors which contributed to heterogeneity if included studies were not homogeneous. The proportion of variation due to heterogeneity was computed and expressed as I(2). Six studies, comprising a sample size of 84 MSA and 180 PD, were included in this meta-analysis. The overall effect indicated that putamen volume in MSA was significantly more reduced than that in PD with heterogeneous studies (P = 0.0004, 6 studies, n = 264, I(2) = 87%). A subgroup analysis revealed that the category of "Hoehn-Yahr stage of PD" showed a significant subgroup difference with a significant subgroup summary effect (subgroup difference: P = 0.003). Our findings based on group-level analysis suggested that volumetry of the putamen could be useful for differential diagnosis between MSA and PD at the early stage of disease, and also help to enroll more accurate disease group for disease modifying study in future.

Effects of non-motor symptoms on health-related quality of life in Parkinson's disease

To explore the effects of non-motor symptoms (NMS) on health-related quality of life (HRQOL) in Parkinson's disease (PD) patients. By convenient sampling, 128 PD patients were recruited. NMS was assessed by the non-motor symptoms scale for PD (NMSS) and HRQOL by the 39-item PD Questionnaire (PDQ39). All PD patients (100%) had NMS with a general score of (124 ± 48) . Among these NMS, constipation was ranked the highest and the general level of NMS was significantly positively associated with age (r = 0.226, P < 0.05), Hoehn-Yahr staging (r = 0.442, P < 0.05) and disease course (r = 0.223, P < 0.05). However there was no correlation with gender (r = 0.085, P < 0.05). For PD patients, HRQOL became impaired with a general score of (44 ± 16) . Activities of daily living (60 ± 15), mobility (49 ± 21), emotional well-being (49 ± 28) and stigma (48 ± 46) were the most seriously affected. Females (χ² = -1.821 P < 0.05) and senile bereaved patients (χ² = -1.512, P < 0.05) had significantly lower HRQOL than that of others. For PD patients, the general level of HRQOL was significantly positively associated with disease course (r = 0.260, P < 0.05) and severity (r = 0.259, P < 0.05). The general level of HRQOL was significantly positively associated with the general level of NMS (r = 0.686, P < 0.01). Non-motor symptoms (NMS) are quite common in PD patients. For PD patients, NMS has a more negative impact on HRQOL than other symptoms.

Clinical REM sleep behavior disorder and motor subtypes in Parkinson’s disease: A questionnaire-based study

ObjectivesStudies documenting the association between rapid eye movement sleep behavior disorder (RBD) and motor subtypes in Parkinson’s disease (PD) are rare. Our hypothesis is that RBD may be more severe in non-tremor dominant (NTD) patients with RBD than those tremor dominant (TD) with RBD. In this study, we investigated the association between motor subtypes and clinical RBD in PD. Patients and methodsWe evaluated 104 consecutive patients older than 18 years presenting with PD to the Neurology Clinic of the University Hospital for one year in this study. The clinical diagnosis of RBD was based on the minimal diagnostic criteria of International Classification of Sleep Disorders, revised. The Stavanger Sleepiness Questionnaire was used to rate the severity of clinical RBD. The patients were divided into two subgroups as TD and NTD. The patient and control groups were compared with each other for severity and frequency of clinical RBD, and the Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn–Yahr stage scores. The correlation between severity of clinical RBD and clinical severity of PD was analyzed in the patient groups. ResultsOf the patients, 45.2% (n=47) had the NTD subtype of PD and 54.8% (n=57) had the TD subtype of PD. There was no significant difference among the groups in terms of frequency and severity of clinical RBD. For the NTD patients, there was a weak positive correlation between severity of clinical RBD and clinical severity of PD. However, there was no correlation in the TD subgroup. ConclusionIn our study, frequency of clinical RBD was unrelated to motor subtypes of PD. However, in the present study, we found a weak correlation between clinical severity (UPDRS and the Hoehn–Yahr) of PD and severity of clinical RBD in the NTD subtype but not in the TD subtype.

