Life Of Parkinson's Disease Patients Research Articles

Moving Beyond Medication: Harnessing the Power of Physical Therapy and Dance Therapy in Parkinson's Disease Management

Introduction Parkinson's disease (PD) poses significant challenges due to its complex array of motor and non-motor symptoms, impacting patients' quality of life. While traditional pharmacological treatments focus on motor symptoms, non-pharmacological interventions, including physical and dance therapy, offer alternative approaches. Aim of the Study This study aims to evaluate the therapeutic potential of physical and dance therapy, including tango, in managing motor symptoms and improving overall well-being in individuals with PD. It seeks to compare these interventions with traditional treatments and explore their efficacy. State of Knowledge Parkinson's disease management involves a combination of pharmacological and non-pharmacological approaches. Traditional treatments target motor symptoms but have limitations. Non-pharmacological interventions, such as deep brain stimulation and physical therapy, complement traditional treatments. Dance therapy, including tango, shows promise in improving motor function and quality of life. Conclusions Physical and dance therapy, including tango, offer promising avenues for managing motor symptoms and enhancing quality of life in PD patients. While traditional treatments remain essential, non-pharmacological interventions provide valuable alternatives. Further research is needed to refine intervention parameters and compare their effectiveness comprehensively. Overall, these therapies present holistic approaches to PD management, addressing both motor and non-motor symptoms for improved patient outcomes.

Comprehensive Review on Parkinson's Disease: Insights into Prevalence, Pathophysiology, Diagnosis, and Multifaceted Treatment Approaches

Background: Parkinson's disease (PD), a prevalent neurodegenerative condition affecting more than seven million individuals globally, manifests through the loss of dopaminergic neurons, leading to diverse motor and non-motor symptoms. This comprehensive review aims to explore PD's multifaceted nature, covering its introduction, prevalence patterns, pathophysiology, diagnostic challenges, and varied treatment strategies. Genetic and environmental influences on prevalence, brain region degeneration, Lewy body formation, and early-stage diagnostic difficulties are key focus areas. The review emphasizes the necessity of personalized approaches, innovative clinical criteria-, and subtype categorizations for effective management. Objective: This review aims to provide a holistic understanding of Parkinson's disease, contributing to improved insights for both individuals and healthcare professionals. By consolidating knowledge on PD's various facets, it seeks to facilitate informed decision-making for better management and enhanced quality of life. Methods: A thorough review of research literature, including studies, trials, and historical perspectives, was done. It covers prevalence, causes, diagnosis, and treatment options, including both traditional and herbal remedies, alongside conventional approaches. Results: The review reveals the complex interplay of genetic predisposition, environmental factors, and the neurodegenerative mechanisms underlying PD. It underscores the challenges of early-stage diagnosis and the wide array of treatment options available, emphasizing the need for personalized care. Conclusion: Understanding Parkinson's disease in its entirety is crucial for effective management. By presenting a comprehensive overview, this review advocates for a holistic approach, integrating diverse treatments and individualized strategies, thereby offering valuable guidance for improved quality of life in PD patients. Keywords: Parkinson's, neurodegeneration, DBS, Lewy bodies, motor & non-motor symptoms, diagnosis

Golexanolone reduces glial activation in the striatum and improves non-motor and some motor alterations in a rat model of Parkinson's disease.

Parkinson's disease (PD) affects more than 6 million people worldwide. Along with motor impairments, patients and animal models exhibiting PD symptoms also experience cognitive impairment, fatigue, anxiety, and depression. Currently, there are no drugs available for PD that alter the progression of the disease. A body of evidence suggests that increased GABA levels contribute to the reduced expression of tyrosine hydroxylase (TH) and accompanying behavioral deficits. TH expression may be restored by blocking GABAA receptors. We hypothesized that golexanolone (GR3027), a well-tolerated GABAA receptor-modulating steroid antagonist (GAMSA), may improve Parkinson's symptoms in a rat model of PD. The aims of this study were to assess whether golexanolone can ameliorate motor and non-motor symptoms in a rat model of PD and to identify some underlying mechanisms. We used the unilateral 6-OHDA rat model of PD. The golexanolone treatment started 4 weeks after surgery. Motor symptoms were assessed using Motorater and CatWalk tests. We also analyzed fatigue (using a treadmill test), anhedonia (via the sucrose preference test), anxiety (with an open field test), and short-term memory (using a Y maze). Glial activation and key proteins involved in PD pathogenesis were analyzed using immunohistochemistry and Western blot. Rats with PD showed motor incoordination and impaired locomotor gait, increased fatigue, anxiety, depression, and impaired short-term memory. Golexanolone treatment led to improvements in motor incoordination, certain aspects of locomotor gait, fatigue, anxiety, depression, and short-term memory. Notably, golexanolone reduced the activation of microglia and astrocytes, mitigated TH loss at 5 weeks after surgery, and prevented the increase of α-synuclein levels at 10 weeks. Golexanolone may be useful in improving both motor and non-motor symptoms that adversely affect the quality of life in PD patients, such as anxiety, depression, fatigue, motor coordination, locomotor gait, and certain cognitive alterations.

Efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait in Parkinson's disease patients.

To evaluate the efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait (FOG) in Parkinson's disease (PD) patients. A total of 60 PD patients with FOG treated in the First People's Hospital of Fuyang District from January 2020 to January 2023 were retrospectively collected and analyzed. Patients were divided into a control group (n = 28, treated with Selegiline alone) and an observation group (n = 32, treated with Selegiline and exercise interventions). Gait parameters, FOG indices, motor and balance functions, Berg Balance, psychological status, and quality of life were compared between the groups pre- and post-treatment. After treatment, the observation group exhibited longer step length, higher step speed, and lower step frequency (P = 0.000, 0.003, 0.001, respectively), with enhanced balance as indicated by lower Timed Up and Go Test and higher Berg Balance Scale scores than the control group (P = 0.000, 0.000, respectively). The Beck Depression Inventory and Beck Anxiety Inventory scores were notably lower in the observation group than those in the control group (P = 0.000, 0.004, respectively). Additionally, the observation group showed better quality of life across several dimensions of the Parkinson's Disease Quality of Life Questionnaire, including mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (P = 0.000, 0.000, 0.000, 0.000, 0.017, 0.000, 0.000, 0.000, respectively) than the control group. The combination of exercise interventions and Selegiline effectively rectifies the gait parameters, enhances the balance function, alleviates psychological distress, and improves the overall quality of life in PD patients experiencing FOG.

Research status and prospect on the mechanisms of acupuncture and moxibustion treatment for constipation of Parkinson's disease.

Constipation may accelerate the progression of Parkinson's disease (PD). The quality of life in PD patients can be significantly improved when constipation is treated, hence the disease progression may be delayed. At present, the mechanism research is still at the initial stage for acupuncture in treatment of PD, focusing on neurohumoral factors, intestinal flora, bacterial fermentation products and intestinal inflammation； and there are the problems such as single intervention, thinking limitation and insufficient cooperation among disciplines. This paper systematically reviews the mechanism research progress of acupuncture for the treatment of constipation in PD so as to provide the references for the subsequent studies.

Morbidity Milestones Demonstrate Long Disability-Free Survival in Parkinson's Disease Patients with Deep Brain Stimulation of the Subthalamic Nucleus.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD). The long-term benefit in PD patients with STN-DBS in comparison to medical treatment (MT) alone has not yet been demonstrated conclusively. To judge the long-term outcome of patients with STN-DBS. To assess the evolution of PD symptoms and health-related quality of life (HRQoL) after deep brain stimulation (DBS) surgery, we conducted a cross-sectional analysis of 115 patients with STN-DBS with rater-based scales and self-reported questionnaires. In addition, we screened records of all our STN-DBS patients (2001-2019, n=162 patients) for the onset of the morbidity milestones (falls, hallucinations, dementia, and nursing home placement) to assess disability-free life expectancy. In the first year of STN-DBS, levodopa equivalent dose was reduced and motor function improved. Nonmotor symptoms and cognition remained stable. These effects were similar to previous studies. Morbidity milestones occurred 13 ± 7 years after diagnosis. Motor function, cognition, and HRQoL significantly worsened after the occurrence of any milestone, confirming the clinical relevance of these milestones. After onset of the first milestone, mean survival time was limited to 5 ± 0.8 years, which is comparable with patients with PD but without STN-DBS. On average, PD patients with STN-DBS live with their disease for a longer time, and morbidity milestones occur later in the disease course than in PD patients with MT. As judged by morbidity milestones, morbidity remains compressed into the final 5 years of life in PD patients with STN-DBS.

