Group Of Parkinson's Disease Patients Research Articles

MHealth-assisted expiratory muscle strength training in Parkinson's disease patients: A proof-of-concept study

Background Expiratory muscle strength training (EMST) is acknowledged for its therapeutic benefits in Parkinson's disease (PD), yet long-term adherence remains a challenge. Objective The primary aim of this study was to assess the preliminary effects of EMST coupled with a mobile health app (SpiroGym) on self-efficacy and exercise adherence in PD patients. The secondary aim was to assess the usability of the SpiroGym app. Methods This single-group, multicenter, multinational proof-of-concept study involved 63 PD patients across four tertiary PD centers. Participants were enrolled in either a 1-week (n = 35) or 24-week (n = 28) EMST program coupled with SpiroGym app. Self-efficacy was assessed using the Self-Efficacy for Home Exercise Program scale (SEHEPS) and exercise adherence was monitored by SpiroGym app. Usability was evaluated using the System Usability Scale. Results Post-intervention, significant improvements in SEHEPS were observed in 1-week group (d = 0.48; p = 0.02) and 24-week group (d = 0.57; p = 0.002). Adherence rates in the 24-week PD patient group were high throughout the course of the study. Post-training SEHEPS was found to correlate (rho = 0.55; adjusted p = 0.016) with adherence to EMST during the non-supervised maintenance phase. The SpiroGym app exhibited high usability (>85th percentile score), with no significant differences noted between short-term and long-term use, indicating sustained user satisfaction. Conclusions The results of our study suggest a promising role for SpiroGym app in supporting adherence to home-based EMST in PD patients. Nevertheless, future comparative studies are required to confirm SpiroGym's effectiveness.

The Effects of Multimodal Exercise Program on Functional Capacity and Quality of Life in Elderly Patients with Parkinson's Disease

Introduction: Parkinson's disease (PD) is a degenerative neurological illness characterized by various motor and non-motor symptoms that can lead to varying degrees of functional impairment. This study aims to investigate the effects of a multimodal exercise program (MEP) on functional capacity and quality of life in elderly patients with PD. Methods: Thirty elderly patients with PD were randomly divided into two equal groups of MEP and control, with no significant differences in age, weight, and height. The variables of Functional Factors and Quality of Life were assessed in pre- and post-tests. MEP was performed five days a week for twelve weeks. Data were analyzed using repeated measures ANOVA at a significance level of p < 0.05. Results: The study observed significant differences in quality of life, static balance, dynamic balance, wrist strength, and walking performance between the two groups of PD patients (p <0.001). The mean scores of quality of life, static balance, dynamic balance, and wrist strength in the MEP group were significantly higher compared to the control group (p <0.001). Additionally, after the intervention, the walking speed in the MEP group showed a significant improvement, with a lower completion time compared to the control group (p <0.001). Conclusion: MEP can be used as a useful and effective method to improve quality of life, static balance, dynamic balance, wrist strength and walking performance of PD patients. Therefore, MEP (resistance, aerobic, and balance) is recommended as the most effective complementary therapeutic strategy for PD.

White Matter Microstructure Alteration in Patients with Drug-Induced Parkinsonism: A Diffusion Tensor Imaging Study with Tract-Based Spatial Statistics.

This research aimed to investigate the pathophysiological mechanism of how drug-induced parkinsonism (DIP) affects the integrity of the white matter (WM) fiber microstructure as measured by magnetic resonance diffusion tensor image (DTI) fractional anisotropy (FA) and mean diffusivity (MD). We recruited 17 participants diagnosed with DIP, 20 Parkinson's disease (PD) patients, and 16 normal controls (NCs) with a similar age, gender, and years of education. Subsequently, all participants underwent DTI magnetic resonance imaging scanning. To analyze the data, we utilized the software packages Functional MRI of the Brain Centre (FMRIB) Diffusion Toolbox (FDT), developed by the FMRIB laboratory at Oxford University, and tract-based spatial statistics (TBSS). The Argentina Hyposmia Rating Scale (AHRS) scores of patients in DIP group were markedly higher than those in PD patients group. Compared with the NC group, the FA values in the genu and body of the corpus callosum (CC), anterior limb of the right internal capsule, bilateral anterior corona radiata, bilateral superior corona radiata, right external capsule, and right superior fronto-occipital fasciculus (could be a part of the anterior internal capsule) were significantly decreased in the DIP group; however, no significant cluster was found in MD. The present study provides novel insights into the alterations in WM microstructure among DIP patients, suggesting that these methodologies have the potential to aid in the early diagnosis and treatment of DIP.