Low Frontal Assessment Battery Score as a Risk Factor for Falling in Patients with Hoehn-Yahr Stage III Parkinson's Disease: A 2-Year Prospective Study

Background: Recently, we evaluated factors responsible for falling, including walking speed evaluated with the use of originally designed, suddenly narrowed paths, in patients with Hoehn-Yahr stage III PD. We prospectively studied the same cohort of patients with PD who were followed up for 2 years, to determine predictors of future falls. Methods: We performed clinical assessments and evaluated balance in 26 patients. A total of 19 variables including PD-related independent variables, balance investigation-related independent variables and gait independent-related variables were evaluated. Results: The Frontal Assessment Battery (FAB) score (p = 0.002), Tinetti balance (p = 0.009), and gait velocity (p = 0.001) were higher in fallers than in non-fallers. On multiple logistic regression analysis, the FAB score was related to falling (odds ratio = 3.328, p = 0.033, 95% confidence interval = 1.104-10.03). On the FAB, the scores of ‘inhibitory control' and ‘sensitivity to interference' were significantly lower in fallers than in non-fallers. Conclusions: The use of the originally designed, suddenly narrowed path was the primary reason for demonstrating for the first time that a low FAB score is a risk factor for future falls. Calculation of the FAB score may be useful for predicting the risk of future falls.

BDNF G196A (Val66Met) polymorphism associated with cognitive impairment in Parkinson's disease

Brain-derived neurotrophic factor (BDNF) is a neurotrophin widely expressed in the mammalian brain, regulating neuronal survival and known to influence dopaminergic neurons and cognitive processes. The present study investigated the BDNF Val66Met polymorphism associations with PD risk, and cognitive impairment in PD. A total of 486 study subjects (244 PD and 242 age and sex matched controls) were included in the study. UPDRS score, Hoehn–Yahr staging and the Schwab–England scale were used to assess motor abilities and activity during daily life. The patients were classified into groups with dementia (PDD, n=69) and without it (nPDD, n=166) on the basis of neuropsychological assessment. The most common functional polymorphism in BDNF Val66Met (rs6265, G196A) gene was determined using TaqMan real-time PCR assay. Frequencies of evaluated BDNF alleles and genotypes were similar in PD and the controls. The mean age of disease onset among BDNF Met/Met carriers was later (65.00±6.13) in comparison to Val/Val (57.45±10.68) and Val/Met (56.33±10.91) subjects (p=0.077). The studied BDNF polymorphism was not associated with cognitive status in PD patients. However, patients with Met/Met alleles demonstrated better delayed recall of information than patients with Val/Val alleles. The results of multivariate logistic regression analysis revealed age (p=0.0003) and the disease stage (p=0.002) as independent risk factors predisposing to PD dementia.

Therapeutic Effects of Tai Chi in Patients with Parkinson’s Disease

Objective. The purpose of the study was to investigate the effects of a 12-week program of therapeutic Tai Chi on the motor function and physical function of idiopathic Parkinson's disease patients (PDs). Methods. The participants were 22 clinically stable PDs in Hoehn-Yahr stages 1-2 randomly assigned to a therapeutic Tai Chi group (TTC, N = 11) or a control group (CON, N = 9). Two subjects in control group did not complete the study for personal reasons. TTC was performed three days a week (60 min/session). Motor symptoms by the UPDRS were assessed, and tests of physical function were administered before and after the 12-week trial. Results. The TTC group, as compared to the CON group, showed changes in the mentation, behavior, mood, and motor scales of the UPDRS (P < 0.05, P < 0.01, resp.), with no significant main effects on the activities of daily living scale (ADL). However, there was a significant interaction between the time and intervention group on ADL (P < 0.05). There were no significant main effects for any of the physical function variables. There were significant interaction effects in balance and agility (P < 0.05, resp.). Conclusions. This study showed that TTC training had modest positive effects on the functional status of Parkinson's disease patients.

Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: A preliminary prospective longitudinal study

Decreased mobility and walking capacity occur frequently in Parkinson's disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. Seventy patients with idiopathic Parkinson's disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinson's Disease Rating Scale (UPDRS) motor section and Parkinson's Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1-3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control. As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment.