Occupational performance skills in Parkinson's disease: relationship with health-related quality of life and caregiver burden.

The progression of Parkinson's disease (PD) results in a loss of ability to performance activities of daily living and health-related quality of life. The objectives of this study were to establish the relations between occupational performance skills and health-related quality of life, and the degree of caregiver burden in PD patients. Forty-nine patients at different stages of PD according to the Hoehn and Yahr scale participated in the study. Patients were assessed using the Parkinson's Disease Questionnaire (PDQ-39), the EuroQoL (EQ-5D), the Assessment of Motor and Process Skills (AMPS), and the Zarit Caregiver Burden Interview (ZCBI). Strong correlations were found between the motor skills section of the AMPS scale and the PDQ-39 (r = -0.76; p = 0.001), and the EQ-5D questionnaires (r = 0.72; p = 0.001), while moderate correlations were found with the process skills. AMPS process skills were moderately correlated with mobility and activities of daily living. The ZCBI was only weakly correlated with the AMPS motor skills (r = -0.34; p = 0.02). Declining scores on the AMPS scale are closely related to the loss of health-related quality of life in PD patients, and, to a lesser extent, with the degree of caregiver burden.

Rasagiline, sleep quality and well-being in Parkinson's disease: a pilot study.

Sleep disordersand excessive daytime sleepiness are among the commonest nonmotor symptoms in Parkinson disease (PD) and can contribute to significantly lower quality of life in affected patients. Various antiparkinson drugs exert a relevant influence on sleep quality, daily vigilance and well-being. In the latest years, administration of monoamine oxidase type B inhibitor (iMAO-B) medications in PD, especially rasagiline, has gained importance due to the hypothesized neuroprotective effect of these agents. Whereas the ‘wakepromoting’ effect of selegine, due to its activating amphetamine-like compounds, has been already described, less is known regarding the effect of rasagiline, a world-wide used iMAO-B drug. A pilot study was carried out to analyze the effects of rasagiline on sleep and healthrelated quality of life in a small cohort of PD patients. According to our results, PD patients treated with rasagiline referred better sleep quality, required less frequently hypnotic medication, complained of lower daytime sleepiness and presented higher scores in social functioning, perceived energy levels and emotional well-being. Albeit limited by the small sample size, our study suggests an intriguing role of rasagiline in improving sleep and quality of life in PD patients. Further studies are necessary to confirm our preliminary observations.

Comparison of pramipexole and citalopram in the treatment of depression in Parkinson's disease: A randomized parallel-group trial.

Background:Depression is one of the most common neuropsychiatric symptoms in Parkinson's disease (PD). There is little evidence to guide depression treatment in these patients. The aim of this study was to compare citalopram and pramipexole in reducing depressive symptoms in patients with PD.Materials and Methods:In the present 8-week randomized trial, we compared the efficacy of pramipexole versus citalopram in the treatment of depression in PD patients. For this purpose, 44 PD patients with depression randomly received open-label oral citalopram tablets or pramipexole and their depression, quality of life, and daytime sleepiness scores were evaluated at baseline and after the 8-week trial period.Results:The median age of the patients was 64 years, and about 85% of them were male in both groups. The Beck Depression Inventory score, Parkinson's disease summary index (PDSI), and Epworth Sleepiness Scale were significantly decreased (P < 0.05) in both citalopram and pramipexole groups throughout this period and without significant difference (P > 0.05) between these two groups, except for PDSI score which showed significant improvement in pramipexole group compared with citalopram group (P < 0.0001, r = 0.319). There were neither serious adverse effects nor treatment discontinuation due to the adverse effects.Conclusion:The results indicated that both citalopram and pramipexole were effective in the alleviation of depression and improving the quality of life in PD patients; however, pramipexole was seemed to be slightly more beneficial on quality of life in these patients. Therefore, pramipexole seems to be an effective treatment for depression in addition to its benefits for motor symptoms of PD patients.

The Efficacy of Tai Chi and Stretching Exercises Based on a Smartphone Application for Patients With Parkinson's Disease: A Protocol for a Randomized Controlled Trial.

