Parkinson Disease Rating Scale Scores Research Articles

Effects of dietary supplements, foods, and dietary patterns in Parkinson's disease: meta-analysis and systematic review of randomized and crossover studies.

Diet significantly impacts Parkinson's disease (PD) with plausible biological hypotheses. Although the thesis has been explored in several human clinical trials, no current meta-analyses or reviews summarize the results. We examined the effect of intervention of dietary supplements, foods, and dietary patterns in treating PD. We conducted a meta-analysis and systematic review of randomized and crossover studies published between 1989 and 26 June 2022, searching from PubMed, Embase, Medline, Scopus, Cochrane Library databases, and Chinese databases. Twenty-four studies were included in this review. The meta-analysis results show that dietary supplements intervention significantly increased the quantitative insulin sensitivity check index (QUICKI) [MD = 0.02, 95% CI (0.01, 0.02), p < 0.00001]. Dietary supplement intervention does not significantly affect the total Unified Parkinson Disease Rating Scale (UPDRS) score and six-min walk test (6MWT) distance. We did not find evidence that dietary supplements or food intervention may minimize the UPDRS III score. However, systematic review results indicated that the Mediterranean, low-fat, and ketogenic diets significantly reduced the total UPDRS score; low-protein diets meaningfully mitigated motor symptoms. This meta-analysis result displays that diet and diet supplements had a very modest but statistically significant impact on QUICKI but no effect on motor and non-motor symptoms in PD. The systematic review concludes that dietary patterns intervention may positively attenuate the overall symptoms of PD, including both motor and non-motor symptoms.

Comprehensive analysis of clinical and biological features in Parkinson's disease associated with the LRRK2 G2019S mutation: Data from the PPMI study.

The Parkinson's Progression Marker Initiative (PPMI) aims to identify biomarkers for Parkinson's disease (PD) risk, onset, and progression. This study focuses on the G2019S missense mutation in the LRRK2 gene, which is associated with hereditary and sporadic PD. Utilizing data from the PPMI database, we conducted an analysis of baseline clinical characteristics, as well as serum and cerebrospinal fluid levels in two groups: patients with PD with the G2019S mutation (PD + G2019S) and patients with PD without the mutation (PD-G2019S). Multiple linear regression and longitudinal analysis were performed, controlling for confounding factors. Compared to the PD-G2019S group, the PD + G2019S group showed more obvious initial motor dysfunction-higher baseline Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) scores (false discovery rate [FDR]-adjusted p < 0.001), but progressed more slowly. Mechanism of Coordinated Access and activities of daily living (ADL) scores were lower at baseline (FDR-adjusted p < 0.001), whereas Scales for Outcomes of Parkinson's Disease (SCOPA)-Thermoregulatory (FDR-adjusted p = 0.015) scores were higher, emphasizing the increase of non-motor symptoms associated with LRRK2-G2019S mutation. During the follow-up period, the motor and non-motor symptoms changed dynamically with time, and there were longitudinal differences in the scores of MDS-UPDRS (FDR-adjusted PI = 0.013, PII = 0.008, PIV < 0.001), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (FDR-adjusted p = 0.027), SCOPA-Thermoregulatory (FDR-adjusted p = 0.021), and ADL (FDR-adjusted p = 0.027) scale scores. PD associated with the LRRK2 G2019S mutation demonstrated more severe symptoms at baseline but slower progression. Motor complications and thermoregulatory disorders were more pronounced.

An investigation of neuromelanin distribution in substantia nigra and locus coeruleus in patients with Parkinson’s disease using neuromelanin-sensitive MRI