Comparison of the clinical profile of Parkinson's disease between Spanish and Cameroonian Cohorts

BackgroundThere are limited data in terms of the clinical profile of Parkinson's disease in sub-Saharan African patients. ObjectiveTo compare the clinical profile and access to standard antiparkinsonian therapies of a Cameroonian cohort of patients with an age, sex, and disease duration-matched Spanish cohort (Longitudinal Study of Parkinson's disease, ELEP). MethodsObservational, cross-sectional design. Demographic data were collected and the following ELEP assessments were applied: Scales for Outcomes in Parkinson's disease (SCOPA) Motor, Autonomic, Cognition, Sleep and Psychosocial; Hoehn and Yahr staging; modified Parkinson Psychosis Rating Scale; Cumulative Illness Rating Scale-Geriatrics; Hospital Anxiety and Depression Scale; pain and fatigue visual analog scales; Zarit, and EuroQoL. Results74 patients with idiopathic Parkinson's disease were included (37 from each country) with a mean age of 64.4±10.5years old, 70.3% males, and mean disease duration of 5.6±5.9years. Compared to the Spanish cohort, Cameroonians were intermittently treated, less frequently received dopaminergic agonists (p<0.001), had a trend for taking lower doses of levodopa (p=0.06), and were more frequently on anticholinergics (p<0.0005). Cameroonians were more severely impaired in terms of motor (Hoehn Yahr stage, p=0.03; SCOPA-Motor, p<0.001), cognitive status (p<0.001), anxiety and depression (p<0.001), psychosis (p=0.008), somnolence, fatigue and pain (p<0.001, respectively), caregiver burden (p<0.0001), and quality of life (p=0.002). Instead, autonomic, comorbidity, and nocturnal sleep problems were similarly found. ConclusionsLimited and intermittent access to dopaminergic drugs has a negative impact on motor symptoms, nonmotor symptoms and quality of life in patients with Parkinson's disease and their caregivers.

Trigger medications and patient-related risk factors for Parkinson disease psychosis requiring anti-psychotic drugs: a retrospective cohort study

BackgroundPsychoses such as hallucinations are a frequent non-motor problem in patients with Parkinson disease (PD) and serious psychosis requires anti-psychotic medications that worsen Parkinsonism. Although psychosis could be associated with patient-related or biological factors such as cognition, age, and severity of PD, it can also be associated with medications.Therefore we aimed to investigate patient-related and medication-related risks of psychosis requiring anti-psychotic medications (serious psychosis).MethodsA retrospective cohort of 331 PD patients was followed for 2 years. Patient-related factors associated with risk of psychosis were identified by a survival time analysis. In patients who developed psychosis, medications during the hazard period (1-14 days before psychosis) were contrasted with those during the control periods (1 and 3 months before psychosis) using a case–crossover analysis to identify medication-related risks of psychosis.ResultsSerious psychosis was detected in 52 patients and the incidence was estimated to be 116 (95% confidence interval [CI], 85-148) per 1,000 person-years. Analyses of baseline characteristics revealed the risk to be higher in patients with a modified Hoehn–Yahr stage of ≥4 (hazard ratio [HR], 2.22; 95% CI, 1.11-4.40), those with a longer duration of PD (HR, 1.25; 95% CI, 1.00-1.55, per 5 years) and those with Mini-Mental State Examination scores of ≤24 (HR, 2.66; 95% CI, 1.37-5.16). The case-crossover analysis revealed that anti-cholinergics use (HR, 19.7; 95% CI, 2.39-162) elevated the risk, while donepezil use reduced it (HR, 0.48; 95% CI, 0.27-0.85).ConclusionsRisk of psychosis was elevated by increasing severity of PD, cognitive dysfunction and duration of the disease. It was elevated by use of anti-cholinergic drugs and reduced by use of donepezil. The medication-related risk was higher in patients aged ≥ 70 years. In contrast, there was no significant medication-related risk in younger patients, suggesting different pathomechanisms between young and old patients.

