Idiopathic Parkinson's Disease Patients Research Articles

Correlation between alpha activity and neuropsychometric tests in Parkinson's disease

Parkinson’s disease (PD) is a neurodegenerative disease that leads to memory impairment and executive and visuospatial dysfunction as the disease progresses. Alpha activity on EEG has been related to cognition in previous studies. We aimed to investigate the correlation between alpha activity and neuropsychometric tests (NPTs) in PD patients. Fifty-five idiopathic PD patients and 20 healthy controls were included. The Standardized Mini-Mental Test (SMMT), Verbal Learning Memory Test (VLMT), Wechsler Memory Scale (WMS), Stroop Color–Word Test, Categorical Verbal Fluency Test (CVFT), Benton’s Face Recognition Test (BFR), and Benton Line Judgment Orientation Test (BLOT) were administered to all participants. Patients were separated into four groups according to NPT results: healthy controls (HC); PD patients with normal cognition (PDNC); PD patients with MCI (PDMCI); and PD patients with dementia (PDD). Analysis of the EEG data showed that HC had the highest alpha activity, and PDD had the lowest. High SMMT scores were correlated with high alpha activity at posterior electrode locations in all PD groups. VLMT and WMS test scores were associated with alpha activity at the parietal sites in PDMCI. VLMT, WMS, and CVFT test scores were correlated with alpha activity at parietooccipital sites in PDD. Verbal and visuospatial memory dysfunction related to low alpha activity was evident in both PDMCI and PDD, whereas executive dysfunction was more strongly associated with low alpha activity in PDD. Analysis of alpha activity could help clinicians predict the progression of cognitive dysfunction in PD patients.

Characterization of idiopathic Parkinson’s disease subgroups using quantitative gait analysis and corresponding subregional striatal uptake visualized using 18F-FP-CIT positron emission tomography

BackgroundGait disturbance is one of the most common symptoms among patients with idiopathic Parkinson’s disease (IPD). Nevertheless, Parkinson’s disease subtype clustering according to gait characteristics has not been thoroughly investigated. Research questionThe aim of this study was to identify subgroups according to gait pattern among patients with IPD. MethodsThis study included 88 patients with IPD who underwent 18F-fluorinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-4-iodophenyl-nortropane positron emission tomography (18F-FP-CIT PET) and three-dimensional gait analysis (3DGA) between January 1, 2014 and December 31, 2016. We performed cluster analysis using temporal-spatial gait variables (gait speed, stride length, cadence, and step width) and divided patients into four subgroups. The kinematic and kinetic gait variables in 3DGA were compared among the four subgroups. Furthermore, we compared the uptake patterns of striatum among the four subgroups using 18F-FP-CIT PET. ResultsThe patients were clustered into subgroups based on gait hypokinesia and cadence compensation. Group 1 had decreased stride length compensating with increased cadence. Group 2 had decreased stride length without cadence compensation and wider step width. Group 3 had relatively spared stride length with decreased cadence. Group 4 had spared stride length and cadence. The uptake of posterior putamen was significantly decreased in Group 3 compared with Group 4. SignificanceGait hypokinesia and cadence can help to classify gait patterns in IPD patients. Our subgroups may reflect the different gait patterns in IPD patients.

The effect on deep brain stimulation of subthalamic nucleus and dopaminergic treatment in Parkinson disease.

Impulsivity is a frequent non-motor symptom in Parkinson disease (PD). It comprises psycho-behavioral alterations that negatively impact quality of life. Dopaminergic treatments underpin many impulsive controls disorders however, side effects, such as increased impulsivity, are described also after neurosurgical procedure of deep brain stimulation (DBS). We investigated the effect of deep brain stimulation on psycho-behavioral alterations and quality of life (QoL) in PD patients, analyzing, also, the role of dopaminergic therapies.Twenty idiopathic PD patients with and 20 idiopathic PD patients without DBS were included in the study. All patient underwent to neuropsychological assessment for a screening of executive functions, impulsivity, anxiety and depressive symptoms and QoL.Differences were found between DBS and no DBS groups and in term of dopaminergic therapies. The comparison between 2 groups showed a greater motor and attentional impulsivity in DBS patients. Moreover, this impulsivity worse QoL and interpersonal relationships. The combination of Levodopa and dopamine agonists exerted a great impact on impulsivity behavior.The emergence of postoperative impulsivity seems to be a neurostimulator phenomenon related to the computational role of the subthalamic nucleus in modulation of behavior.