Loss of neuromelanin in the midbrain is known in Parkinson’s disease(PD), which can now be directly detected by neuromelanin-sensitive MRI(NM-MRI). This case-control study was to investigate the distribution of neuromelanin in the substantia nigra(SN) and the locus coeruleus(LC) using NM-MRI technique and evaluate its potential as a diagnostic marker for PD. 10 early PD patients(H&Y stage I, II), 11 progressive PD patients(H&Y stage III-V), and 10 healthy controls matched in age and gender were recruited. All participants completed clinical and psychometric assessments as well as NM-MRI scans. Neuromelanin signal intensities in SN and LC were measured by contrast-to-noise ratios(CNRs) derived from NM-MRI scans. There were significant decreases of CNRs in SNpc(including anterior, central, and posterior) and LC in PD patients compared to controls. There were also significant differences of CNR between the left and right sides. CNR in LC had a negative correlation with the Non-Motor Symptoms Scale(NMSS) score in PD patients(|R|=0.49), whereas CNR in SNpc did not correlate with Unified Parkinson Disease Rating Scale(UPDRS) score(|R|<0.3). The receiver operating characteristic(ROC) curves revealed that the CNR in LC had a high diagnostic specificity of 90.1% in progressive patients. This study provides new evidence for the asymmetric distribution of neuromelanin in SN and the LC of patients with PD. The neuromelanin loss is bilateral and more predominately in LC than that in SN. This distinct neuromelanin distribution pattern may offer a potential diagnostic marker and a potential neuropharmacological intervention target for PD patients.

Associations of striatal dopamine transporter binding with motor and non-motor symptoms in early Parkinson's disease.

Dopamine transporter (DAT) imaging is an in vivo tool to assess presynaptic dopaminergic function in the clinical practices of Parkinson's disease (PD). Current clinical practices focused on qualitatively visual interpretation of DAT imaging, whereas quantitative analyses are potentially more helpful when monitoring the progression of PD. Previous cross-sectional studies indicated certain motor and non-motor features were associated with striatal DAT binding, whereas limited data were reported in terms of the longitudinal correlation between clinical features of PD with striatal DAT binding. The purpose of our study is to clarify current and longitudinal correlations between striatal DAT binding and clinical measures. A total of 352 untreated PD individuals and 167 healthy controls with complete baseline clinical measures and neuroimaging data were identified from the Parkinson's Progression and Markers Initiative (PPMI) database. Patients with PD underwent DAT imaging at the screening visit and following months 12, 24, and 48. Multiple linear regression models and linear mixed-effect models were respectively conducted to investigate the cross-sectional and longitudinal correlation between clinical characteristics and DAT binding. Associations between changes in clinical characteristics and changes in DAT binding were further evaluated and the Spearman rank correlation coefficients were reported. In the cross-sectional analysis, baseline striatal DAT binding was significantly associated with the Hoehn and Yahr scale, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) scores, the rigidity scores, and the axial scores in PD individuals (false discovery rate [FDR]-adjusted p=0.0017 for all above). Patients who developed freezing of gait had lower striatal DAT binding (FDR-adjusted p=0.0161). Healthy controls who had higher tremor scores and suffered more severe olfactory dysfunction had lower striatal DAT binding (FDR-adjusted p=0.0257 for all above). Longitudinal analysis indicated that baseline severity of rapid-eye-movement sleep behavior disorder was significantly associated with longitudinal striatal DAT binding in patients with PD (FDR-adjusted p=0.0120). Furthermore, changes in MDS-UPDRS scores and the State-Trait Anxiety Inventory (STAI) scores demonstrated significant correlations with changes in striatal DAT binding over 4 years (p=0.005 and p=0.032, respectively). Our findings clarified quantitative associations between certain motor and non-motor features with current and future striatal dopamine binding, suggesting the feasibility of using DAT images as a progression predictive marker for PD. Further studies are needed to investigate correlations between different regional dopamine binding with specific clinical features.

Is 18F-DOPA a valid cardiac sympathetic neuroimaging agent?