Blood pressure fluctuation and hypertension in patients with Parkinson's disease

ObjectivesBlood pressure (BP) abnormalities have been known in Parkinson's disease (PD) patients. The present study aimed at determining how the BPs of PD patients fluctuate in a day.MethodsA total of 37 PD patients and 44 OD (other disease) patients, all of who were inpatients, were monitored every 30 min by 24-h ambulatory blood pressure monitoring (ABPM).ResultsThe average systolic BP and the number of patients who showed postprandial hypotension were not different between the two groups. However, occurrence of nocturnal hypertension, BP fluctuation of over 100 mmHg in a day and BP of over 200 mmHg were significantly more frequently observed in the PD patients than in the OD patients. In the PD patients, these parameters were not different between those who were suffering from the disease for less than 10 years and those with the disease for 10 years or longer, as well as between those who had a Hoehn–Yahr staging scale of 2–3 and those with a scale of 4–5.ConclusionTwenty-four-hour ABPM, not BP measurement once a day, enables us to determine the actual BP in PD patients. Although hypotension is a severe risk factor for falling and syncope, we emphasize the importance of monitoring rather hypertension and fluctuating BP in PD patients that may lead to a variety of other undesirable conditions. Management of hypotension, hypertension, and BP fluctuation is an important issue in the future.

Lack of association of morphologic and functional retinal changes with motor and non-motor symptoms severity in Parkinson’s disease

Visual symptoms are common among the nonmotor symptoms in Parkinson’s disease. The aims of this study were to assess the diagnostic accuracy and relationship of retinal morphologic and functional changes with motor and non-motor symptoms disturbances in Parkinson’s disease. Thirty patients with Parkinson’s disease, with a median Hoehn-Yahr stage of 2 (1-4), were compared to 30 age- and gender-matched controls. Retinal thinning and function were measured using optical coherence tomography (OCT), visual evoked potentials (VEP), and pattern electroretinography. Motor impairment and motor laterality were measured using the Short Parkinson’s Evaluation Scale/Scales for Outcomes in Parkinson’s disease, and non-motor symptoms severity using the nonmotor symptoms questionnaire. Only pattern electroretinography, P50 and N95 amplitudes, were lower in patients with Parkinson’s disease, compared to controls (p = 0.01, respectively). Age, disease duration, levodopa dose, motor, and non-motor impairment were not significantly associated with retinal thinning and functional changes. The patients vs. controls area under the curve of OCT, VEP, and pattern electroretinography receiver-operating-characteristic curves were<0.50. In conclusion, morphologic and functional retina changes are not significantly correlated with motor and non-motor symptoms impairment severity, and do not discriminate between Parkinson’s disease and controls.

WOQ-19 improves satisfaction of patients with Parkinson's disease

WOQ-19 improves satisfaction of patients with Parkinson's disease

Clinical Factors Associated with Abnormal Postures in Parkinson's Disease

BackgroundAbnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication.PurposeTo clarify factors associated with neck and thoracolumbar AP.MethodsNeck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ΔNFA and ΔTLA, respectively. The association of ΔNFA or ΔTLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H–Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ΔNFA or ΔTLA. The association between predictable factors and ΔNFA or ΔTLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis.ResultsCompared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ΔNFA, the highest quartile was associated with H–Y stage ≥3 [OR 2.99, 95% confidence interval (CI) 1.33–6.70, p = 0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ΔTLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42–23.8), p = 0.014], and UPDRS-3 score [OR 3.04 (1.80–5.15)/10 points, p<0.0001].ConclusionThoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.

Clinical characteristics in Parkinson's disease patients with cognitive impairment and effects of cognitive impairment on sleep