Patients\u2019 experiences of Parkinson\u2019s disease: a qualitative study in glucocerebrosidase and idiopathic Parkinson\u2019s disease

BackgroundApproximately 7–10% of Parkinson’s disease (PD) patients carry a GBA (Glucocerebrosidase) mutation (GBA-PD patients), which may influence the disease’s clinical course.ObjectivesThis study aimed to explore the patient experience of GBA-PD and identify the most important symptoms and impacts to inform clinical trial measurement strategies.MethodsTwenty PD patients (n = 15 GBA-PD; n = 5 idiopathic-PD) participated in qualitative interviews which explored concepts spontaneously reported or identified through a literature review. Telephone interviews with five expert clinicians included discussion of a preliminary conceptual model derived from literature. Verbatim transcripts were thematically analysed.ResultsThirty symptoms reported by patients were categorized as motor, non-motor, and cognitive/psychiatric. Tremor (n = 13), memory loss (n = 13), rigidity/stiffness (n = 11), and speech problems (n = 11) were considered the most important and impactful symptoms by GBA-PD patients, although other symptoms were also relevant to the majority of patients. Key impacts included: sleep disturbances (n = 13), handwriting changes (n = 13), reduced social interaction (n = 12), dyskinesia (n = 10), depressed mood (n = 9), and fear of falling (n = 8). Key symptoms and impacts reported by GBA-PD patients were consistent with those reported by idiopathic-PD patients. Clinician interview results supported the patient findings, although some clinicians indicated that cognitive/psychiatric symptoms may present earlier in GBA-PD patients. The concepts emerging from the research informed updates to a conceptual model of GBA-PD patients’ disease experience.ConclusionsThe findings provide in-depth understanding of the patient experience of GBA-PD. The findings confirm that the concepts relevant to assess in GBA-PD are consistent with those relevant to assess in idiopathic-PD; however, greater consideration of cognitive/psychiatric symptoms may be warranted in GBA-PD populations.

Cerebrospinal fluid and blood levels of neurofilament light chain in Parkinson disease: A protocol for systematic review and meta-analysis.

Background:Parkinson disease (PD) is a common neurodegenerative disorder. Elevations of neurofilament light chain (NfL) concentrations in the cerebrospinal fluid (CSF) and blood are a marker of neuronal/axonal injury and degeneration. However, CSF and blood NfL alterations in patients with PD from existing studies remain inconclusive. To better understand these conflicting data, we will conduct a meta-analysis.Methods:We will comprehensively search PubMed, Embase, and Web of Science databases from each database's inception to 7th June, 2020. This protocol will conform to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. We will only include original studies published in English that evaluated differences of NfL concentrations in the CSF or blood between idiopathic PD patients and healthy controls. The Newcastle-Ottawa Scale will be used to evaluate the quality of the included studies. Meta-analyses will be carried out using the STATA software version 13.0. Between-group difference of NfL concentrations in the CSF and blood will be expressed as the weighted standardized mean difference. A random-effects model will be used. Supplementary analyses, such as heterogeneity analysis, sensitivity analysis, publication bias, subgroup analysis, and meta-regression analysis will be performed.Results:The meta-analysis will provide the differences of NfL concentrations in the CSF and blood between patients with PD and healthy controls and will show the magnitudes of their effect sizes.Conclusions:This meta-analysis will provide the evidence of NfL concentrations in the CSF and blood in PD and we hope that our study has an important impact on clinical practice.Registration number:INPLASY202060025

CD4+ T-cell Transcription Factors in Idiopathic REM Sleep Behavior Disorder and Parkinson's Disease.