Anti-obesity effect of irreversible MAO-B inhibitors in patients with Parkinson’s disease

We read with great interest the report on the new anti-obesity potential in mice models of reversible monoamine oxidase B inhibitors by Moonsun et al., as opposed to the lack of such effects observed with irreversible MAO-B inhibitors (iMAO-Bi). Our research aimed to explore the potential anti-obesity effects of iMAO-Bi in patients with Parkinson’s disease (PD). This retrospective study included 37 PD in-patients from 2018 to 2023. Patients who took iMAO-Bi were assigned to the iMAO-Bi group, and those who never took iMAO-Bi were assigned to the control. The major outcomes were changes in body weight and body mass index (BMI) during follow-up. A subgroup analysis was conducted to compare the anti-obesity effect between the short-term and long-term administrations of the iMAO-Bi group. The results showed a slight yet insignificant trend of bodyweight loss among the iMAO-Bi group of PD patients. Subgroup analysis showed that short-term treatment of iMAO-Bi (less than six months) led to reductions in BMI and body weight, while the long-term treatment of iMAO-Bi displayed a slight increase in BMI and body weight. The results suggested that short-term administration of iMAO-Bi may have potential weight-loss effects. Further studies with larger sample sizes are needed to evaluate the weight-loss effect of iMAO-Bi.

Alteration in EEG Delta and Beta Power During Working Memory Performance Differentiates Patients with Parkinson's Disease with and without Dementia.

Working memory (WM) impairment is a common and progressive abnormality in Parkinson's disease (PD), which ultimately leads to dementia. Individuals with PD exhibit altered electroencephalogram (EEG) patterns while engaging in tasks that require WM. The study examined the EEG patterns associated with WM maintenance in PD patients. The study consisted of two groups of PD patients with a sign of dementia (PDD) who had a Mini Mental State Examination (MMSE) score ≤24, PD patients with no sign of dementia (PDND) with an MMSE score >24, and a group of healthy individuals serving as controls (CON). We obtained EEG during a word memorization task using a 128-channel system. The spectral power of the EEG was computed using the fast Fourier transformation algorithm. Compared to both PDND and CON groups, PDD group exhibited higher power in the delta and beta frequency bands. Conversely, there was a notable decrease in power in the gamma band in both the PDD and PDND groups compared to the CON group. In addition, the PDD group exhibited higher power in the gamma band compared to the PDND group. Power in the alpha (LA1, LA2, and UA) and theta bands was greater in PDND and PDD compared to CON, but was similar between PDND and PDD groups. While performing WM tasks, PDD exhibits increased delta and beta power. These findings can be used as a quantitative biomarker to evaluate the severity of initial WM impairments, which could potentially develop into dementia in the future.

Relevance of genetic testing in the gene-targeted trial era: the Rostock Parkinson's disease study.