To analyze the clinical characteristics, correlation factors and clinical heterogeneities in Parkinson's disease (PD) patients with cognitive impairment and identify whether cognitive impairment could influence the aspect of sleep. A total of 130 PD outpatients and inpatients of sleep center at our hospital were eligible for participation. According to Montreal cognitive assessment (MOCA), they were divided into cognitive normal group (MOCA ≥ 26) (n = 51) and cognitive impairment group (MOCA < 26) (n = 79). Their clinical characteristics were mainly evaluated by unified Parkinson's disease rating scale (UPDRS) , Hoehn-Yahr (H-Y) stage, Hamilton depression scale (HAMD-24 item) and Epworth sleepiness scale (ESS). And all of them underwent video-polysomnography (PSG). The proportion of cognitive impairment (MOCA < 26) was 60.76%. Compared to those without cognitive impairment, the PD patients with cognitive impairment had significantly higher score of HAMD (10 ± 7 vs 7 ± 4), increased incidence of hallucinations (40.50% vs 19.60%) and REM behavior disorders (RBD) (63.29% vs 39.21%), significantly higher H-Y stage [2.5(2.0-3.0) vs 2.0 (2.0-2.5)] , United Kingdom Parkinson Disease Society (UPDRS) part III (22 ± 10 vs 19 ± 10) and levodopa-equivalent daily dose (LED) (511 ± 302vs 380 ± 272) (all P < 0.05). However, no significant differences existed in the subscores of MOCA between PD patients with different sides of onset and motor subtypes of onset (all P > 0.05). Non-conditional Logistic regression analysis showed that PD duration, score of HAMD and H-Y stage were the major influencing factors of cognition. On PSG, significantly decreased sleep efficiency (57% ± 21% vs 66% ± 17%), higher percentage of non-REM sleep stage 1 (NREMS1) (37% ± 21% vs 27% ± 13%), lower percentage of NREMS2 (40% ± 17% vs 46% ± 13%) and REM sleep (39% ± 28% vs 54% ± 36%) were found for PD patients with cognitive impairment (all P < 0.05). The PD patients with cognitive impairment have more severe disease and partial nonmotor symptoms. And the severity of disease and depression is closely associated with cognitive impairment. Cognitive impairment may also affect sleep to cause decreased sleep efficiency and severe sleep structure disorder.

The study of subjective and objective evaluation of sleep disturbances in Parkinson's disease

Background Sleep disorder is one of the most common non-motor symptoms in Parkinson's disease (PD) patients. At present, there are subjective and objective tools to evaluate sleep disorders. Nevertheless, previous studies commonly used single subjective questionnaires or objective examinations. Therefore, we used the combinations of subjective and objective tools to analyze clinical characteristics of sleep disturbances in PD and investigated differences and consistence between subjective and objective tools. Methods One hundred and sixteen PD patients were eligible to participate into this study. All participants were evaluated by Pittsburgh Sleep Quality Index (PSQI), Unified Parkinson's Disease Rating Scale (UPDRS) in on condition, Hoehn-Yahr (H-Y) stage, Hamilton Depression Rating Scale (HAMD 24 items), Montreal Cognitive Assessment (MoCA), Epworth Sleepiness Scale (ESS), and underwent a video-polysomnography (Video-PSG). Results According to PSQI score of 116 PD patients, the proportion of PD patients with sleep disturbances (PSQI ≥ 7) was 50% (N = 58). Compared to PD patients without sleep disturbances, PD patients with sleep disturbances had lower score of MoCA (23.34 ± 3.50 vs 24.89 ± 3.52; t = 2.377, P = 0.019), higher score of UPDRSⅠ[4.00 (2.00, 5.00) vs 3.00 (2.00, 5.00); U = - 2.306, P = 0.021], UPDRSⅡ[12.00 (9.00, 16.00) vs 10.00 (6.00, 13.00); U = - 1.995, P = 0.046], higher levodopa equivalent daily dose [LED, (508.14 ± 335.85) vs (394.06 ± 236.40) mg/d; t = - 2.115, P = 0.037]. Although PD patients with sleep disturbances had more score of UPDSR Ⅲ and higher H-Y stage, the differences were not significant (P > 0.05). On the other hand, decreased total sleep time (TST), reduced sleep efficiency (SE), increased sleep latency (SL), decreased non-rapid eye movement (NREM) sleep stage Ⅱ time were found for PD patients with sleep disturbances (P 0.05, for all). The score of PSQI was positively correlated with the score of ESS (r = 0.200, P = 0.032), HAMD (r = 0.202, P = 0.030), UPDRSⅠ (rs = 0.266, P = 0.004) and Ⅱ (rs = 0.254, P = 0.007), LED (r = 0.213, P = 0.022), SL (rs = 0.211, P = 0.023). Moreover, the score of PSQI was negatively correlated with TST (r = -0.231, P = 0.003), SE (r = -0.192, P = 0.039) and MoCA (r = -0.236, P = 0.011). Conclusion PD patients with sleep disturbances had worse cognition impairment, more mood disorders, decreased activity of daily life. Meanwhile, most of PSG parameters were altered in PD patients with sleep disturbances. Moreover, the severity of sleep disturbances in PD patients was correlated with these factors. Overall sleep quality of PD patients assessed with the objective tool could be predicted by the subjective scale. However, to evaluate sleep architecture and other sleep disorders for PD patients, the objective tools (such as Video-PSG monitoring) are necessary to be used.