CD4+ T-cell dysregulation occurs in Parkinson's disease (PD); however, it is unknown whether it contributes to PD development. The objective of this study was to investigate transcription factor gene expression in CD4+ T cells in idiopathic rapid eye movement sleep behavior disorder, the strongest risk factor for prodromal PD. Expression of transcription factors (TBX21, STAT1, STAT3, STAT4, STAT6, RORC, GATA3, FOXP3, and NR4A2) was measured in CD4+ T cells from 33 polysomnographically confirmed idiopathic rapid eye movement sleep behavior disorder subjects and compared with expression in cells from matched healthy subjects and antiparkinson drugs-naive PD patients. Compared with healthy subjects, idiopathic rapid eye movement sleep behavior disorder subjects and PD patients had lower TBX21, STAT3, and STAT4, and higher FOXP3 expression. TBX21 expression discriminated healthy subjects from idiopathic rapid eye movement sleep behavior disorder subjects and PD patients, but not idiopathic rapid eye movement sleep behavior disorder subjects with PD. In idiopathic rapid eye movement sleep behavior disorder subjects CD4+ T cells exhibit a peculiar molecular signature strongly resembling cells from PD patients, suggesting early involvement of peripheral immunity in PD. © 2020 International Parkinson and Movement Disorder Society.

The discerning eye of computer vision: Can it measure Parkinson's finger tap bradykinesia?

ObjectiveThe worldwide prevalence of Parkinson's disease is increasing. There is urgent need for new tools to objectively measure the condition. Existing methods to record the cardinal motor feature of the condition, bradykinesia, using wearable sensors or smartphone apps have not reached large-scale, routine use. We evaluate new computer vision (artificial intelligence) technology, DeepLabCut, as a contactless method to quantify measures related to Parkinson's bradykinesia from smartphone videos of finger tapping. MethodsStandard smartphone video recordings of 133 hands performing finger tapping (39 idiopathic Parkinson's patients and 30 controls) were tracked on a frame-by-frame basis with DeepLabCut. Objective computer measures of tapping speed, amplitude and rhythm were correlated with clinical ratings made by 22 movement disorder neurologists using the Modified Bradykinesia Rating Scale (MBRS) and Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). ResultsDeepLabCut reliably tracked and measured finger tapping in standard smartphone video. Computer measures correlated well with clinical ratings of bradykinesia (Spearman coefficients): −0.74 speed, 0.66 amplitude, −0.65 rhythm for MBRS; −0.56 speed, 0.61 amplitude, −0.50 rhythm for MDS-UPDRS; −0.69 combined for MDS-UPDRS. All p < .001. ConclusionNew computer vision software, DeepLabCut, can quantify three measures related to Parkinson's bradykinesia from smartphone videos of finger tapping. Objective ‘contactless’ measures of standard clinical examinations were not previously possible with wearable sensors (accelerometers, gyroscopes, infrared markers). DeepLabCut requires only conventional video recording of clinical examination and is entirely ‘contactless’. This next generation technology holds potential for Parkinson's and other neurological disorders with altered movements.

Detailed Anatomical Volumetric Study of Deep Nuclei of Brain and Other Structures Between Parkinson’s Disease Patients Who Had Deep Brain Stimulation and Control Group

BackgroundDeep brain stimulation (DBS) was pioneered by Neuroscience team of Hospital Universiti Sains Malaysia (HUSM) nearly a decade ago to treat advanced medically refractory idiopathic Parkinson’s disease (IPD) patients.ObjectivesBrain volume reduction occurs with age, especially in Parkinson plus syndrome or psychiatric disorders. We searched to define the degree of volume discrepancy in advanced IPD patients and correlate the anatomical volumetric changes to motor symptoms and cognitive function.MethodsWe determined the magnetic resonance imaging (MRI)-based volumetry of deep brain nuclei and brain structures of DBS-IPD group and matched controls.ResultsDBS-IPD group had significant deep nuclei atrophy and volume discrepancy, yet none had cognitive or psychobehavioural disturbances. Globus pallidus volume showed positive correlation to higher mental function.ConclusionThe morphometric changes and clinical severity discrepancy in IPD may imply a more complex degenerative mechanism involving multiple neural pathways. Such alteration could be early changes before clinical manifestation.