Estimates of the spectrum and frequency of pathogenic variants in Parkinson's disease (PD) in different populations are currently limited and biased. Furthermore, although therapeutic modification of several genetic targets has reached the clinical trial stage, a major obstacle in conducting these trials is that PD patients are largely unaware of their genetic status and, therefore, cannot be recruited. Expanding the number of investigated PD-related genes and including genes related to disorders with overlapping clinical features in large, well-phenotyped PD patient groups is a prerequisite for capturing the full variant spectrum underlying PD and for stratifying and prioritizing patients for gene-targeted clinical trials. The Rostock Parkinson's disease (ROPAD) study is an observational clinical study aiming to determine the frequency and spectrum of genetic variants contributing to PD in a large international cohort. We investigated variants in 50 genes with either an established relevance for PD or possible phenotypic overlap in a group of 12 580 PD patients from 16 countries [62.3% male; 92.0% White; 27.0% positive family history (FH+), median age at onset (AAO) 59 years] using a next-generation sequencing panel. Altogether, in 1864 (14.8%) ROPAD participants (58.1% male; 91.0% White, 35.5% FH+, median AAO 55 years), a PD-relevant genetic test (PDGT) was positive based on GBA1 risk variants (10.4%) or pathogenic/likely pathogenic variants in LRRK2 (2.9%), PRKN (0.9%), SNCA (0.2%) or PINK1 (0.1%) or a combination of two genetic findings in two genes (∼0.2%). Of note, the adjusted positive PDGT fraction, i.e. the fraction of positive PDGTs per country weighted by the fraction of the population of the world that they represent, was 14.5%. Positive PDGTs were identified in 19.9% of patients with an AAO ≤ 50 years, in 19.5% of patients with FH+ and in 26.9% with an AAO ≤ 50 years and FH+. In comparison to the idiopathic PD group (6846 patients with benign variants), the positive PDGT group had a significantly lower AAO (4 years, P = 9 × 10-34). The probability of a positive PDGT decreased by 3% with every additional AAO year (P = 1 × 10-35). Female patients were 22% more likely to have a positive PDGT (P = 3 × 10-4), and for individuals with FH+ this likelihood was 55% higher (P = 1 × 10-14). About 0.8% of the ROPAD participants had positive genetic testing findings in parkinsonism-, dystonia/dyskinesia- or dementia-related genes. In the emerging era of gene-targeted PD clinical trials, our finding that ∼15% of patients harbour potentially actionable genetic variants offers an important prospect to affected individuals and their families and underlines the need for genetic testing in PD patients. Thus, the insights from the ROPAD study allow for data-driven, differential genetic counselling across the spectrum of different AAOs and family histories and promote a possible policy change in the application of genetic testing as a routine part of patient evaluation and care in PD.

Improved Outcomes When Home-Dose Carbidopa-Levodopa Is Continued in the Geriatric Emergency Department in Patients With Parkinson's Disease.

Parkinson's disease (PD) is a debilitating condition that affects 1.8% of people 65 years of age and older. Patients with PD often require hospitalization and are frequently admitted through the emergency department (ED). Notably, their hospital durations tend to be lengthier compared with patients without PD. The primary outcome of this research was to compare the length of stay (LOS) of patients who received carbidopa-levodopa (CL) in the ED with those who did not. Secondary outcomes included 30-day-readmission rates and administration of injectable for agitation. In addition, the percentage of patients receiving CL before and after an information management technology (IMT) alert implementation was compared in a sub-analysis. Patients that received CL during their inpatient stay were identified by a database report in this retrospective study. Patients were excluded if they were not admitted through the ED, younger than 65 years of age, or admitted to the intensive care unit after the ED. There was a total of 266 in the control group and 217 patients in the intervention group. The intervention group had a significantly shorter LOS than the control group (3.29 vs 5.37 days; P = 0.002), significantly less frequent 30-day readmissions (P = 0.032), and used fewer injectables for agitation (P = 0.035). The sub-analysis of the IMT alert revealed that prior to the alert's implementation, 28.5% of patients received CL in the ED; whereas post-alert, this percentage increased to 91.4% (P < 0.001). The results of this study found that the group of PD patients who received CL in the ED had shorter LOS, lower 30-day readmissions, and used less injectables for agitation compared with the group that did not receive CL in the ED. This improvement is possibly due to continuity of CL supply considering its short half-life and clinical importance for PD.

Associations between gut microbiota characteristics and non-motor symptoms following pharmacological and surgical treatments in Parkinson's disease patients.

The gut microbiota has been implicated in Parkinson's disease (PD), with alterations observed in microbial composition and reduced microbial species richness, which may influence gastrointestinal symptoms in PD patients. It remains to be determined whether the severity of gastrointestinal symptoms correlates with microbiota variations in PD patients treated pharmacologically or with subthalamic nucleus deep brain stimulation (STN-DBS) therapy. This study aims to explore how these treatments affect gut microbiota and gastrointestinal symptoms in PD, identifying specific microbial differences associated with each treatment modality. A total of 42 individuals diagnosed with PD, along with 38 age-matched household control participants, contributed stool samples for microbiota characterization. Differences in the gut microbiota across various groups of PD patients and their households were identified through comprehensive sequencing of the 16S rRNA gene amplicon sequencing. Differences in microbial communities were observed between PD patients and controls, as well as between PD patients receiving pharmacological treatment and those with STN-DBS. Pharmacologically treated advanced PD patients have higher gastrointestinal dysfunctions. Gut microbiota profile linked to STN-DBS and reduced levodopa consumption, characterized by its anti-inflammatory properties, might play a role in diminishing gastrointestinal dysfunction relative to only pharmacological treatments. Advanced PD patients on medication exhibit more gastrointestinal issues, despite relatively stable microbial diversity, indicating a complex interaction between gut microbiota, PD progression, and treatment effects. An imbalanced gut-brain axis, particularly due to reduced butyrate production, may lead to constipation by affecting the enteric nervous system, which emphasizes the need to incorporate gut microbiome insights into treatment strategies.

