Use Of Levodopa Research Articles

Is DBS in the treatment of Parkinson’s surgery able to improve all symptoms: a bibliographic review

Parkinson's disease (PD) is a neurological, chronic and progressive disease that affects the patient's central nervous system, thus compromising their movements and routine activities. There are several surgical interventions to minimize the symptoms of the disease, however, deep brain stimulation (DBS) can be used, as it is effective in reducing motor and non-motor symptoms, however, research shows that the technique can also cause side effects. Objective: to report through a literature review, the positive and negative effects of the use of deep brain stimulation in the treatment of Parkinson's disease on motor and non-motor symptoms. Methodology: Theoretical foundation was carried out from online access to the National Library of Medicine database - PubMed MEDLINE, covering the keywords "brain stimulation", "Parkinson's disease", "treatment", "neurosurgery", "motor and non-motor symptoms”, the period of publication between 2018 to 2022 and journal impact factor above 3. Results: The articles demonstrated that patients' quality of life, motor complications and activities of daily living improved significantly in different age groups after bilateral STN-DBS. For non-motor factors such as sleep, mood, cardiovascular disease and depression, the use of DBS showed little significant improvement in quality of life. Final considerations: Treatment with deep brain stimulation is effective in reducing the progression of Parkinson's disease, however, factors such as age, place where the electrical current is applied (lateral, bilateral), use of levodopa are decisive factors for efficiency in the improvement of motor and non-motor symptoms.

Continuous Subcutaneous Foslevodopa-Foscarbidopa in Parkinson's Disease: A Mini-Review of Current Scope and Future Outlook.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, primarily because of the impairment of dopaminergic neurons. Long-term use of levodopa, the standard PD treatment, often results in fluctuating therapeutic effects and dyskinesia, necessitating alternative therapies. This review aims to synthesize current insights and clinical experiences with foslevodopa-foscarbidopa, focusing on its pharmacokinetics, efficacy, and safety profile, to evaluate its potential in transforming PD therapy. A systematic literature search was conducted up to November 2023 using databases PubMed, Web of Science, and Cochrane Library. The search yielded eight eligible articles, including pharmacological studies, case reports, observational studies, and controlled trials. No language restrictions were applied. Foslevodopa and foscarbidopa, as prodrugs of levodopa and carbidopa, exhibited excellent chemical stability and solubility, facilitating continuous subcutaneous infusion. Clinical trials demonstrated that these prodrugs maintain stable levodopa levels, thereby addressing the limitations of oral levodopa therapy. Phase 1 and 3 studies indicated significant improvements in motor function and quality of life in advanced PD patients. However, a higher incidence of treatment-emergent adverse events, mainly infusion site reactions, was observed compared to oral therapies. Foslevodopa-foscarbidopa emerges as a promising alternative for advanced PD treatment, offering sustained symptom control. Its efficacy in managing motor fluctuations and dyskinesia makes it a viable option in the PD therapeutic spectrum. Future research should focus on long-term safety, economic impact, and broader accessibility. Foslevodopa-foscarbidopa is now commercially distributed in many countries in Europe and in Japan.

Monitoring cognitive functions during deep brain stimulation (DBS) interventions by Real Time Neuropsychological Testing (DBS-RTNT).

We monitored cognition during Deep brain stimulation (DBS) surgery, when the electrode is positioned at the target subthalamic nucleus (i.e., STN motor area) in 14 PD patients. We present the Real Time Neuropsychological Testing (DBS-RTNT) protocol, our preliminary experience, along with patients' performance comparing intraoperative results with baseline data. Compared to baseline, DBS-RTNT in the target area showed a significantly decreased performance at some tasks belonging to memory and executive functions domains. Significantly decreased short-term memory and sequencing scores were found for right (vs. left) hemisphere DBS-RTNT. PD patients' performance should be monitored during DBS surgery as STN-DBS may induce changes in cognitive performance. These preliminary data contribute to improve, during DBS-surgery the anatomo-functional topography of the STN in order to identify, in future approaches, in the individual patient the best site producing positive motor effects, without causing negative cognitive and/or emotional changes. Medications (i.e., the patients underwent surgery in a levodopa off state) could in principle have influenced our results therefore future studies are needed to address possible confounding effect of levodopa use.