Introduction: Parkinson's disease (PD) is a common neurodegenerative disease that seriously impairs patients' quality of life, and increases the burden of patients and caregivers. Both drugs and exercise can alleviate its motor and non-motor symptoms, improving the quality of life for PD patients. Telehealth, an increasingly popular tool, makes rehabilitation accessible at home, overcoming the inconvenience of traffic and scheduling. Care-PD is a phone application designed for rehabilitation training, which provides Tai Chi and stretching exercises through tutorial videos as well as an online evaluation system. In this protocol, we will explore the efficacy of Tai Chi and stretching exercises as a PD rehabilitation therapy based on the smartphone application Care-PD.Methods and Analysis: A double-blind, parallel randomized controlled trial will be conducted in this study. The recruitment, intervention, and evaluation processes will be implemented through the Care-PD application. Persons with PD will fill out questionnaires on Activities of Daily Living (ADL), upload the latest case report, and sign the informed consent form in the application. Afterward, doctors and researchers will screen and enroll 180 participants who will be randomly (1:1:1) assigned to Tai Chi group, stretching exercises group, or control group. The subjects will participate in a 1-h exercise session three times per week for 12 weeks, ending with another 4 weeks of follow-up study. Each exercise session includes 10 min of warm-up, 45 min of exercise, and 5 min of cool-down. The primary outcomes are Motor Aspects of Experiences of Daily Living and the 39-item Parkinson's disease Questionnaire. The secondary outcomes include the 9-item Wearing-Off Questionnaire, the Freezing of Gait Questionnaire, the Caregiver Strain Index, Non-motor Experiences of Daily Living, ADL, and Morse Fall Scale. All assessments will be performed at baseline, week 12 and 16.Discussion: Care-PD integrates subject recruitment, intervention, and evaluation, providing a new perspective on clinical rehabilitation for persons with PD. This study will evaluate the efficacy of Tai Chi and stretching exercises on patients' quality of life and disease progression based on a smartphone application. We aim to provide a new rehabilitation training platform for persons with PD.Ethics and Dissemination: This study was approved by the Scientific Research Ethics Committee (102772020RT132) of Shanghai University of Sport. Data collection begins after the approval of the ethics committee. The participants must sign an informed consent form before enrollment. The results will be published in relevant journals, seminars, and be disseminated among rehabilitation practitioners and patients with PD.Clinical Trial Registration: Chinese Clinical Trial Registry, identifier [ChiCTR2100042096]. Registered on January 13, 2021.

Can Levodopa Challenge Testing Predict the Effect of Deep Brain Stimulation? One-Year Outcomes in a Chinese Cohort.

Objective: Our study examined whether levodopa challenge test (LCT) results could predict quality of life (QoL) outcomes after surgery to implant subthalamic nucleus deep brain stimulation (STN-DBS) electrodes to treat advanced Parkinson’s disease (PD).Methods: Forty patients with STN-DBS underwent a follow-up 1 year after implantation surgery to analyze the correlation between preoperative levodopa impact test results and postoperative Unified Parkinson’s Disease Rating Scale (UPDRS) III motor score, postoperative PD Questionnaire-39 (PDQ-39) score, and PDQ-39 improvement.Results: Improvements in QoL were associated with several preoperative characteristics including preoperative UPDRS-III tremor, UPDRS-III tremor (off-60) (p = 0.049), UPDRS-III tremor (off-120) (p = 0.012), Mini-Mental State Examination (p = 0.012), and PDQ-39 (p = 0.012) before surgery. Multiple linear regression model using preoperative MMSE [odds ratio (OR) = 0.342, 95% confidence interval (CI) = 0.051–2.297], preoperative UPDRS-III tremor (OR = 2.099, 95% CI = 0.585–7.535), UPDRS-III tremor (off-60) [OR = 1.316, 95% CI = 0.804–2.154, UPDRS-III tremor (off-120) OR = 0.913, 95% CI = 0.691–1.207], correctly classified 88.5% of patients.Conclusion: Levodopa challenge test results cannot predict the effect of DBS. However, the test can be incorporated into a regression prediction model to the quality of life of PD patients after DBS with other preoperative factors.

Early implementation of intended exercise improves quality of life in Parkinson's disease patients.