Circulating Inflammatory miRNAs Associated with Parkinson's Disease Pathophysiology.

Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide, being largely characterized by motor features. MicroRNAs (miRNAs) are small non-coding RNAs, whose deregulation has been associated with neurodegeneration in PD. In this study, miRNAs targeting cell death and/or inflammation pathways were selected and their expression compared in the serum of PD patients and healthy controls. We used two independent cohorts (discovery and validation) of 20 idiopathic PD patients (iPD) and 20 healthy controls each. We also analyzed an additional group of 45 patients with a mutation in the leucine-rich repeat kinase 2 (LRRK2) gene (LRRK2-PD). miRNA expression was determined using Taqman qRT-PCR and their performance to discriminate between groups was assessed by receiver operating characteristic (ROC) curve analysis. We found miR-146a, miR-335-3p, and miR-335-5p downregulated in iPD and LRRK2-PD patients versus controls in both cohorts. In addition, miR-155 was upregulated in LRRK2-PD compared to iPD patients showing an appropriate value of area under the ROC curve (AUC 0.80) to discriminate between the two groups. In conclusion, our study identified a panel of inflammatory related miRNAs differentially expressed between PD patients and healthy controls that highlight key pathophysiological processes and may contribute to improve disease diagnosis.

Wearable haptic anklets for gait and freezing improvement in Parkinson's disease: a proof-of-concept study.

In a proof-of-concept study, we aimed to verify whether the wearable haptic anklets, a device that delivers personalized suprathreshold alternating exteroceptive stimulation at the anklets on demand, may improve the quality of walking, including the freezing of gate (FOG), in idiopathic Parkinson's disease (PD) patients. The clinical relevance of the presented device as a walking pacemaker to compensate the disturbed locomotion through the generation of a more physiological internal walking rhythm should be verified in a dedicated clinical trial. We tested 15 patients diagnosed as idiopathic PD, during their regular treatment regimen. Patients were evaluated during walking with the device switched on and off, personalized at their most comfortable cadence. Stride velocity, variance, and length, as well as FOG episode duration during walking or turning of 180°, were quantified by an optical high-performance motion capture VICON system. The alternating, rhythmic, sensory stimulation significantly improved either walking velocity or reduced inter-stride variance. Effects were more variable on stride length. The significant reduction of FOG episodes' duration correlated with clinical severity of scales rating gate and balance. No safety problems occurred. The WEARHAP-PD device, whose Technology Readiness Level (TRL) is 6, significantly improved some walking abilities (walking velocity and stride variance) and reduced the duration of FOG episodes in idiopathic PD patients. Unlike the traditional auditory and visual explicit cues that require the user's allocation of attention for correct functioning, the interaction of the patients with the surrounding environment was preserved, due to the likely implicit processing of haptic stimuli.

PND78 AUTOMATED ASSESSMENT OF THE SUBSTANTIA NIGRA ON SUSCEPTIBILITY MAP-WEIGHTED IMAGING USING DEEP CONVOLUTIONAL NEURAL NETWORKS FOR DIAGNOSIS OF IDIOPATHIC PARKINSONâ⑬ⓢS DISEASE