Associations between Constipation and Use of Levodopa with Nutritional Status, Polypharmacy, and Stage of Parkinson's Disease.

Parkinson's disease (PD) is a highly prevalent disease characterized by motor and non-motor symptoms; the latter include constipation, which is considered a prodromal symptom. On the other hand, sarcopenia, polypharmacy, and malnutrition due to deficits are common in PD and lead to poorer health and quality of life. to associate constipation and use of levodopa with nutritional status, sarcopenia, duration and stage of the disease, and polypharmacy in individuals with PD. analytical cross-sectional observational study where an online survey was applied to 161 people suffering from PD. a significant association is observed between constipation and BMI (p = 0.022), as well as between the use of levodopa with BMI (p = 0.049) and polypharmacy (p = 0.046). On the other hand, there is a relationship between the average time of PD diagnosis and constipation (p = 0.0047). Finally, there is a relationship between SARC-F score applied to those over 60 years of age (p = 0.0446) and the use of levodopa. Having sarcopenia, being overweight, and having had the disease for less than five years is associated with a higher probability of experiencing constipation, according to the logistic regression analysis (p > 0.005). nutritional assessment and subsequent follow-up is of vital importance to avoid complications that could be associated with levodopa use, constipation, and sarcopenia.

Unveiling differential gene co-expression networks and its effects on levodopa-induced dyskinesia

Levodopa-induced dyskinesia (LID) refers to involuntary motor movements of chronic use of levodopa in Parkinson's disease (PD) that negatively impact the overall well-being of people with this disease. The molecular mechanisms involved in LID were investigated through whole-blood transcriptomic analysis for differential gene expression and identification of new co-expression and differential co-expression networks. We found six differentially expressed genes in patients with LID, and 13 in patients without LID. We also identified 12 co-expressed genes exclusive to LID, and six exclusive hub genes involved in 23 gene-gene interactions in patients with LID. Convergently, we identified novel genes associated with PD and LID that play roles in mitochondrial dysfunction, dysregulation of lipid metabolism, and neuroinflammation. We observed significant changes in disease progression, consistent with previous findings of maladaptive plastic changes in the basal ganglia leading to the development of LID, including a chronic pro-inflammatory state in the brain.

An Evaluation of The Relationship Between Falls, Osteoporosis And The Parkinson’s Disease Rating Scale In Patients With Parkinson’s Disease

Objective: The purpose of this study is to examine conditions such as balance disorder, risk of falling, fear of falling, vitamin D deficiency and osteoporosis in people with Parkinson's Disease (PD), and their association with the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) sub-components, which are used to follow-up these patients. Methods: The study comprised 38 patients who were followed up for idiopathic PD. All the patients’ demographic data, falls efficacy scale, number of falls within the last year, history of fractures, Berg Balance Scale, the MDS-UPDRS sub-components, vitamin D levels, and bone mineral densitometry values were recorded. Results: There was a positive correlation between the MDS-UPDRS Part I and the number of falls and the history of fractures, and a positive correlation with the Hoehn and Yahr scale, and the MDS-UPDRS Part II, III and total and the Berg Balance Scale, the Falls Efficacy Scale, and the number of falls. Our study found that the bone mineral densitometry values for the femoral neck were lower in women than in men, and there was a positive correlation between the bone mineral densitometry values for the femoral neck and the body mass index. A positive correlation was established between levodopa use and the falls efficacy scale. Conclusion: Falls, imbalance, osteoporosis are life-threatening conditions in patients with PD. This study established that the MDS-UPDRS, used to follow-up patients, was associated with these conditions. It is believed that this assessment method may also give an idea about these conditions in PD patients who are followed up using this scale.

Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial

Rationale: Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity. Its prodrug levodopa is a promising agent for stroke recovery. Aim and hypothesis: To investigate the hypothesis that levodopa, in addition to standardized rehabilitation therapy based on active task training, results in an enhancement of functional recovery in acute ischemic or hemorrhagic stroke patients compared to placebo. Design: ESTREL (Enhancement of Stroke REhabilitation with Levodopa) is a randomized (ratio 1:1), multicenter, placebo-controlled, double-blind, parallel-group superiority trial. Participants: 610 participants (according to sample size calculation) with a clinically meaningful hemiparesis will be enrolled ⩽7 days after stroke onset. Key eligibility criteria include (i) in-hospital-rehabilitation required, (ii) capability to participate in rehabilitation, (iii) previous independence in daily living. Intervention: Levodopa 100 mg/carbidopa 25 mg three times daily, administered for 5 weeks in addition to standardized rehabilitation. The study intervention will be initiated within 7 days after stroke onset. Comparison: Matching placebo plus standardized rehabilitation. Outcomes: The primary outcome is the between-group difference of the Fugl-Meyer-Motor Assessment (FMMA) total score measured 3 months after randomization. Secondary outcomes include patient-reported health and wellbeing (PROMIS 10 and 29), patient-reported assessment of improvement, Rivermead Mobility Index, modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), and as measures of harm: mortality, recurrent stroke, and serious adverse events. Conclusion: The ESTREL trial will provide evidence of whether the use of Levodopa in addition to standardized rehabilitation in stroke patients leads to better functional recovery compared to rehabilitation alone.

Study on the relationship between peripheral nerve fiber types and levodopa usage in Parkinson's disease.

<p>The aim of this study is to comprehensively determine the types of affected fibers in Parkinson&rsquo;s disease (PD) patients by employing nerve conduction studies (NCS), sympathetic skin response (SSR) examinations, and current perception threshold (CPT) testing and to analyze the correlation between levodopa use and nerve involvement.</p>. <p>This retrospective study included 36 clinically diagnosed PD patients who were recruited between January 2018 and April 2019. All patients underwent NCS, SSR testing, and CPT sensory examinations. Additionally, the PD patients were assessed for disease staging using the Hoehn and Yahr (H-Y) scale.&nbsp;</p>. <p>Fifteen patients were included in the tremor-dominant subtype, ten patients in the rigid-dominant subtype, and eleven patients in the mixed subtype. Eleven patients were using levodopa, while twenty-five patients had never used any anti-Parkinson&rsquo;s medication. Ten patients (28%) showed abnormal sympathetic skin responses (SSR). The CPT examination revealed sensory abnormalities in twenty-four patients (67%), with eighteen patients (75%) experiencing sensory hypersensitivity and six patients (25%) experiencing sensory hypoesthesia. Twelve patients (33%) had normal CPT results. Among the patients with abnormal CPT findings, seven cases (29%) involved large myelinated fiber damage, twenty-two cases (92%) involved small myelinated fiber damage, and nineteen cases (79%) involved unmyelinated fiber damage. The rate of sensory abnormalities was 64% (7/11) in the levodopa group and 68% (17/25) in the non-levodopa group, with no statistically significant difference between the two groups.&nbsp;</p>. <p>The incidence of abnormal CPT findings in PD patients was higher than that of abnormal SSR responses, suggesting that nerve fiber damage primarily affects small fiber nerves (SFN).</p>.

Predictors of stress resilience in Parkinson’s disease and associations with symptom progression

People with Parkinson’s disease (PD) are sensitive to effects of long-term stress, but might differ in stress resilience, i.e. the ability to maintain mental health despite adversity. It is unclear whether stress resilience in PD is predominantly determined by dopamine deficiency, psychosocial factors, or both. In PD animal models, chronic stressors accelerate disease progression, but evidence in humans is lacking. Our objectives were to (1) distinguish stressor-reactive from resilient PD patients, (2) identify resilience factors, and (3) compare symptom progression between stressor-reactive and resilient patients. We conducted a longitudinal survey in Personalized Parkinson Project participants (N = 350 PD). We used the COVID-19 pandemic as a model of a stressor, aligned in time for the entire cohort. COVID-19-related stressors, perceived stress, and PD symptoms were assessed at 11 timepoints (April-October 2020). Both pre-COVID and in-COVID clinical assessments were available. We quantified stressor-reactivity as the residual between actual and predicted perceived stress relative to COVID-19-related stressors, and modeled trajectories of stressor-reactivity across timepoints. We explored pre-COVID predictors of 6-month average stressor-reactivity, and tested whether stressor-reactivity was prospectively associated with one-year clinical progression rates. Latent class trajectory models distinguished patients with high (N = 123) or low (N = 227) stressor-reactivity. Pre-existing anxiety, rumination and non-motor symptom severity predicted high stressor-reactivity (risk factors), whereas quality of life, social support, positive appraisal style and cognitive abilities predicted low stressor-reactivity (resilience factors). PD-specific factors, e.g. disease duration, motor severity, and levodopa use, did not predict stressor-reactivity. The COVID-19 pandemic did not accelerate disease progression, but worsened depressive symptoms in stressor-reactive PD patients.