Intraoperative transcutaneous electroacupoint stimulation on early postoperative fatigue in patients with Parkinson's disease undergoing deep brain stimulation surgery

BackgroundIn this clinical trial, we evaluated the effects of transcutaneous electroacupoint stimulation (TEAS) on postoperative fatigue (POF) in Parkinson disease (PD) patients undergoing deep brain stimulation (DBS) surgery. MethodsA total 60 PD patients undergoing DBS surgery were enrolled. They were randomized to receive either electrical stimulation [alternative frequency 2/10 Hz, dense and disperse, intensity adjusted to the maximum tolerated by the participants (6–15 mAmp)] via surface electrodes (TEAS group) or surface electrodes only without electrical stimulation (Con group) at bilateral Zusanli and Sanyinjiao acupuncture points. All participants received their assigned intervention (TEAS or Con) during the 1st stage of surgery [(except during microelectrode recording (MER)] and the entire 2nd stage of surgery. Intraoperative anesthetic requirements were adjusted based on bispectral index (BIS) monitor. POF was assessed by Christensen fatigue scales (ChrFS), along with Quality of Recovery-15 (QoR-15) and mini-mental state examination (MMSE) postoperatively over a 7-day-period. We recorded the usage of rescue analgesics and anti-emetics. ResultsFifty-nine patients’ datasets were included for final analyses. Fewer patients in TEAS experienced severe POF (defined as ChrFS ≥6) at T3 than those in the Con group (TEAS vs. Con: 7 vs. 22, p < 0.001). During the 1st stage of surgery, more patients in Con group required dexmedetomidine infusion (TEAS vs. Con: 2 vs. 6; P < 0.01). Total dosages of propofol and remifanil during the 2nd stage of surgery were TEAS vs. Con: 374.7 ± 61.2 vs 421.5 ± 81.9; p < 0.001 and 572.3 ± 82.0 vs. 662 ± 148.2; P < 0.001, respectively. Postoperative rescue analgesics (TEAS vs. Con: 2 vs. 6; P < 0.001) were used less in the TEAS group. TEAS patients reported better POF, MMSE and QoR15 scores than those in the Con group during most of the assessment period. ConclusionsIntraoperative TEAS decreased the severity of POF, reduced intraoperative anesthetic requirements and facilitated post-DBS recovery in this group of PD patients.

Facial expressions and identities recognition in Parkinson disease

Parkinson's Disease (PD) is associated with motor and non-motor symptoms. Among the latter are deficits in matching, identification, and recognition of emotional facial expressions. On one hand, this deficit has been attributed to a dysfunction in emotion processing. Another explanation (which does not exclude the former) links this deficit with reduced facial expressiveness in these patients, which prevents them from properly understanding or embodying emotions. To disentangle the specific contribution of emotion comprehension and that of facial expression processing in PD's observed deficit with emotions we performed two experiments on non-emotional facial expressions. In Experiment 1, a group of PD patients and a group of Healthy Controls (HC) underwent a task of non-emotional expression recognition in faces of different identity and a task of identity recognition in faces with different expression. No differences were observed between the two groups in accuracies. In Experiment 2, PD patients and Healthy Controls underwent a task where they had to recognize the identity of faces encoded through a non-emotional facial expression, through a rigid head movement, or as neutral. Again, no group differences were observed. In none of the two experiments hypomimia scores had a specific effect on expression processing. We conclude that in PD patients the observed impairment with emotional expressions is likely due to a specific deficit for emotions to a greater extent than for facial expressivity processing.