Despite the utility for determining nigrostriatal degeneration, lack of objective interpretation of nigrosome 1 susceptibility map-weighted imaging (SMWI) limits its generalized use. The purpose of this study is to implement and evaluate a deep learning (DL)-based approach for interpreting nigrosome 1 SMWI. This retrospective study enrolled 427 subjects (267 patients with idiopathic Parkinson’s disease (IPD) and 160 control subjects (patients with drug-induced parkinsonism and healthy subjects) at our institute, and additionally enrolled 25 IPD patients and 31 control subjects at other two institutes on approval of the local institutional review boards. All patients underwent both SMWI and dopamine transporter (DAT) imaging, while healthy subjects only underwent SMWI. DAT imaging served as reference standard for the presence or absence of abnormality on SMWI. Diagnostic performance was compared between a deep learning-based diagnostic algorithm and the visual assessment by an experienced neuroradiologist for both internal and external datasets by using “DTCompair” package of R. Per-subtantia nigra (SN) diagnostic sensitivity and specificity for determining abnormality in SN by an experienced neuroradiologist were 96.8% and 92.3%, and those by the developed algorithm were 97.7% and 89.7%, respectively (internal validation); 89.1% and 95.5%, and 93.5% and 92.4%, respectively (external validation). Per-participant diagnostic sensitivity and specificity for determining abnormality in SN by an experienced neuroradiologist were 99.1% and 93.3%, and those by the developed algorithm were 97.4% and 93.3%, respectively (internal validation); 96.0% and 93.6%, and 96.0% and 96.8%, respectively (external validation). Both per-SN and per-participant analyses showed differences of 90% lower confidence interval and 90% upper confidence interval within -0.1 – 0.1 for both sensitivity and specificity, indicative of comparable diagnostic performance. Our deep learning-based algorithm for determining the presence or absence of abnormality in SN on SMWI showed the diagnostic performance comparable to that by an experienced neuroradiologist.

Prevalence, clinical features and factors associated with psychosis among Idiopathic Parkinson’s Disease (IPD) patients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Introduction: This was a cross sectional study of the prevalence of psychosis and its characteristic in patients with Idiopathic PD (IPD) attending the neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Methods: The assessment was using a structured demographic data and clinical information questionnaire, Mini-International Neuropsychiatric Interview (MINI) 6.0.0, Starkstein’s Apathy Scale (AS), Mini Mental State Examination (MMSE), Movement Disorder Society – Unified Parkinson Disease Rating Scale (MDS-UPDRS) Q1-Q6, Hoehn and Yahr (H&amp;Y) stages of PD and Schwab and England Activities of Daily Living (ADL) scale. Results: 112 patients were studied. Psychosis was identified in 39 (34.8 %) patients (33 patients with hallucination only, 6 with hallucination and delusion (psychotic disorder) and none with delusions only). Among patients experiencing hallucinations, 14 (35.9%) had a visual hallucination only, 12 (30.8%) had auditory hallucinations only, and 13 (33.3%) had both visual and auditory hallucinations. Psychosis were more common in IPD patients with cognitive impairment using MDSQ1 scoring (OR 0.15; 95% CI, 0.05-0.63; P = p‹0.05) while others variables were not significant. The analysis, among patients with psychotic symptoms only and patients with psychotic disorder showed education level (p&lt;0.05), duration of illness (OR 1.8; 95% CI, (-10.7 - -3.5; p &lt;0.01), cognitive impairment score - MDSQ1 (OR 0.2; 95% CI, 0.2-0.9; p&lt;0.01), H&amp;Y score (OR 0.4; 95% CI, -2.1- -0.6; p&lt;0.01) and ADL score (OR 0.6; 95% CI, 0.3 – 2.6; p&lt;0.05) were significant. Conclusions: Lower education level, longer duration of illness, more advance stage of Parkinson disease and less functioning in ADL were significant in psychotic disorder in IPD.

Associations of Lower Caffeine Intake and Plasma Urate Levels with Idiopathic Parkinson's Disease in the Harvard Biomarkers Study.