Recent data have shown that regular exercise may ameliorate motor symptoms in Parkinson's disease (PD). This study aims to investigate how intended exercise impacts motor and non-movement symptoms of PD. Eighty-eight patients were randomly assigned to an early exercise group (E-EG), late exercise group (L-EG), or a control group (CG) using a randomized delayed-start design. The E-EG carried out a rigorous, formal exercise program for 1h, twice per week, for 18months (May 2018-November 2019). The L-EG took part in the exercise program in the final 6-12months of the study. We assessed outcomes using the Unified Parkinson's Disease Rating Scale (UPDRS), PDQ-39 Questionnaire, Line A test, Line B test, Nine-hole column test, 30s squat and stand-up test (30s SST), 10-m walk test (10mW), Balance Evaluation Systems Mini Test (MiniBESTest), FAB, and Time Up and Go Test (TUG). The patients with PD in the E-EG had lower performance in the UPDRS and Line B test compared to those in the L-EG at post-exercise (p < 0.05). Moreover, the patients with PD in the E-EG had much lower performance in the PDQ-39 and 9-Hole Peg test compared to those in the L-EG at post-exercise (p < 0.01). Implementation of an exercise regimen improved the movement abilities and quality of life in PD patients, especially in the E-EG. This data supports the idea that intended exercise should be implemented as part of the treatment strategy for PD patients as early as possible.

Influence of current and previous smoking on current phenotype in Parkinson's disease

IntroductionAlthough an inverse correlation between smoking and Parkinson's disease (PD) has been reported, research into the effect of smoking on current clinical progression remains limited for PD patients. Elucidation of a specific PD population who would benefit from smoking is challenging. MethodsWe evaluated 110 consecutive PD patients (mean age; 71.0 ± 8.0 years) at a single neurology clinic between 2010 and 2018. The association with smoking status was evaluated in sex- and age-matched controls (non-PD). This study assessed the impact of previous smoking exposure on the outcome of current PD-related parameters, along with any confounders, in addition to assessing fluctuation of parkinsonism induced by smoking exposure. ResultsThe current smoking rate was significantly lower in PD versus non-PD (5.5% vs. 15.5%, P = 0.026), while there were similar rates between former and never smokers. Among the former smokers, most PD patients (97.3%) quit smoking prior to the onset of PD. There were no differences between PD patients with and without a history of smoking for current clinical parameters. Three PD patients with the mean onset age of 51.0 ± 5.3 y reported transient deterioration of their parkinsonism when smoking. Negative mood during cigarette smoke exposure was significantly increased over the entire life in PD patients with a history of smoking than those without (p < 0.001). ConclusionsAlthough previous smoking history reportedly had a neuroprotective effect prior to onset, the association between the previous history and current phenotype in PD was not visible in the present study. However, the possibility that current nicotine intake might modify the parkinsonism deterioration will need to be further evaluated, especially in non-elderly patients. Cigarette smoke-related negative mood could be a confounder for quitting smoking in PD patients.

Hypomimia in Parkinson's Disease: What Is It Telling Us?

Introduction: Amimia is one of the most typical features of Parkinson's disease (PD). However, its significance and correlation with motor and nonmotor symptoms is unknown. The aim of this study is to evaluate the association between amimia and motor and nonmotor symptoms, including cognitive status, depression, and quality of life in PD patients. We also tested the blink rate as a potential tool for objectively measuring upper facial bradykinesia.Methods: We prospectively studied amimia in PD patients. Clinical evaluation was performed using the Unified Parkinson's Disease Rating Scale (UPDRS) and timed tests. Cognitive status, depression, and quality of life were assessed using the Parkinson's Disease Cognitive Rating Scale (PD-CRS), the 16-Item Quick Inventory of Depressive Symptomatology (QIDS-SR16), and the PDQ-39, respectively. Amimia was clinically evaluated according to item 19 of UPDRS III. Finally, we studied upper facial amimia by measuring resting blink frequency and blink rate during spontaneous conversation.Results: We included 75 patients. Amimia (item 19 UPDRS III) correlated with motor and total UPDRS (r: 0.529 and 0.551 Spearman), and its rigidity, distal bradykinesia, and motor axial subscores (r: 0.472; r: 0.252, and r: 0.508, respectively); Hoehn and Yahr scale (r: 0.392), timed tests, gait freezing, cognitive status (r: 0.29), and quality of life (r: 0.268) correlated with amimia. Blinking frequency correlated with amimia (measured with item 19 UPDRS), motor and total UPDRS.Conclusion: Amimia correlates with motor (especially axial symptoms) and cognitive situations in PD. Amimia could be a useful global marker of overall disease severity, including cognitive decline.