18F-Dopamine positron emission tomography is a validated method for identifying cardiac noradrenergic deficiency, a characteristic feature of Lewy body forms of neurogenic orthostatic hypotension; however, 18F-dopamine is a research drug. Brain 18F-DOPA positron emission tomography is FDA-approved. Since 18F-DOPA is converted to 18F-dopamine in the heart, 18F-DOPA might be useful for cardiac sympathetic neuroimaging. We compared 18F-DOPA with 18F-dopamine in patients who either had or did not have low 18F-dopamine-derived radioactivity. Brain and cardiac 18F-DOPA scanning and cardiac 18F-dopamine scanning were done on separate days in patient groups with neurogenic orthostatic hypotension or Parkinsonism or control subjects across a range of values for 18F-dopamine-derived radioactivity. The lower limit of normal for myocardial 18F-dopamine-derived radioactivity was 6000Bq-kg/cc-MBq. We also examined inter-relationships among cardiac 18F-DOPA-derived radioactivity, cardiac 18F-dopamine-derived radioactivity, putamen/occipital cortex ratios of 18F-DOPA-derived radioactivity, and Unified Parkinson Disease Rating Scale scores in patients with or without Parkinsonism. For putamen/occipital cortex ratios, the cutoff value was 2.70. Twelve subjects had severely decreased and eight normal cardiac 18F-dopamine-derived radioactivity. Cardiac 18F-DOPA-derived radioactivity did not distinguish the two groups and was unrelated to 18F-dopamine-derived radioactivity. Left ventricular myocardial 18F-DOPA-derived radioactivity was poorly resolved from that in the chamber. Putamen/occipital cortex ratios of 18F-DOPA-derived radioactivity were negatively correlated with Unified Parkinson Disease Rating Scale scores (-0.67, p = 0.0015). 18F-DOPA does not seem to be a valid cardiac sympathetic neuroimaging agent, although brain 18F-DOPA scanning provides a biomarker of Parkinsonism.

Tuned Homogenous Ensemble Regressor Model for Early Diagnosis of Parkinson Disorder Based on Voice Features Modality

Parkinson Disorder (PD) is a neurological disorder which is progressive and degenerative in nature. There are no specific tests pertaining to the diagnosis of PD. The symptoms at an early stage are mild. The early diagnosis of PD is really essential to delay the progression of the disorder. Speech disorder namely dysphonia is experienced by approximately 90% of PD patients. The incorporation of Artificial Intelligence (AI) techniques integrated with non-invasive capture of speech data from patients in diagnosis system aids to provide a robust, reliable and accurate estimation of Unified Parkinson Disease Rating Scale (UPDRS) score which ease the decision-making process effective for healthcare professionals. The proposed system incorporates a novel tuned Homogenous Ensemble Regressor wherein the hyperparameters are chosen and tuned using various experiments. Tuned Extreme Gradient (XgBoost) Regressor and Tuned Random Forest (RF) Regressor are the two homogenous regressor model. The proposed system is compared with the Tuned Linear Regression (LR) model which is the single Regressor model. The proposed system is evaluated using the large database of voice features samples of 42 PD patients. The Mean Absolute Error (MAE) and Mean Squared Error (MAE) values are minimal for the proposed system and it shows that the errors of the proposed system are lower than the single classifier errors and existing similar system.

Sexual Dysfunction in Parkinson's Disease: A Systematic Review of the Arizona Sexual Experience Scale Sexual Dysfunction in Parkinson Disease: A Systematic Review of the Arizona Sexual Experience Scale.

Parkinson's disease (PD) affects older individuals and can cause sexual dysfunction (SD). SD is a determinant of general well-being; but is infrequently assessed in professionally. The Arizona Sexual Experience Scale (ASEX) measures SD; unlike other scales, it is minimally invasive and requires little time to complete. This review aimed to assess the prevalence of SD in patients with PD using ASEX. Were searched the keywords, "sexual dysfunction," "Parkinson's disease" and "ASEX" in 9 databases. The prevalence of SD ranged from 65%-90%. SD was associated with older age at disease onset, higher Unified Parkinson Disease Rating Scale scores, age and depression (p ranged from .001 to <.05). The most observed SD was erectile dysfunction in men. SD is common among patients with PD. ASEX, although not specific to PD, is an easy and quickly applied tool that can help evaluate SD and guide treatments in PD.

Poly (ADP-Ribose) and α-synuclein extracellular vesicles in patients with Parkinson disease: A possible biomarker of disease severity.