The Analysis of relation to brain iron deposition of Parkinson’s Disease using Quantitative Susceptibility Mapping

Objectives: This study aimed to investigate the levels of brain iron deposition in Parkinson's disease (PD) patients using Quantitative Susceptibility Mapping (QSM) and to determine whether distinctions compared to the general population exist. Furthermore, we examined potential variations in iron deposition among different PD subtypes.Methods: Structural brain imaging was conducted on 75 participants at Gangdong Kyung Hee University Hospital between August 2017 and May 2020. PD patients were categorized into Tremor Dominant (TD) and Postural Instability and Gait Difficulty (PIGD) subtypes. Voxel-based morphometry and QSM were employed to compare voxel-wise magnetic susceptibility across the entire brain between Normal Controls (NC) and PD groups. Subsequently, QSM values were compared between TD and PIGD groups.Results: QSM values were compared among 46 PD patients and 23 normal controls, as well as between TD (n=22) and PIGD (n=24) groups. Voxel-based QSM analysis revealed no significant differences between groups. Similarly, ROI-based QSM analysis showed no significant distinctions.Conclusions: No significant variations were observed between the PD patient group, NC group, or PD subtypes. This study systematically compared QSM values across a broad range of brain regions potentially linked to PD pathology. Additionally, the subdivision of the PD group into TD and PIGD subtypes for QSM-based iron deposition analysis represents a meaningful and innovative approach.

Aberrations in temporal dynamics of cognitive processing induced by Parkinson’s disease and Levodopa

The motor symptoms of Parkinson's disease (PD) have been shown to significantly improve by Levodopa. However, despite the widespread adoption of Levodopa as a standard pharmaceutical drug for the treatment of PD, cognitive impairments linked to PD do not show visible improvement with Levodopa treatment. Furthermore, the neuronal and network mechanisms behind the PD-induced cognitive impairments are not clearly understood. In this work, we aim to explain these cognitive impairments, as well as the ones exacerbated by Levodopa, through examining the differential dynamic patterns of the phase-amplitude coupling (PAC) during cognitive functions. EEG data recorded in an auditory oddball task performed by a cohort consisting of controls and a group of PD patients during both on and off periods of Levodopa treatment were analyzed to derive the temporal dynamics of the PAC across the brain. We observed distinguishing patterns in the PAC dynamics, as an indicator of information binding, which can explain the slower cognitive processing associated with PD in the form of a latency in the PAC peak time. Thus, considering the high-level connections between the hippocampus, the posterior and prefrontal cortices established through the dorsal and ventral striatum acting as a modulatory system, we posit that the primary issue with cognitive impairments of PD, as well as Levodopa’s cognitive deficit side effects, can be attributed to the changes in temporal dynamics of dopamine release influencing the modulatory function of the striatum.

Stereotactic Staged Asymmetric Bilateral Radiofrequency Lesioning for Parkinson’s Disease

Introduction: Parkinson’s disease (PD) is one of the most common neurodegenerative progressive disorders. Despite the dominance of neurostimulation technology, stereotactic lesioning operations play a significant role in the treatment of PD. The aim of the study was to evaluate the effectiveness and safety of staged bilateral asymmetric radiofrequency (RF) stereotactic lesioning in a highly selected group of PD patients. Material and Methods: A retrospective review of 418 consecutive patients undergoing stereotactic ablation for advanced PD at our institution revealed 28 patients who underwent staged asymmetric bilateral ablation. In this subset, after initial RF thalamotomy, contralateral pallidotomy was performed in 16 (57.1%) patients (group Vim-GPi), and contralateral lesion of the subthalamic nucleus (STN) was performed in 12 (32.9%) patients (group Vim-STN). The mean duration of disease before the first surgery was 9.9 ± 0.8 years. The mean interval between the two operations was 3.5 ± 0.4 years (range, 1–10 years); in the Vim-GPi group, it was 3.1 ± 0.4 years; and in the Vim-STN group, it was 4.3 ± 0.1 years. After the second operation, the long-term follow-up lasted from 1 to 8 years (mean 4.8 ± 0.5 years). All patients were evaluated 1 year after the second operation. Results: One year after staged bilateral lesioning, the mean tremor score improved from baseline, prior to the first operation, from 19.8 to 3.8 (improvement of 81%), the overall mean rigidity score improved from 11.0 to 3.7 (improvement of 66%), and hypokinesia improved from 14.8 to 8.9 (improvement of 40%). One year after staged bilateral lesioning, the total UPDRS score improved in the Vim-GPi group by 47% in the OFF and 45.9% in the ON states. In the Vim-STN group, the total UPDRS score improved from baseline, prior to the first operation, by 44.8% in the OFF and 51.6% in the ON states. Overall, levodopa dose was reduced by 43.4%. Neurological complications were observed in 4 (14.3%) cases; among them, 1 (3.6%) patient had permanent events related to local ischemia after pallidotomy. Conclusion: Staged asymmetric bilateral stereotactic RF lesioning can be a safe and effective method in highly selected patients with advanced PD, particularly where deep brain stimulation is not available or desirable. Careful identification and selection of patients for ablative surgery allow achieving optimal results in the treatment of PD with bilateral symptoms.