Two purines, caffeine and urate, have been associated with a reduced risk of idiopathic Parkinson's disease (PD) in multiple cohorts and populations. The Harvard Biomarkers Study (HBS) is a longitudinal study designed to accelerate the discovery and validation of molecular diagnostic and progression markers of early-stage PD. To investigate whether these 'reduced risk' factors are associated with PD within this cohort, we conducted a cross-sectional, case-control study in 566 subjects consisting of idiopathic PD patients and healthy controls. Caffeine intake as assessed by a validated questionnaire was significantly lower in idiopathic PD patients compared to healthy controls in males (mean difference -125 mg/day, p < 0.001) but not in females (mean difference -30 mg/day, p = 0.29). A strong inverse association was also observed with plasma urate levels both in males (mean difference -0.46 mg/dL, p = 0.017) and females (mean difference -0.45 mg/dL, p = 0.001). Both analyses stratified for sex and adjusted for age, body mass index, and either urate level or caffeine consumption, respectively. These results highlight the robustness of caffeine intake and urate as factors inversely associated with idiopathic PD.

Serum Uric Acid Level as a Biomarker in Idiopathic and Genetic (p.A53T Alpha-Synuclein Carriers) Parkinson's Disease: Data from the PPMI Study.

Blood uric acid level represents an emerging biomarker in Parkinson's disease (PD). Whether uric acid levels change in genetic forms of PD is just beginning to be explored. The aim of the present study was to assess differences in serum uric acid level among PD patients harboring the p.A53T mutation in the alpha-synuclein gene, idiopathic PD, and healthy controls. Longitudinal 5-year serum uric acid measurement data of 369 de novo idiopathic PD patients and 174 age- and gender-matched healthy controls have been downloaded from the Parkinson's Progression Markers Initiative (PPMI) database. Furthermore, we assessed baseline serum uric acid measurements of 24 p.A53T alpha-synuclein PD patients enrolled in PPMI and followed in our site as compared to 24 age-, gender- and disease duration-matched sporadic PD patients and 24 healthy controls. Longitudinal serum uric acid measurements did not differ statistically between idiopathic PD patients and healthy controls (despite a trend for lower uric acid in the PD group) (p = 0.879). This was also true when male and female subgroups were assessed separately. The p.A53T SNCA mutation carrier PD group exhibited lower baseline serum uric acid level as compared to their matched healthy controls (p = 0.025). In the present study we did not replicate the established lower serum uric acid measurements in PD patients as compared to controls using PPMI data, possibly due to the fact that PD patients in baseline visit were de novo and the average disease duration was shorter than that observed in most epidemiological PD studies. The faster progression rate and increased disease severity in p.A53T PD possibly correlate with the lower serum uric acid observed in this subgroup.

Orofacial Strength and Voice Quality as Outcome of Levodopa Challenge Test in Parkinson Disease.

To assess the usefulness of orofacial strength and voice quality as assessment of response to levodopa challenge test (LCT) used in the diagnosis of early idiopathic Parkinson disease (IPD). Controlled Prospective Study. From January 2014 to April 2019, patients with early IPD and healthy individuals were recruited and evaluated for clinical findings (Hoehn and Yahr scale; Unified Parkinson's Disease Rating Scale); Voice Handicap Index (VHI); grade of dysphonia, roughness, breathiness, asthenia, and strain and instability (GRBASI); maximal phonation time; phonation quotient; acoustic parameters; and orofacial muscle strength Oral Performance Instrument (IOPI; IOPI Medical, Woodinville, WA, USA) t) at baseline and 45 minutes after the levodopa intake (LCT). A total of 32 IPD patients and 20 healthy individuals completed the study. Healthy individuals exhibited better VHI, grade of dysphonia, breathiness, asthenia, strain, instability, and acoustic measurements (noise-related, tremor, F0 short- and mid-term and intensity short-term parameters) than healthy subjects. The mean values of muscle strength of lips, cheeks, fundamental frequency (F0), highest F0, and shimmer significantly improved from pre- to post-LCT in IPD patients. Healthy individuals did not exhibit significant changes of orofacial strength and voice quality assessment from pre- to post-LCT. Significant associations were found between clinical, orofacial strength, and some aerodynamic and acoustic measurements. Orofacial strength and acoustic voice quality measurements may be used as objective outcomes of the LCT responsiveness in patients with early IPD. 3A. Laryngoscope, 2020.

Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson's Disease.

Introduction: Evidence suggests urinary urgency is associated with cognitive impairment in a subtype of Parkinson’s disease (PD) patients. This study investigates if cognitive impairment independently predicts the presence of urinary dysfunction.Methods: We report data of 189 idiopathic PD patients, excluding those with concomitant diseases or medication interacting with bladder function. A standardized questionnaire was used to define the presence of urinary urgency. All patients underwent a comprehensive motor, cognitive non-motor and health-related quality of life (HRQoL) assessment. Multivariable linear regression analysis was performed to identify independent variables characterizing urinary urgency in PD (PD-UU), which were assigned as discriminant features to estimate their individual contribution to the phenotype of the PD-UU group.Results: Of 189 PD patients, 115 (60.8%) reported PD-UU. The linear regression analysis showed that among cognitive domains, executive function (EF; p = 0.04) had a significant negative association with PD-UU. In a second model, scores of the Montreal Cognitive Assessment (MoCA) significantly differentiated between study groups (p = 0.007) and also non-motor symptom (NMS) burden (p < 0.001). The third model consisted of reports of HRQoL, of which stigma was the only subscale of the Parkinson’s Disease Questionnaire (PDQ-39) differentiating between patients with and without PD-UU (p = 0.02). The linear discriminant analysis provided evidence that the combination of EF, NMS burden, nocturia, and stigma discriminated between groups with 72.4% accuracy.Conclusion: In our large, non-demented PD cohort, urinary urgency was associated with executive dysfunction (EF), supporting a possible causative link between both symptoms. A combination of neuropsychological and non-motor aspects identified patients with PD-UU with high discriminative accuracy.

Effect of Endurance Training on Balance in Parkinson's Patients

Abstract Background: Postural instability and resulting falls are major factors determining quality of life, morbidity, and mortality in individuals with Parkinson's Disease (PD). Aim of Study: This study was to determine if there is an effect of endurance training on balance in idiopathic Parkinson's patients. Patients and Methods: A referred diagnosed twenty Par-kinson patients from both genders, with age ranged from (60- 65) years old, were randomly assigned to equal two groups: A study group and a control group. Control group received conventional physical therapy program (Wobble board training, ROM, stretching exercises and gait training). For 12 sessions every other day, each session for one hour and study group received endurance training exercises in addition to conven-tional physical therapy program as control group, each session for one and half hours (one hour conventional treatment and 30 minutes treadmill training). All patients were evaluated with Biodex Stability System (BSS) including dynamic limit of stability test, dynamic balance test and functional reach test pre and post-treatment. The study was done in out clinics and balance lab. of Faculty of Physical Therapy, Cairo Uni-versity for one month. Results: This study revealed that there is a significant improvement in balance in both groups but there was no significant difference between both groups. Conclusion: This study concluded that four weeks of endurance training combined with conventional physical therapy program for every patient was effective physical therapy technique on balance impairment in Parkinson's patients.

Young-onset and late-onset Parkinson's disease exhibit a different profile of fluid biomarkers and clinical features

Young-onset Parkinson's disease (YOPD) is a relevant condition whose neurobiology is questioned if different from those of typical late-onset Parkinson's disease (LOPD). Here, we explored whether the clinical-biochemical profile of Parkinson's disease (PD) could be affected by the age-of-onset (AO), as a possible result of a distinct neurodegenerative process. A panel of fluid biomarkers (CSF lactate, 42-amyloid-β peptide, total and 181-phosphorylated tau; serum uric acid) and the standard scores for motor and nonmotor signs were assessed in 76 idiopathic PD patients (genetic cases excluded; YOPD, AO ≤ 50, n = 44; LOPD, AO > 50, n = 32) and 75 sex/age-matched controls, adjusting the models for the main confounding factors. In PD, AO directly correlated to either CSF lactate and tau proteins or the nonmotor symptoms scale score. Specifically, a younger AO was associated with lower levels of biomarkers and minor burden of nonmotor symptoms. Our findings indicate that clinical-biochemical features of idiopathic PD may vary depending on the AO, accounting for different profiles in YOPD and LOPD whose recognition is fundamental for further pathophysiological implications and clinical applications.