Background/ObjectiveDespite multiple attempts, no surrogate biomarker of Parkinson disease (PD) has been definitively identified. Alternatively, identifying a non-invasive biomarker is crucial to understanding the natural history, severity, and progression of PD and to guide future therapeutic trials. Recent work highlighted alpha synuclein-containing extracellular vesicles and Poly (ADP-ribose) polymerase (PARP-1) activity as drivers of PD pathogenesis and putative PD biomarkers. This exploratory study evaluated the role of alpha-synuclein-positive extracellular vesicles and PARP-1 activity in the plasma of PD patients as non-invasive markers of the disease’s severity and progression.MethodsWe collected plasma of 57 PD patients (discovery cohort 20, replication cohort 37) and compared it with 20 unaffected individuals, 20 individuals with clinically diagnosed Alzheimer’s disease, and 20 individuals with dementia with Lewy bodies. We analyzed alpha-synuclein-positive extracellular vesicles from platelet-free plasma by nanoscale flow cytometry and blood concentrations of poly ADP-ribose using sandwich ELISA kits.ResultsMedian concentration of α-synuclein extracellular vesicles was significantly higher in PD patients compared to the other groups (Kruskal-Wallis, p < .0001). In the discovery cohort, patients with higher α-synuclein extracellular vesicles had a higher Unified Parkinson Disease Rating Scale score (UPDRS III median = 22 vs. 5, p = 0.045). Seven out of 20 patients (35%) showed detectable PAR levels, with positive patients showing significantly higher levels of α-synuclein extracellular vesicles. In the replication cohort, we did not observe a significant difference in the PAR-positive cases in relationship with UPDRS III.ConclusionsNon-invasive determination of α-synuclein-positive extracellular vesicles may provide a potential non-invasive marker of PD disease severity, and longitudinal studies are needed to evaluate the role of α-synuclein-positive extracellular vesicles as a marker of disease progression.

Efficacy and safety of combination therapy with pramipexole and levodopa vs levodopa monotherapy in patients with Parkinson disease: A systematic review and meta-analysis.

Background:Pramipexole (P) or levodopa (L) treatment has been suggested as a therapeutic method for Parkinson disease (PD) in many clinical studies. Nonetheless, the combined effects of 2 drugs for PD patients are not completely understood.The aim of this research was to evaluate the clinical efficacy and safety of P plus L (P+L) combination therapy in the treatment of PD compared to that of L monotherapy, in order to confer a reference for clinical practice.Methods:Randomized controlled trials (RCTs) of P+L for PD published up to April, 2020 were retrieved. Standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was measured with the I2 test. Sensitivity analysis was also carried out. The outcomes of interest were as follows: the efficacy, unified Parkinson disease rating scale (UPDRS) scores, Hamilton depression rating scale score or adverse events.Results:Twenty-four RCTs with 2171 participants were included. Clinical efficacy of P+L combination therapy was significantly better than L monotherapy (9 trials; OR 4.29, 95% CI 2.78 to 6.64, P < .00001). Compared with L monotherapy, the pooled effects of P+L combination therapy on UPDRS score were (22 trials; SMD −1.31, 95% CI −1.57 to −1.04, P < .00001) for motor UPDRS score, (16 trials; SMD −1.26, 95% CI −1.49 to −1.03, P < .00001) for activities of daily living UPDRS score, (12 trials; SMD −1.02, 95% CI −1.27 to −0.77, P < .00001) for mental UPDRS score, (10 trials; SMD −1.54, 95% CI −1.93 to −1.15, P < .00001) for complication UPDRS score. The Hamilton depression rating scale score showed significant decrease in the P+L combination therapy compared to L monotherapy (12 trials; SMD −1.56, 95% CI −1.90 to −1.22, P < .00001). In contrast to L monotherapy, P+L combination therapy reduced the number of any adverse events obviously in PD patients (16 trials; OR 0.36, 95% CI 0.27 to 0.50, P < .00001).Conclusions:P+L combination therapy is superior to L monotherapy for improvement of clinical symptoms in PD patients. Moreover, the safety profile of P+L combination therapy is better than that of L monotherapy. Further well-designed, multicenter RCTs needed to identify these findings.

Application of continuous relative phase analysis for differentiation of gait in neurodegenerative disease

Continuous relative phase (CRP) is a measure of coordination between two joints, and CRP based analysis is being used to characterise joint or segmental coordination during gait. Postural instability or balancing issue is one of the major motor symptoms of Parkinson’s Disease (PD). This study aimed to use CRP variables to distinguish between PD, healthy control (CO) groups, and PD groups divided according to clinical evaluations. The subjects were separated into two groups: healthy controls and Parkinson’s disease subjects. Additionally, the PD group was subdivided according to the unified Parkinson disease rating scale (UPDRS) scores: UPDRS 0 and UPDRS 1. Each subject performed the designated walking motor task three times. Four inertial measurement units (IMU) were used to measure movement of the lower limbs. Statistically significant differences in CRP mean, deviation phase (DP), and root mean square CRP (CRPRMS) were found for PD vs CO (right stance, right swing, right mid-stance) and UPDRS 0 vs UPDRS 1 (right stride, left stride, right swing). CRP can be used to separate PD and CO groups, and groups subdivided based on UPDRS score.