Sexual dysfunction in a sample of Egyptian patients with Parkinson’s disease

BackgroundSexual dysfunction (SD) is a common, yet underdiagnosed problem in Parkinson Disease (PD) patients. It can negatively impact their quality of life (QoL) and clinical outcome. we tried to assess SD in a group of Egyptian PD patients.MethodsThe study is a case–control, cross-sectional study that included 200 participants, consisting of 100 PD patients and 100 matched healthy controls. Social, demographic information, and clinical variables were collected from both groups. Sexual functions were assessed using the Arabic Female Sexual Function Index (ArFSFI), and the Arabic version of International Index of Erectile Function (IIEF).ResultsWomen with PD scored worse on FSFI total score compared to controls (p < 0.001). Regarding the FSFI domains, they scored significantly lower in individual domains of desire (p < 0.001), arousal (p < 0.001), lubrication (p = 0.006), orgasm (p < 0.001), satisfaction (p < 0.001), and pain (p = 0.003), compared with controls. Men with PD scored worse on IIEF total scores compared to controls (p < 0.001). They showed significantly worse scores of erectile functions (p < 0.001), orgasmic function (p < 0.001), sexual desire (p < 0.001), intercourse satisfaction (p < 0.001), and overall satisfaction (p < 0.001). Both groups reported significant effect of SD on their QoL. There was a significant correlation between disease severity and SD.ConclusionSD is common in PD patients. It negatively impacts their QoL and partnership. Healthcare professionals should initiate conversations about SD with the patients and provide appropriate education and treatment options.

Impulse Control Disorders in the Polish Population of Patients with Parkinson's Disease.

Background and Objectives: Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the world. It is characterized by the presence of not only typical motor symptoms but also several less known and aware non-motor symptoms (NMS). The group of disorders included in the NMS is Impulse Control Disorders (ICDs). ICDs are a group of disorders in which patients are unable to resist temptations and feel a strong, pressing desire for specific activities such as gambling, hypersexuality, binge eating, and compulsive buying. The occurrence of ICDs is believed to be associated primarily with dopaminergic treatment, with the use of dopamine agonists (DA), and to a lesser extent with high doses of L-dopa. The aim of our study was to develop a profile of Polish ICDs patients and assess the frequency of occurrence of ICDs, as well as determine the risk factors associated with these disorders against the background of the PD population from other countries. Materials and Methods: Our prospective study included 135 patients with idiopathic PD who were hospitalized between 2020 and 2022 at the Neurological Department of University Central Hospital in Katowice. In the assessment of ICDs, we used the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Other scales with which we assessed patients with PD were as follows: MDS-UPDRS part III and modified Hoehn-Yahr staging. Clinical data on age, gender, disease duration and onset, motor complications, and medications were collected from electronic records. Results: ICDs were detected in 27.41% of PD patients (binge eating in 12.59%, hypersexuality in 11.11%, compulsive buying in 10.37%, and pathological gambling occurred in only 5.19% of patients. In total, 8.89% had two or more ICDs). The major finding was that ICDs were more common in patients taking DA than in those who did not use medication from this group (83.78% vs. 54.07%, respectively; p = 0.0015). Patients with ICDs had longer disease duration, the presence of motor complications, and sleep disorders. An important finding was also a very low detection of ICDs in a routine medical examination; only 13.51% of all patients with ICDs had a positive medical history of this disorder. Conclusions: ICDs are relatively common in the population of Polish PD patients. The risk factors for developing ICDs include longer duration of the disease, presence of motor complications, sleep disorders, and use of DA and L-dopa. Due to the low detectability of ICDs in routine medical history, it is essential for physicians to pay more attention to the possibility of the occurrence of these symptoms, especially in patients with several risk factors. Further prospective studies on a larger group of PD patients are needed to establish a full profile of Polish PD patients with ICDs.