Baseline [123I]FP-CIT SPECT (DaTSCAN) severity correlates with medication use at 3 years in Parkinson's disease

Presynaptic dopaminergic deficiency on dopamine transporter imaging supports a clinical diagnosis of Parkinson's disease and correlates with the severity of rigidity and bradykinesia. Baseline dopaminergic deficiency predicts clinical severity, but the relationship with subsequent medication use has not been reported. A randomly selected cross section of 83 Parkinson's disease (PD) patients who had [(123) I] FP-CIT SPECT at the time of clinical diagnosis was identified. Dopaminergic deficiency was graded 1, 2 or 3 with increasing severity using visual assessment and by semiquantitative analysis of putamen and caudate uptake. Antiparkinson medication usage and clinical severity by Hoehn and Yahr were noted annually to 3 years. In 83 patients (66% male, median age 65.0 years, IQ 55.4-71.8), [(123) I]FP-CIT SPECT was grade 1 in 20 (24%), grade 2 in 53 (64%) and grade 3 in 10 patients (12%). Dopamine transporter uptake ratios were inversely associated with antiparkinson medication usage (r = -0.26, P = 0.0201) and Hoehn Yahr stage (r = -0.32, P = 0.0029) at 3 years from baseline, but there was considerable variation in drug usage in individual patients. At 3 years, patients with grade 1 scans at baseline received a median dose of 325 levodopa equivalent units (LEU) (interquartile range 175-433); grade 2 scan patients 400 LEU (interquartile range 300-635); and grade 3 scan patients 460 LEU (interquartile range 252-658). The degree of reduction in presynaptic dopaminergic uptake at baseline is associated with higher antiparkinson drug dosage at follow-up, but the wide variation means that the baseline FP-CIT SPECT does not reliably predict drug use in individual cases.

Meta-analysis of clinical differences between Parkinson's disease patients with and without REM sleep behavior disorder

Objective To compare the clinical differences between Parkinson's disease (PD) patients with and without rapid eye movement sleep behavior disorder (RBD). Methods PubMed, EMBASE, Cochrane Library, Chinese Biology Medicine (CBM) and China National Knowledge Infrastructure (CNKI) databases were used to search for studies RBD in PD patients. Meticulous data were extracted and Meta-analysis was performed. All analyses were conducted with the software of Revman Manager 5.2.4. Results Five clinical studies involving total 650 PD patients were included. The Meta-analysis showed that PD patients with RBD had an older mean age ( WMD = 2.870, 95%CI:1.490-4.260; P = 0.000), a higher Hoehn-Yahr stage ( WMD = 0.300, 95% CI: 0.160-0.450; P = 0.000), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores during the on state ( WMD = 2.370, 95%CI: 0.260-4.490; P = 0.030), and larger levodopa dose ( WMD = 90.550, 95% CI: 31.040-150.060; P = 0.003) in comparison with PD patients without RBD. In addition, PD patients with RBD were more likely to develop motor fluctuation ( OR = 1.520, 95% CI: 1.080-2.140; P = 0.020) and orthostatic hypotension ( OR = 11.390, 95% CI: 4.790-27.090; P = 0.000) as compared to PD patients without RBD. However, gender ( OR = 1.850, 95%CI: 0.810-4.230; P = 0.150), disease duration ( WMD = 0.130, 95% CI: ⁃ 1.230-1.500; P = 0.850) and Mini-Mental State Examination (MMSE) scores ( WMD = ⁃ 0.220, 95%CI: ⁃ 0.600-0.160; P = 0.260) did not differ between PD patients with and without RBD. Conclusion PD patients with RBD were more likely to be associated with older age, more severe motor disability, higher levodopa usage, higher incidence of motor fluctuation and orthostatic hypotension, indicating thatPD with RBD might be at an advanced stage and had more widespread and severe neurodegeneration.