Fatigue correlates with sleep disturbances in Parkinson disease

Background:Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients.Methods:Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances.Results:Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score.Conclusion:Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.

Safety and Tolerability of Cannabidiol in Parkinson Disease: An Open Label, Dose-Escalation Study.

Background: Cannabis is increasingly used in Parkinson disease (PD), despite little information regarding benefits and risks. Objectives: To investigate the safety and tolerability of a range of doses of cannabidiol (CBD), a nonintoxicating component of cannabis, and it's effect on common parkinsonian symptoms. Methods: In this open-label study Coloradans with PD, substantial rest tremor, not using cannabis received plant-derived highly purified CBD (Epidiolex®; 100 mg/mL). CBD was titrated from 5 to 20-25 mg/kg/day and maintained for 10-15 days. Results: Fifteen participants enrolled, two were screen failures. All 13 participants (10 male), mean (SD) age 68.15 (6.05), with 6.1 (4.0) years of PD, reported adverse events, including diarrhea (85%), somnolence (69%), fatigue (62%), weight gain (31%), dizziness (23%), abdominal pain (23%), and headache, weight loss, nausea, anorexia, and increased appetite (each 5%). Adverse events were mostly mild; none serious. Elevated liver enzymes, mostly a cholestatic pattern, occurred in five (38.5%) participants on 20-25 mg/kg/day, only one symptomatic. Three (23%) dropped out due to intolerance. Ten (eight male) that completed the study had improvement in total and motor Movement Disorder Society Unified Parkinson Disease Rating Scale scores of 7.70 (9.39, mean decrease 17.8%, p=0.012) and 6.10 (6.64, mean decrease 24.7%, p=0.004), respectively. Nighttime sleep and emotional/behavioral dyscontrol scores also improved significantly. Conclusions: CBD, in the form of Epidiolex, may be efficacious in PD, but the relatively high dose used in this study was associated with liver enzyme elevations. Randomized controlled trials are needed to investigate various forms of cannabis in PD.

Parkinson's disease phenotype is influenced by the severity of the mutations in the GBA gene

ObjectiveMutations in the glucocerebrosidase (GBA) gene are divided into mild and severe (mGBA, sGBA) based on their contribution to the phenotype of Gaucher disease (GD) among homozygotes. We conducted a longitudinal analysis of Parkinson's disease (PD) patients carrying mutations in the GBA gene to better characterize genotype-phenotype correlations. MethodsPatients underwent a comprehensive assessment of medical, neurological, cognitive and non-motor functions. Data from these patients was explored to evaluate differences in disease phenotype based on genotype. ResultsA total of 355 PD patients participated in this study; 152 idiopathic PD patients, 139 mGBA, 48 sGBA and 16 GD-PD. Groups were similar in age, sex, years of education and age of onset. Both sGBA and GD-PD had higher Unified Parkinson Disease Rating Scale (UPDRS) scores (p = 0.041), higher frequencies of REM sleep behavior disorder (RBD) (p = 0.022) and hallucinations (p < 0.0001) compared to the other groups of patients. sGBA experienced more non-motor symptoms (p < 0.0001), depression (p < 0.001) and worse hyposmia (p = 0.010). Trail making test was significantly longer in GD-PD followed by sGBA, mGBA and iPD (p = 0.005). DiscussionMotor, cognitive, olfactory and psychiatric symptoms are more severe in sGBA and GD-PD compared to mGBA and iPD, reinforcing the notion that the severity of the PD phenotype is related to the severity of the mutation in the GBA gene.

Improvement of impulse control disorders associated with levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease.