Prevalence and Outcome of COVID-19 Among Parkinson’s Disease: A Report from Iran

Background: Parkinson's disease (PD) is a widely prevalent neurodegenerative disorder in the central nervous system, predominantly affecting older adults and frequently coexisting with other health conditions. The heightened vulnerability of individuals with chronic diseases and advanced age to adverse outcomes during the COVID-19 pandemic suggests an increased risk of COVID-19 infection in PD patients. Objectives: This cross-sectional study, conducted from July to September 2021, aimed to evaluate the impact of COVID-19 on PD patients by examining infection rates, associated complications, and outcomes. Methods: We utilized hospital records to reach out to 567 PD patients during the designated timeframe. If a patient had passed away, their families were contacted to ascertain whether COVID-19 was a contributing factor. Results: Among the 558 PD patients who participated, 25.4% were tested for COVID-19, with 42.2% of those tested returning positive results. Significantly, 34.4% of the positive cases required oxygen therapy, 32.8% were admitted to the hospital, and 9.8% needed intensive care unit (ICU) admission. The prevalence of COVID-19 among the families of the patients was 29.8%, with 13.7% requiring hospitalization and 4.2% resulting in death. Common complications included worsening of movement issues (21.3%), weight loss (19.7%), and urinary problems (14.8%). Early-onset Parkinson's was associated with a decreased risk of COVID-19 (OR: 0.976, 95% CI: 0.953 - 0.999, P = 0.037), whereas the use of Levodopa was linked to an increased risk of infection (OR: 3.672, 95% CI: 1.095 - 12.31, P = 0.037). Conclusions: This study underscores the changing clinical manifestations of PD during the COVID-19 pandemic. Further research is crucial to clarify the complex interaction between COVID-19 and Parkinson's disease.

Differences in the treatment needs of patients with dementia with Lewy bodies and their caregivers and differences in their physicians’ awareness of those treatment needs according to the clinical department visited by the patients: a subanalysis of an observational survey study

BackgroundWe investigated whether the treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers, along with their attending physicians’ perception of those treatment needs, differ according to the clinical department visited by the patients.MethodsThis was a subanalysis of a multicenter, cross-sectional, observational survey study. Data from the main study were classified according to the clinical department visited by the patient: psychiatric group (P-group), geriatric internal medicine group (G-group), and neurology group (N-group). The treatment needs of patients and caregivers were defined as “the symptom that causes them the most distress”, and the frequency of each answer was tabulated.ResultsThis subanalysis included 134, 65, and 49 patient–caregiver pairs in the P-, G-, and N-groups, respectively. Statistically significant differences in patient background characteristics such as patient age; initial symptom domains; use of cholinesterase inhibitors, levodopa, antipsychotics, and Yokukansan; and total scores of the Mini-Mental State Examination, Neuropsychiatric Inventory-12, and Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Parts II and III were shown among the three subgroups. While there were no differences in patients’ treatment needs among the subgroups, residual analysis showed that in the N-group, parkinsonism was more of a problem than other symptom domains (p = 0.001). There were significant differences in caregivers’ treatment needs among the three subgroups (p < 0.001). The patient–physician concordance rates for the symptom domains that caused patients the most distress were: P-group, 42.9% (kappa coefficient [κ] = 0.264); G-group, 33.3% (κ = 0.135), and N-group, 67.6% (κ = 0.484). The caregiver–physician concordance rates for the symptom domains that caused the caregivers the most distress were: P-group, 54.8% (κ = 0.351), G-group, 50.0% (κ = 0.244), and N-group, 47.4% (κ = 0.170).ConclusionThis subanalysis revealed differences in the treatment needs of patients with DLB and their caregivers according to the clinical department they attended. There might be a lack of awareness of those treatment needs by the attending physicians, regardless of their specialty.Trial registrationUMIN Clinical Trials Registry UMIN000041844.