The Clinical Non-Motor Connectome in Early Parkinson's Disease.

Background:Non-motor symptoms (NMS) of various anatomical origins are seen in early stage idiopathic Parkinson’s disease (IPD).Objective:To analyse when and how NMS are linked together at this stage of the disease.Methods:Prospective study recruiting 64 IPD patients with ≤3 years of disease duration and 71 age-matched healthy controls (HC). NMS were clustered in 7 non-motor domains (NMD): general cognition, executive function, visuospatial function, autonomic function, olfaction, mood, and sleep. Correlation coefficients ≥|0.3| were considered as significant. Bootstrapped correlation coefficients between the scores were generated in both groups. Fourteen IPD patients and 19 HC were available for a follow-up study two years later.Results:The mean age of both groups was similar. 58% of IPD patients and 37% of HC were male (p = 0.01). At baseline IPD patients performed less well than HC on all NMD (p value between 0.0001 and 0.02). Out of 91 possible correlations between NMD, 21 were significant in IPD patients and 14 in HC at the level of ≥|0.3|. The mean correlation level was higher in IPD patients than in HC, as evidenced by the higher box plot of correlation coefficients. Visuospatial scores at baseline were predictive of the motor deterioration at the follow-up exam.Conclusion:At early IPD stage various NMS are linked together, although not connected by anatomical networks. Such a clinical NMD connectome suggests almost synchronous disease initiation at different sites as also supported by fMRI findings. Alternatively, there may be compensation-driven interconnectivity of NMD.

Validity of International Classification of Functioning, Disability, and Health Core Set in Patients with Parkinson's Disease and the Correlation with other Parkinson Scales

Objectives: Idiopathic Parkinson's Disease (IPD) is a movement disorder that cause tremor, rigidity, bradykinesia, postural instability and deterioration quality of life. To assess the disease different scales can be used: The Unified Parkinson's Disease Rating Scale (UPDRS) for clinical severity, Parkinson's Disease Questionnaire (PDQ39) to assess quality of life, Beck Depression Scale (BD) for mood assessment and Hoehn Yahr Scale (HY) for clinical staging. The International Classification of Functioning, Disability and Health (ICF) is a classification to develop an international common language for the evaluation of the functionality and disability of patients. We aimed to compare validity and efficacy of ICF classification with other scales. Materials and Methods: Thirty-one patients with idiopathic Parkinson's disease were evaluated. PDQ39, UPDRS, Hoehn Yahr, Beck Depression Scale and 'Brief ICF core set for hand condition' which was recommended for Parkinson's disease were applied to patients. The brief ICF core set and other scales were compared and assessed if there was any correlation. For analyzes, the MedCalc Statistical Software version 12.7.7 programme was used. Results: The mean age of the IPD patients was 68.3 ± 6.9 years and 71% of them were female (22) and 29% were male (9). According to ICF codes, patients who have eight or more corrupted codes were recorded as 'major code impairment patients', and those with less than eight codes recorded as 'minor code impairment patients'. The total UPDRS score of major code impairment patients was 58.4 ± 29.8, while the mean score of minor code impairment patients was 21.2 ± 14.05. The PDQ39 score of major code impairment patients was 66.4 ± 24.1, while the mean score of minor code impairment patients was 19.3 ± 13.5. According to Hoehn Yahr stage, the ratio of stage 1 were higher in minor ICF patients. Conclusion: While assessing the functioning of the Parkinson's disease patients, we need comprehensive scales that include many parameters. The ICF coding system is an international system, which is very important to develop a common language. The significant correlation between ICF coding system and other scales in our Parkinson's patients, shows the validity of the coding system.