Epworth sleepiness scale is associated with increased striatal dopamine uptake in Parkinson's disease: a cross-sectional study.

A cross-sectional study was designed to investigate the possible association between Epworth sleepiness scale (ESS) scores and striatal dopamine uptake in the early stages of Parkinson's disease (PD). Two groups of PD patients (n = 464) and healthy controls (HC) (n = 162) were enrolled in the current study from the Parkinson's progression markers initiative cohort ( https://www.ppmi-info.org ). All the subjects were evaluated for excessive daytime sleepiness (EDS) using the ESS. They also completed specific measures to be assessed for motor and non-motor symptoms, including cognitive, gait, autonomic, and olfactory dysfunction. Dopamine transporter (DaT) scans were used to identify dopamine transporter impairments. Spatial normalization for DaTscan imaging of participants was performed to reach consistent orientation. A significant correlation was found between ESS score and right putamen (P < 0.001; correlation coefficient = 0.186) and left putamen (P = 0.003; correlation coefficient = 0.139) dopamine uptake in PD patients. The same results were revealed after adjusted Pearson's correlation for the effects of handedness, age, gender, and education. No significant correlation was found between the ESS score and the amount of caudate nucleus dopamine uptake in PD patients. Moreover, there was a significant association between caudate nucleus dopamine uptake and ESS score in neither PD patients nor HCs. The results of our study suggest that increased dopaminergic function of putamen nuclei may be associated with ESS scores in the early stages of PD. Further studies are needed at different PD stages and evaluate PD progression as a possible confounder.

Altered Functional Connectivity of the Subthalamic Nucleus in Parkinson's Disease: Focus on Candidates for Deep Brain Stimulation.

The hypothesis that the effectiveness of deep brain stimulation (DBS) in Parkinson's disease (PD) would be related to connectivity dysfunctions between the site of stimulation and other brain regions is growing. To investigate how the subthalamic nucleus (STN), the most frequently used DBS target for PD, is functionally linked to other brain regions in PD patients according to DBS eligibility. Clinical data and resting-state functional MRI were acquired from 60 PD patients and 60 age- and sex-matched healthy subjects within an ongoing longitudinal project. PD patients were divided into 19 patients eligible for DBS and 41 non-candidates. Bilateral STN were selected as regions of interest and a seed-based functional MRI connectivity analysis was performed. A decreased functional connectivity between STN and sensorimotor cortex in both PD patient groups compared to controls was found. Whereas an increased functional connectivity between STN and thalamus was found in PD patient groups relative to controls. Candidates for DBS showed a decreased functional connectivity between bilateral STN and bilateral sensorimotor areas relative to non-candidates. In patients eligible for DBS, a weaker STN functional connectivity with left supramarginal and angular gyri was related with a more severe rigidity and bradykinesia whereas a higher connectivity between STN and cerebellum/pons was related to poorer tremor score. Our results suggest that functional connectivity of STN varies among PD patients eligible or not for DBS. Future studies would confirm whether DBS modulates and restores functional connectivity between STN and sensorimotor areas in treated patients.