Impulse control behaviors are a frequent comorbidity for patients with Parkinson's disease (PD). The objective of the present study was to evaluate the effectiveness levodopa-carbidopa intestinal gel (LCIG) therapy on impulse control disorders (ICDs) in patients with advanced PD. We conducted a multicenter, observational, and prospective (6months follow-up) study that included consecutive PD patients assigned to LCIG through routine medical practice. Patients completed visits at baseline, 1, 3, and 6months after percutaneous endoscopic gastrostomy procedure. The following outcomes were evaluated: presence and severity of ICDs and other neuropsychiatric disorders, sleep disturbances, patients' quality of life, and caregivers' burden. Sixty-two patients were included at baseline: mean age 72.2years (SD±7.0), 42% women. Median duration of PD symptoms was 13.5years (IQR 5.5-21.5) and median time with motor fluctuations was 5.0years (IQR 1.0-9.0). Treatment with LCIG infusion was associated with progressive and significant improvements in ICDs symptoms over the study period (64.4% reduction in the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease-Rating Scale score). Psychotic and other neuropsychiatric symptoms were also significantly reduced, and patients' sleep quality and psychosocial function improved. Caregivers' burden remained unchanged. There was a significant improvement in the daily "Off" time [7.4h (SD±4.0) vs 1.5h (SD±1.8); p<0.0001] at the end of follow-up, whereas duration of dyskinesias was not affected. ICDs significantly improved after 6-month LCIG treatment in a group of PD patients with mild-to-moderate neuropsychiatric disturbances.

A randomized double-blind, placebo-controlled multi-center trial of molecular hydrogen water for Parkinson’s disease

Background: Our previous randomized double-blind study showed that drinking 1 L of hydrogen (H2) water for 48 weeks significantly improved (p < 0.05) the total Unified Parkinson disease rating scale (UPDRS) score of patients with Parkinson’s disease (PD) receiving levodopa.

Vestibulo-ocular reflex abnormality in Parkinson's disease detected by video head impulse test.

Parkinson's disease (PD) is a common neurodegenerative disease characterized by dopaminergic neuronal loss. The underlying cause of PD is unknown. To assess the clinical relevance of vestibular-ocular reflex (VOR) gain in patients with PD, especially those in the early stages. Sixty-three PD patients and 56 control healthy individuals were enrolled in this study between Mar 2015 and Aug 2015. VOR gains were determined by video head impulse test (vHIT) device. Statistical analysis was performed to assess the difference in VOR gains between PD patients and normal people. The relationship of VOR gain with age, duration and severity of disease was also assessed. In the control group, average VOR gain was 0.98±0.09 on the left side and 0.99±0.16 on the right side. No statistically significant difference was observed between the two sides in the control group (P>0.05). In the PD group, average VOR gain was 1.20±0.22 on the left side and 1.23±0.23 on the right side. No statistically significant difference was observed between the two sides in the PD group (P>0.05). There was a significant difference in VOR gain between the PD (both in early and mid-late stages) and the control group (P<0.05). A weak correlation was observed between VOR gain and the motor Unified Parkinson Disease Rating Scale score. No correlation of VOR gain with age, duration of disease or the Hoehn and Yahr Scale score was observed. VOR gains in PD patients were found to be higher than normal, especially in the early stages of the disease. vHIT is a potential tool to determine the VOR gain in PD patients and may help detect PD at an early stage.

Toxoplasma gondii exposure and Parkinson's disease: a case–control study

ObjectivesTo determine the association between Toxoplasma gondii infection and Parkinson's disease and to investigate whether T. gondii seropositivity is associated with the general characteristics of patients with Parkinson's disease.DesignCase–control study.SettingCases...

Structural changes of substantia nigra in patients with unilateral Parkinson′s disease