The Mechanism of Physical Activity-induced Amelioration of Parkinson's Disease: A Narrative Review.

Physical activity, together with its ameliorative effects on Parkinson’s disease (PD) symptoms, remains a relatively unappreciated factor which may be beneficial for the treatment outcome. Contemporary evidence supports the positive effects of non-pharmacological approaches to PD symptom management, in particular the effects of the exercise on both, motor and non-motor symptoms. The aim of the study was to review the mechanisms of exercise-induced amelioration of PD symptoms. Methods: Electronic databases (PubMed, Web of Science and Google Scholar) were searched using the following key words: “Parkinson and physical activity” OR “Parkinson disease and exercise” OR “Parkinson disease and lifestyle factors” OR “Parkinson disease and longevity”. A total of 97 studies which investigated PD genetics and various forms of exercise and their etiologic impact on PD were reviewed. The studies were subdivided into four topic groups: 1) genetics of PD, 2) exercise and the brain, 3) physical activity and PD, 4) mind-body interventions, and discussed accordingly. Adequate levels of physical activity are associated with higher quality of life in PD patients. Physical activity may have protective and stimulatory effects for better functional efficiency in higher-level cognitive networks. It can also improve balance and motor functions by improving muscle strength. Given the etiologic evidence of the beneficial effects of physical activity on PD, albeit tentative, a concerted effort to elucidate the processes and outcomes of physical activity on ameliorating symptoms of PD must be undertaken.

Changes in Epidemiological Trends and Rehabilitation Usage in Neurological Diseases in Korea: Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by typical motor symptoms such as resting tremor, bradykinesia, and rigidity, as well as non-motor manifestations, including psychiatric symptoms, autonomic dysfunction, and cognitive impairment. These symptoms induce a marked impact on functional independence in daily activities and quality of life in PD patients. Recent guidelines recommend adequate rehabilitation education and treatment from the early stages of PD, and rehabilitation has become part of standard care for PD. In Korea, the number of patients with PD has more than tripled over 15 years, from 39,265 in 2004 to 125,607 in 2019. However, the rehabilitation usage of PD patients has not changed remarkably, and it remains suboptimal in Korea compared to several developed countries, which have advanced and disseminated guidelines and implemented specialized care delivery systems for PD over the past 20 years. Additional efforts are warranted to provide adequate rehabilitation therapies for PD patients in Korea.

Profiling Non-motor Symptoms in Monogenic Parkinson's Disease.

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elder population, pathologically characterized by the progressive loss of dopaminergic neurons in the substantia nigra. While the precise mechanisms underlying the pathogenesis of PD remain unknown, various genetic factors have been proved to be associated with PD. To date, at least 23 loci and 19 disease-causing genes for PD have been identified. Although monogenic (often familial) cases account for less than 5% of all PD patients, exploring the phenotypes of monogenic PD can help us understand the disease pathogenesis and progression. Primary motor symptoms are important for PD diagnosis but only detectable at a relatively late stage. Despite typical motor symptoms, various non-motor symptoms (NMS) including sensory complaints, mental disorders, autonomic dysfunction, and sleep disturbances also have negative impacts on the quality of life in PD patients and pose major challenges for disease management. NMS is common in all stages of the PD course. NMS can occur long before the onset of PD motor symptoms or can present in the middle or late stage of the disease accompanied by motor symptoms. Therefore, the profiling and characterization of NMS in monogenic PD may help the diagnosis and differential diagnosis of PD, which thereby can execute early intervention to delay the disease progression. In this review, we summarize the characteristics, clinical phenotypes, especially the NMS of monogenic PD patients carrying mutations of SNCA, LRRK2, VPS35, Parkin, PINK1, DJ-1, and GBA. The clinical implications of this linkage between NMS and PD-related genes are also discussed.

Anxiety, depression, and quality of life in Parkinson's disease: the implications of multidisciplinary treatment.