Anatomical correlates of apathy and impulsivity co-occurrence in early Parkinson’s disease

BackgroundAlthough apathy and impulse control disorders (ICDs) are considered to represent opposite extremes of a continuum of motivated behavior (i.e., hypo- and hyperdopaminergic behaviors), they may also co-occur in Parkinson’s disease (PD).ObjectivesWe aimed to explore the co-occurrence of ICDs and apathy and its neural correlates analyzing gray matter (GM) changes in early untreated PD patients. Moreover, we aimed to investigate the possible longitudinal relationship between ICDs and apathy and their putative impact on cognition during the first five years of PD.MethodsWe used the Parkinson’s Progression Markers Initiative (PPMI) database to identify the co-occurrence of apathy and ICDs in 423 early drug-naïve PD patients at baseline and at 5-year follow-up. Baseline MRI volumes and gray matter changes were analyzed between groups using voxel-based morphometry. Multi-level models assessed the longitudinal relationship (across five years) between apathy and ICDs and cognitive functioning.ResultsAt baseline, co-occurrence of apathy and ICDs was observed in 23 patients (5.4%). This finding was related to anatomical GM reduction along the cortical regions involved in the limbic circuit and cognitive control systems. Longitudinal analyses indicated that apathy and ICDs were related to each other as well as to the combined use of levodopa and dopamine agonists. Worse apathetic and ICDs states were associated with poorer executive functions.ConclusionsApathy and ICDs are joint non-exclusive neuropsychiatric disorders also in the early stages of PD and their co-occurrence was associated with GM decrease in several cortical regions of the limbic circuit and cognitive control systems.

Learning Spatio-Temporal Radon Footprints for Assessment of Parkinson’s Dyskinesia

Parkinson’s disease is a severe neurodegenerative disorder that leads to loss of control over various motor and mental functions. Its progression can be limited with medication, particularly through the use of levodopa. However, prolonged administration of levodopa often results in disorders independent of those caused by the disease. The detection of these disorders is based on the clinical examination of patients, through different type of activities and tasks, using the Unified Dyskinesia Rating Scale (UDysRS). In the present work, our aim is to develop a state-of-the-art assessment system for levodopa-induced dyskinesia (LID) using the joint coordinate data of a human skeleton body depicted on videotaped activities related to UDysRS. For this reason, we combine a robust mathematical method for encoding action sequences known as Spatio-temporal Radon Footprints (SRF) with a Convolutional Neural Network (CNN), in order to estimate dyskinesia’s ratings for six body parts. We introduce two different methodological approaches: Global SRF-CNN and Local SRF-CNN, based on the set of skeletal points used in the encoding scheme. A comparison between these approaches reveals that Local SRF-CNN demonstrates better performance than the Global one. Finally, Local SRF-CNN outperforms the state-of-the-art technique, on both tasks, for UDysRS dyskinesia assessment, using joint coordinate data of the human body, achieving an overall performance in mean RMSE value of 0.6198 for Drinking task and 0.4885 for Communication, compared to 0.6575 and 0.5175, respectively. This illustrates the ability of the proposed machine learning system to successfully assess LID.

Impact of Istradefylline on Levodopa Dose Escalation in Parkinson's Disease: ISTRA ADJUST PD Study, a Multicenter, Open-Label, Randomized, Parallel-Group Controlled Study.