Postural abnormality as a risk marker for leg deep venous thrombosis in Parkinson's disease.

BackgroundPulmonary thromboembolism is a common cause of death in patients with autopsy-confirmed Parkinsonism. This study investigated the incidence of leg deep vein thrombosis in Parkinson’s disease and relationships between deep vein thrombosis and clinical/laboratory findings, including postural abnormalities as assessed by photographic measurements.MethodsThis cross-sectional study assessed the presence of deep vein thrombosis using bilateral leg Doppler ultrasonography in 114 asymptomatic outpatients with Parkinson’s disease.ResultsDeep vein thrombosis was detected in 23 patients (20%) with Parkinson’s disease. Deep vein thrombosis was located in the distal portion in 18 patients and in the proximal portion in 5 patients. No significant differences in age, sex, body mass index, disease duration, Hoehn-Yahr stage, anti-Parkinson’s drugs, or daily levodopa-equivalent dose were seen between deep vein thrombosis-positive and -negative groups. Univariate analysis for developing deep vein thrombosis in patients with Parkinson’s disease identified the following markers: long-term wheelchair use, bent knee, bent spine, and D-dimer elevation. Bending angles were significantly greater in the deep vein thrombosis-positive group at the knee and spine than in the deep vein thrombosis-negative group. Half of Parkinson’s disease patients with camptocormia had deep vein thrombosis. Among diabetes mellitus cases, long-term wheelchair use, bent knee over 15°, camptocormia, D-dimer elevation, the more risk markers were associated with a higher incidence of DVT. The presence of risk markers contributed to the development of deep vein thrombosis. On multivariate logistic regression analysis, a bent knee posture was strongly associated with an increased risk of deep vein thrombosis.ConclusionPresence of leg deep vein thrombosis correlated with postural abnormalities in Parkinson’s disease. We recommend non-invasive ultrasonographic screening for leg deep vein thrombosis in these high-risk patients with Parkinson’s disease.

A clinical observation of the influence of deep brain stimulation on peripheral blood lymphocytes in patients with Parkinson's disease

Objective To study the changing in number of peripheral blood lymphocyte (PBL) of patients with Parkinson's disease (PD) after deep brain stimulation (DBS), and to explore the mechanism of DBS in treating PD. Methods One hundred and thirty PD patients were divided into 2 groups, namely, non-DBS group [N = 105; 68 males and 37 females; mean age (61.54 ± 10.44) years; mean duration (7.29 ± 4.57) years], and DBS group [N = 25; 16 males and 9 females; mean age (59.20 ± 10.67) years; mean disease duration (12.16 ± 4.79) years]. There were 73 healthy subjects [37 males and 36 females; mean age (61.89 ± 12.20) years] in control group. The differences of the number of PBL among the 3 groups were analyzed. Spearman's rank correlation analysis was used to assess the relationship between PBL number and influenzing factors [gender, age, disease duration, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅲ score, Hoehn-Yahr (H-Y) stage, and drug equivalent daily dose]. Results The number of PBL in non-DBS group was less than that in control group ( P = 0.000). There was significant correlation between UPDRS Ⅲ and PBL number ( rs = ⁃ 0.403, P = 0.031). No correlation was found between PBL number and gender, age, disease duration, H-Y stage or drug equivalent daily dose ( P > 0.05, for all). No difference was shown between PBL number in control group and in DBS group ( P = 0.137) and no correlations were found with clinical variables ( P > 0.05). The PBL number in non-DBS group was less than that in DBS group ( P = 0.006). With the same H-Y stage, PBL number in non-DBS group was also less than that in DBS group in Mann-Whitney U test (H-Y 2.5: Z = ⁃ 2.197, P = 0.043; H-Y 3: Z = ⁃ 1.875, P = 0.027; H-Y 4: Z = ⁃ 3.760, P = 0.016). Conclusion The changing in the number of PBL is the specific feature of PD and may be correlated with the immuno-inflammation of central nervous system, which may be relieved by DBS.