Environmental and genetic risk factors for Parkinson’s disease

Aim. To analyze risk factors in the group of patients with Parkinson’s disease (PD) and compare them with the literature data.Materials and methods. The study included 439 patients with PD and 354 controls, comparable by gender and age. For each individual, a registration card was filled in containing demographic, epidemiological, clinical, and neuropsychological data. The severity of the disease was studied according to the MDS-UPDRS scale; the stage of PD was determined according to the Hoehn and Yahr scale. Cognitive functions were assessed by the MoCA test and MMSE. The length of the (CAG)n repeat region in the HTT gene was determined using fragment analysis on the ABI 3730 DNA analyzer. The obtained results were analyzed using GeneMapper Software v4.1 (Applied Biosystems, USA).Results. When comparing patients with PD and the control group, the odds ratio (OR) for PD in individuals with traumatic brain injury was 3.13 (95% confidence interval (CI): 2,27–4.34; p = 4.94 × 10–13), which showed the significance of this risk factor for PD. Consumption of coffee in the anamnesis distinguished the group of PD patients from the control group (OR = 0.41 (95% CI: 0.30–0.56); p &lt; 0.0001), confirming its neuroprotective effect. Analysis of the variability in the length of the (CAG)n repeat regions in the HTT gene showed that patients whose genotype contained an allele with 17 repeats in combination with any allele other than an allele containing 18 repeats had a protective effect (OR = 0.50 (95% CI: 0.27–0.92); p = 0.025). All genotypes containing an allele with 18 repeats were predisposed to PD (OR = 2.57 (95% CI: 1.66–4.28); p = 0.007). The predisposing effect of the allele to PD, unrelated to the expansion of CAG repeats in the HTT gene, was revealed for the first time.Conclusion. Traumatic brain injury and the allele with 18 CAG repeats in the HTT gene are risk factors for PD. Coffee consumption can be attributed to protective factors in relation to PD.

Striatal Subregion Analysis Associated with REM Sleep Behavior Disorder in Parkinson's Disease.

REM sleep behavior disorder (RBD) in Parkinson's disease (PD) is associated with characteristic clinical subtypes and prognosis. In addition, nigrostriatal pathway, the most vulnerable anatomical area in PD, formed neuronal network interplaying with cortical and subcortical structures, and which may cause PD clinical phenotype. We evaluated the regional selectivity of presynaptic striatal dopaminergic denervation associated with RBD in PD. We compared two groups (n = 16) of PD patients with and without RBD in terms of specific binding ratios (SBR) in subregions of the striatum, which were measured using positron emission tomography with 18F-FP-CIT. SBRs of the anterior and posterior caudate, ventral striatum, and posterior and ventral putamen regions were measured in more or less affected side, and right or left side, or bilateral sum of the striatum. Age, disease duration, and severity of parkinsonism were not significantly different between groups. Although group differences in all areas were not significant with multiple comparison corrections, SBR of the ventral striatum and anterior caudate in sum of both sides was significantly less in the RBD than in the non-RBD group without correction (p < 0.05). In the right anterior caudate and left ventral striatum, SBR was also lower in the RBD than in the non-RBD group without correction (p < 0.05). Attention function was impaired in the RBD group compared with the non-RBD group (p < 0.05). However, these statistical significances were not definite after correction of multiple comparisons (p > 0.05). There is a possibility that RBD in early PD may be associated with presynaptic dopaminergic denervation in the ventral striatum and anterior caudate, which may explain decreased attention in our RBD group. RBD in PD may imply a distinct pathological progression. However, further study using large numbers of participants or longitudinal observation is necessary for the statistical conclusion because of small sample size.

Life events and the onset of motor symptoms in Parkinson's disease

BackgroundWhether there may be any relationship between stressful or traumatic life events (LE) and the subsequent motor symptoms onset in Parkinson's disease (PD) is still controversial. ObjectivesTo explore whether a subjectively perceived as stressful or traumatic LE were more frequently present in a group of recent motor onset parkinsonian patients (Recent Onset Parkinsonism - ROP) compared with healthy controls (HC) and a group of patients already diagnosed as PD. MethodsA consecutive series of 139 ROP patients, 138 matched PD patients and 138 HC were pooled through a validated LE exposure questionnaire evaluating the number of patients affected by LE and the amount of LE per group occurred in the last year, segregating by subjective severity in total and severe LE. ResultsThere was no significant difference in the percentage of patients affected by total (p = 0.134) nor by severe (p = 0.133) LE within the 3 groups. No significant difference was observed in the number of total LE between ROP and HC (p = 0.063), ROP and PD (p = 0.688), nor in severe LE (ROP vs. HC, p = 0.637. ROP vs. PD, p = 0.500). ConclusionsDuring the year of parkinsonian motor symptoms onset, the number of ROP patients exposed to total or severe LE or the amount of total or severe LE suffered by ROP were not significantly different to the group of PD patients or HC. A casual relationship between LE and the onset of motor symptoms in parkinsonian patients may be suggested.