A higher levodopa dose is a risk factor for motor complications in Parkinson's disease (PD). Istradefylline (IST) is used as adjunctive treatment to levodopa in PD patients with off episodes, but its impact on levodopa dose titration remains unclear. The objective of this study was to investigate the effect of IST on levodopa dose escalation in PD patients with wearing-off. This was a multicenter, open-label, randomized, parallel-group controlled study (ISTRA ADJUST PD) in which PD patients experiencing wearing-off (n = 114) who were receiving levodopa 300-400mg/day were randomized to receive IST or no IST (control). Levodopa dose was escalated according to clinical severity. The primary endpoint was cumulative additional levodopa dose, and secondary endpoints were changes in symptom rating scales, motor activity determined by a wearable device, and safety outcomes. The cumulative additional levodopa dose throughout 37weeks and dose increase over 36weeks were significantly lower in the IST group than in the control group (both p < 0.0001). The Movement Disorder Society Unified Parkinson's Disease Rating Scale Part I and device-evaluated motor activities improved significantly from baseline to 36weeks in the IST group only (all p < 0.05). Other secondary endpoints were comparable between the groups. Adverse drug reactions (ADRs) occurred in 28.8% and 13.2% of patients in the IST and control groups, respectively, with no serious ADRs in either group. IST treatment reduced levodopa dose escalation in PD patients, resulting in less cumulative levodopa use. Adjunctive IST may improve motor function more objectively than increased levodopa dose in patients with PD. Japan Registry of Clinical Trials: jRCTs031180248.

Udruženost polimorfizama gena za katehol-Ometiltransferazu sa terapijskim odgovorom i komplikacijama izazvanim levodopom kod Parkinsonove bolesti - rezime sadašnjih saznanja

Catechol-O-methyltransferase (COMT) is one of the cardinal enzymes in the degradation of catecholamines and levodopa. Genetic variants of the COMT gene may affect COMT enzyme activity. The most examined COMT gene polymorphism is the nonsynonymous single nucleotide polymorphism (SNP) in exon 4 (Val108/158Met; rs4680). This highly functional polymorphism is responsible for fourfold variations in enzyme activity and Dopamine catabolism. Recent data suggested that even synonymous SNPs of the COMT gene can lead to changes in enzyme activity. Genetically determined COMT activity can affect an individual's response to levodopa therapy and carries the risk of complications from prolonged levodopa use in Parkinson's disease (PD) patients. Identifying at-risk individuals through genetic susceptibility markers could help to prevent the development of levodopa-induced complications in PD.

Perioperative Use of Intravenous Levodopa as an Anti-Parkinsonian Drug: A Propensity Score Analysis.

Perioperative discontinuation of oral anti-parkinsonian medication can negatively impact the prognosis of abdominal surgery in patients with Parkinson's disease. Although intravenous levodopa may be an alternative, its efficacy has not yet been investigated. To determine the efficacy of intravenous levodopa as an alternative to oral anti-Parkinsonian drugs during gastric or colorectal cancer surgery. We identified patients with Parkinson's disease who underwent surgery for gastric or colorectal cancer between April 2010 and March 2020, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were divided into two groups: those who received intravenous levodopa during the perioperative period and those who did not. We compared in-hospital mortalities, major complications, and postoperative length of stay between the groups after adjusting for background characteristics with overlap weights based on propensity scores. We identified 648 patients who received intravenous levodopa and 1207 who did not receive levodopa during the perioperative period. In the adjusted cohort, the mean postoperative length of stay was 24.7 and 29.0 days (percent difference, -7.7%; 95% confidence interval, -13.1 to -1.5); in-hospital death was 3.2% and 3.3% (adjusted odds ratio, 0.95; 95% CI: 0.54-1.67); and incidence of major complications were 21.4% and 19.3% (adjusted odds ratio, 0.89; 95% confidence interval, 0.70-1.13) in those with and without intravenous levodopa, respectively. Intravenous levodopa was associated with a shorter postoperative length of stay, but not with mortality or morbidity. Intravenous levodopa may improve perioperative care in patients with Parkinson's disease.