Magnetic resonance imaging (MRI) findings were studied in 19 patients with non-dementia Parkinson′s disease (PD) Hoehn-Yahr Stage 1 and 1.5 and 38 healthy subjects. The width and area of pars compacta of substantia nigra (SNc), substantia nigra (SN) and midbrain were measured. The width and area ratios of SNc to SN were calculated. Compared with controls, the widths of right SNc was narrower, bilateral ratios of SNc to SN width were decreased in PD group. As to the area of substantia nigra, there was no significant difference between PD and controls. The width of left SN and the ratio of right SNc to SN width was negatively correlation with age of patients. The ratio of left SNc to SN width, the area of bilateral SNc and left SN, as well as the ratio of right SNc to SN area had negative correlation with the disease duration; however, there was no correlation with gender, Hoehn-Yahr Stage, the Unified Parkinson disease rating scale score, mini mental state scale, education years, levodopa equivalent daily dose, Hamilton Depression Scale or Hamilton Anxiety Scale in PD group. The results indicate that there are bilateral structural changes of SN in unilateral PD patients, which may be more significant with increasing disease duration. The measurement of SNc width and SN area can be used as an objective indicator for diagnosis and disease progression monitoring of PD. Key words: Parkinson disease; Magnetic resonance imaging; Pars compacta of substantia nigra

DOPAMINE RESPONSIVE FEATURES IN ALZHEIMER'S DISEASE, ALZHEIMER'S DISEASE WITH LEWY BODIES (LB), AND PURE LB DISEASE

The degree to which Alzheimer disease (“pure AD”), AD with concurrent Lewy body (LB) pathology (“AD w/LBs”), and pure LB disease (“pure LBP”) represent a continuum or distinct disorders is not clear. Parkinsonian symptoms can be disabling in these conditions, are variably responsive to dopaminergic replacement therapy and their characteristics might reflect the nature of the underlying neuropathology. In the current study we looked at the association of dopaminergic-responsive and non-responsive signs and dopaminergic medication use during life in persons with no neuropathologic findings at autopsy (NCs, n = 62), pathologically-proven pure AD (n = 634), AD w/LBs (n = 175), and pure LBP (n = 52) using the National Alzheimer Coordinating Center database (total = 923). We identified such cases that had full Unified Parkinson Disease Rating Scale (UPDRS) scores at their first visit such that dopamine replacement-responsive signs (Levy A scores, 0-80) and non-responsive signs (Levy B scores, 0-20) could be calculated. We performed ANOVA's and two-sided t-tests to compare these scores across groups and compared the use of dopaminergic replacement therapy between groups using chi-square analyses for all subjects for whom such data was available (n= 1,125). At their first visit, 4% of NCs, 3% of persons with pure AD, 8% of persons with AD w/LBs, and 38% of persons with pure LBP were on dopaminergic replacement therapy. Mean Levy A scores were 1.8, 4.4, 6.4, and 12.7 and Levy B scores were 1.6, 2.2, 2.8, and 5.0, respectively (p's < 0.001). Differences in mean Levy A and B scores were significantly different among all groups except for Levy B scores between persons with normal brains and those with pure AD. Despite an increasing prevalence of treatment with dopamine replacement therapy, progressively worse Levy A and B scores predict progressively more pure LB pathology. Dopamine-responsive signs more clearly differentiated the groups. Further analysis of UPDRS sub-items in relation to pathologic diagnosis will be of utility in creating scales to better differentiate these groups and predict medication response during life.

Advances in levodopa therapy for Parkinson disease: Review of RYTARY (carbidopa and levodopa) clinical efficacy and safety.

Parkinson disease (PD) is a slowly progressive, incurable, neurodegenerative disorder with progressive motor symptoms that can be managed with treatments. Levodopa is generally recognized as the most effective and widely used treatment for PD. It improves function and quality of life, morbidity, and mortality, and therefore reduces individual and societal costs. Levodopa has a relatively short half-life, however, and is quickly metabolized in the plasma, leading to fluctuations, including wearing-off of effect and inconsistent symptomatic relief as well as development of dyskinesias, with both wearing off and dyskinesias worsening with advancing disease. Immediate-release and controlled-release formulations have been used with success, but motor fluctuations remain a problem. RYTARY (levodopa and carbidopa, IPX066) is an oral extended-release therapy composed of carbidopa-levodopa microbeads designed to dissolve at various rates that allows for quick absorption and sustained levodopa release over an extended period. In development studies, RYTARY improved symptoms in patients with both early and advanced PD and offered significantly improved Unified Parkinson Disease Rating Scale scores and "on" times, without worsening troublesome dyskinesias when compared to other levodopa formulations. Tolerability and safety were comparable to other formulations. This section reviews the data that support the use of RYTARY in the treatment of PD.