Anxiety and depression in Parkinson’s disease (PD) reduce well-being of the patients. Emotional alterations influence motor skills and cognitive performance; moreover, they contribute significantly and independently to worsen rehabilitative treatment response. We investigated anxiety, depression, and quality of life in PD patients subjected to multidisciplinary rehabilitative training. The self-controlled study included 100 PD patients (49 males and 51 females with the mean age of 64.66 years) admitted to 60 days hospitalization rehabilitative program, between January 2017 and December 2018. Motor, cognitive, linguistic abilities, and functional independence were evaluated at admission (T0 baseline visit) and 60 days after (T1) the multidisciplinary rehabilitation including motor exercises, speech therapies, and cognitive intervention. The multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood, motor abilities, autonomy in the activities of daily life, perception of quality of life, cognitive performance and speech skills. Non-motor symptoms may worsen severe disability and reduce quality of life. They are often poorly recognized and inadequately treated. Nonetheless, multidisciplinary rehabilitative training represents an optimal strategy to improve disease management. The study was approved by Istituito di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino-Pulejo” Ethical Committee (approval No. 6/2016) in June 2016.

Prolonged-release melatonin in Parkinson's disease patients with a poor sleep quality: A randomized trial

BackgroundThe present study was a randomized, double-blind, placebo-controlled, multi-center trial to evaluate the efficacy and safety of prolonged-release melatonin (PRM) in Parkinson's disease (PD) patients with poor sleep quality. MethodsPD patients with a global Pittsburgh Sleep Quality Index (PSQI) score > 5 were included. Patients were assessed using the PSQI, a rapid eye movement sleep behavior disorder screening questionnaire, the Epworth Sleepiness Scale, Non-Motor Symptoms Scale (NMSS), Parkinson's Disease Quality of Life-39 (PDQ-39), and Unified Parkinson's Disease Rating Scale (UPDRS)-III at the beginning of the study and after 4 weeks of treatment with 2 mg of PRM. Partial correlation analysis was performed to investigate the relationship between PSQI score and the other scales. ResultsThirty-four PD patients with poor sleep quality were enrolled and divided into 2 groups based on medication; PRM (n = 16) and placebo (n = 18). Regarding efficacy, PSQI was significantly improved in the PRM group compared to the control group. Improvement in the NMSS and PDQ-39 summary index were observed in the PRM but not in the placebo group; UPDRS-III score was not significantly changed in either group. PSQI improvement correlated with improvement in NMSS score and PDQ-39 summary index. Regarding safety, all enrolled subjects did not complain of side effects due to PRM. ConclusionPRM is an effective and safe treatment option for subjective sleep quality in PD patients and beneficial effects on sleep quality are associated with improved non-motor symptoms and quality of life in PD patients.

Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST.

ABSTRACTBackgroundNonmotor symptoms (NMSs) of Parkinson's disease (PD) impair health‐related quality of life.ObjectivesTo identify changes in NMSs during 52 weeks in Japanese PD patients exhibiting motor fluctuations.MethodsIn PD patients with ≥1 NMS and wearing‐off, changes in total/subscore of the Movement Disorder Society Unified PD Rating Scale (MDS‐UPDRS) Part I and 8‐item PD Questionnaire were assessed. Group‐based trajectory models were used to characterize longitudinal patterns of MDS‐UPDRS Part I.ResultsData from 996 patients were analyzed. MDS‐UPDRS Part I subscores for cognitive function decreased linearly over time. Total and subscores for apathy and lightheadedness on standing significantly deteriorated with fluctuations, whereas other subscores fluctuated without significant deterioration. Changes in the MDS‐UPDRS Part I total score correlated with changes in the 8‐item PD Questionnaire total score. Based on group‐based trajectory models, longitudinal pattern analysis of MDS‐UPDRS Part I scores yielded the following 3 separate groups: unchanged (63.8%), deteriorated (20.1%), and improved (16.2%). The improved group had significantly more NMSs at baseline, significantly higher MDS‐UPDRS Part I/8‐item PD Questionnaire total scores, and modified Hoehn and Yahr scores, and had received treatment for NMSs. The multivariate analysis revealed significant associations between severe motor disability and receiving any treatment for NMSs at baseline and improvement of MDS‐UPDRS Part I total scores.ConclusionsChanges in MDS‐UPDRS Part I scores were variable and related to changes in health‐related quality of life in PD patients with motor fluctuations.