A large survey on COVID-19 vaccination in patients with Parkinson’s disease and healthy population

BackgroundA full rollout of COVID-19 vaccination offers the most promising prospect of bringing the pandemic to an end. This study aimed to compare the coverage, safety, and confidence of COVID-19 vaccination between patients with Parkinson’s disease (PD) and healthy individuals so as to give suggestions for future immunization programs. MethodsA web-based, nationwide, multicenter survey was carried out in China from 2021 to 2022. The age and sex-standardized vaccination rate was calculated. Multivariate stepwise logistic regression models were used to estimate the influencing factors of vaccination status. We also investigated vaccination safety, willingness, confidence, and reasons for hesitancy with some ad hoc questions. ResultsA total of 962 PD patients and 1208 healthy individuals participated in this survey with a vaccination rate of 71.1% vs 94.4% respectively. PD patients living in first-tier cities, with comorbidities, experiencing unstable PD with a longer course and levodopa use were less likely to get vaccinated, while healthy individuals living in first-tier cities and feeling physically poor exhibited a lower vaccination rate. For PD patients, concern about the adverse impact on existing illness and disagreement from doctors were the most common reasons for vaccination hesitancy. Whereas, no evidence was present that they experienced any local or systematic adverse events more frequently or seriously than healthy individuals, or their state of PD and comorbidities was seriously exacerbated after vaccination. A prominent transition from a little concerned to unconcerned about the security and efficacy of vaccines was evident among both two populations from pre-vaccination to post-vaccination. ConclusionsThe COVID-19 vaccination rate was remarkably lower in PD patients than healthy individuals in China. The approved vaccines have shown an acceptable safety profile. Our findings would offer a reference to guide future clinical decision-making of COVID-19 vaccination and improve the immunization management of PD patients.

Substantia Nigra Pars Reticulata Projections to the Pedunculopontine Nucleus Modulate Dyskinesia.

Long-term use of levodopa for Parkinson's disease (PD) treatment is often hindered by development of motor complications, including levodopa-induced dyskinesia (LID). The substantia nigra pars reticulata (SNr) and globus pallidus internal segment (GPi) are the output nuclei of the basal ganglia. Dysregulation of SNr and GPi activity contributes to PD pathophysiology and LID. The objective of this study was to determine whether direct modulation of SNr GABAergic neurons and SNr projections to the pedunculopontine nucleus (PPN) regulates PD symptoms and LID in a mouse model. We expressed Cre-recombinase activated channelrhodopsin-2 (ChR2) or halorhodopsin adeno-associated virus-2 (AAV2) vectors selectively in SNr GABAergic neurons of Vgat-IRES-Cre mice in a 6-hydroxydopamine model of PD to investigate whether direct optogenetic modulation of SNr neurons or their projections to the PPN regulates PD symptoms and LID expression. The forepaw stepping task, mouse LID rating scale, and open-field locomotion were used to assess akinesia and LID to test the effect of SNr modulation. Akinesia was improved by suppressing SNr neuron activity with halorhodopsin. LID was significantly reduced by increasing SNr neuronal activity with ChR2, which did not interfere with the antiakinetic effect of levodopa. Optical stimulation of ChR2 in SNr projections to the PPN recapitulated direct SNr stimulation. Modulation of SNr GABAergic neurons alters akinesia and LID expression in a manner consistent with the rate model of basal ganglia circuitry. Moreover, the projections from SNr to PPN likely mediate the antidyskinetic effect of increasing SNr neuronal activity, identifying a potential novel role for the PPN in LID. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Influence of levodopa use on the nutritional status o folder adults with Parkinson’s disease

This study aimed to assess the effect of levodopa on the nutritional status of older adults with Parkinson’s disease (PD) and associated factors. This cross-sectional, analytical, descriptive, observational study collected sociodemographic, clinical, and levodopa daily dose data and conducted nutritional assessment with the Mini-Nutritional Assessment (MNA) and adductor pollicis muscle thickness (APMT). The chi-square test was used to compare proportions and independence, considering p&lt;0.05. The study sample comprised 40 older adults with PD, with a mean age of 69.4±7.6 years; 70% were males. MNA verified a prevalence of malnutrition among those with more than 10 years with the disease, in an advanced stage, and whose levodopa equivalent daily dose was above 600 mg. It was verified that having chronic comorbidities may significantly increase the risk of malnutrition according to the APMT classification. Hence, it is greatly important to assess the nutritional status in the follow-up of older adults with PD to diagnose malnutrition early and ensure assertive and multidisciplinary intervention.

Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson’s disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China

IntroductionParkinson’s disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson’s disease, reduce the use of...