PD Symptoms Research Articles

Efficiency of Vortioxetine in Depressive Symptoms in Parkinson’s Disease

IntroductionParkinson’s disease (PD) is the most common serious movement disorder in the world, affecting about 1% of adults older than 60 years. The disease is attributed to selective loss of neurons in the substantia nigra, and its cause is enigmatic in most individuals. Patients with PD display both motor and non-motor symptoms. For some patients, the non-motor symptoms are more bothersome than the motor symptoms. One of the most common non-motor symptoms of PD is depression.ObjectivesTreatment of depression with antidepressant drugs is well established. In the last 20 years use of antidepressant has risen mainly due to the introduction of the selective serotonin reuptake inhibitors (SSRIs). Our primary aim was to demonstrate an improvement in depressive symptoms in patients who started treatment with vortioxetine. A secondary aim was to show those who was successfully treated with vortioxetine but was unresponsive to paroxetine and escitalopram without worsening the extrapyramidal symptoms of PD.MethodsIn collaboration with the Department of Neurology, we included patients who are being treated for Parkinson’s disease and who meet the criteria for depressive disorder after a psychiatric examination. We divided the patients into two groups: those who had not previously taken any antidepressant drugs and those who were already on therapy with paroxetine and escitalopram but without the expected therapeutic response. All patients were prescribed vortioxetine in their treatment, and the Hamilton Depression Rating Scale (HDRS) was determined during their first meeting with the psychiatrist, and then again after 6 weeks of taking the medication. Also, we used Mini mental state examination (MMSE) to measure cognitive impairment.Our primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)ResultsOur primary outcome measure was the number of patients in each treatment group who responded to treatment. Response was defined as the proportion of patients who had a reduction of at least 50% from the baseline score on the Hamilton Depression Rating Scale (HDRS)ConclusionsIn our research, vortioxetine has proven to be effective in treating depressive symptoms without worsening Parkinson’s disease, unlike paroxetine and escitalopram, which resulted in partial effects.Disclosure of InterestNone Declared

The relationship between objective and subjective executive function in Parkinson’s disease

ABSTRACT Introduction Difficulties in executive functioning (EF) are common in PD; however, the relationship between subjective and objective EF is unclear. Understanding this relationship could help guide clinical EF assessment. This study examined the relationship between subjective self-reported EF (SEF) and objective EF (OEF) and predictors of SEF-OEF discrepancies in PD. Method One-hundred and sixteen non-demented PD participants completed measures of OEF (i.e. problem-solving, cognitive flexibility, inhibition, and working memory) and SEF (Frontal Systems Behavior Scale-Self Executive Dysfunction Subscale). Pearson bivariate correlations and linear regressions were performed to examine the relationship between SEF and OEF and the non-motor symptoms (e.g. mood, fatigue), demographic, and PD characteristic (e.g. MCI status) predictors of discrepancies between OEF and SEF (|OEF minus SEF scores|). Correlates of under-, over-, and accurate-reporting were also explored. Results Greater SEF complaints and worse OEF were significantly associated (β =.200, p = .009) and 64% of participants accurately identified their level of OEF abilities. Fewer years of education and greater symptoms of depression, anxiety, and fatigue significantly correlated with greater discrepancies between OEF and SEF. Fatigue was the best predictor of EF discrepancy in the overall sample (β = .281, p = .022). Exploratory analyses revealed apathy and fatigue associated with greater under-reporting, while anxiety associated with greater over-reporting. Conclusions SEF and OEF are significantly related in PD. Approximately 64% of non-demented persons with PD accurately reported their EF skill level, while 28% under-reported and 8% over-reported. SEF-OEF discrepancies were predicted by fatigue in the overall sample. Preliminary evidence suggests reduced apathy and fatigue symptoms relate to more under-reporting, while anxiety relates to greater over-reporting. Given the prevalence of these non-motor symptoms in PD, it is important to carefully consider them when assessing EF in PD.

Black Phosphorus Microbubbles Combined with Ultrasound for Treating Parkinson's Disease

AbstractParkinson's disease (PD) is a common chronic central nervous system disorder that reduces quality of life and increases mortality. Currently, the treatment of PD is limited due to the challenge of macromolecular drugs crossing the blood‐brain barrier (BBB). Black phosphorus (BP) has antioxidant and anti‐inflammatory effects and shows potential for neuroprotection. To solve the restriction of the BBB, innovative BP microbubbles (BP@MBs) combined with focused ultrasound (FUS) are constructed to facilitate BBB opening. Additionally, the biocompatibility and safety of BP@MBs with varying dimensions are investigated, including BP quantum dot microbubbles (BPQDs@MBs) and BP nanosheet microbubbles (BPNSs@MBs). The findings indicate that low concentrations of BP have good biosafety and that BPQDs@MBs exhibit better biocompatibility than BPNSs@MBs both in vitro and in vivo at the same concentrations. Moreover, a 6‐hydroxydopamine (6‐OHDA)‐induced PD cell model and an animal model are established to verify the anti‐PD effects of BPQDs@MBs and BPNSs@MBs. The results confirmed that BPQDs@MBs and BPNSs@MBs have antioxidant effects that reduced neuronal apoptosis and improved the motor symptoms of PD in rats. BPQDs@MBs combined with FUS may be a promising option for the clinical treatment of PD.

Efficacy of acupuncture (Jin’s three-needle) on motor symptoms and anxiety in patients with Parkinson’s disease: protocol for a multicentre, randomised, assessor-blinded clinical trial

IntroductionParkinson’s disease (PD) has a significant impact on a substantial number of individuals in China. Notably, 31% of patients with PD also grapple with the additional burden of anxiety. This...

Asiaticoside exerts neuroprotection through targeting NLRP3 inflammasome activation

BackgroundParkinson's disease (PD), a neurodegenerative disorder, is characterized by motor symptoms due to the progressive loss of dopaminergic neurons in the substantia nigra (SN) and striatum (STR), alongside neuroinflammation. Asiaticoside (AS), a primary active component with anti-inflammatory and neuroprotective properties, is derived from Centella asiatica. However, the precise mechanisms through which AS influences PD associated with inflammation are not yet fully understood. PurposeThis study aimed to explore the protective mechanism of AS in PD. MethodsTargets associated with AS and PD were identified from the Swiss Target Prediction, Similarity Ensemble Approach, PharmMapper, and GeneCards database. A protein-protein interaction (PPI) network was constructed to identify potential therapeutic targets. Concurrently, GO and KEGG analyses were performed to predict potential signaling pathways. To validate these mechanisms, the effects of AS on 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD in mice were investigated. Furthermore, neuroinflammation and the activation of the NLRP3 inflammasome were assessed to confirm the anti-inflammatory properties of AS. In vitro experiments in BV2 cells were then performed to investigate the mechanisms of AS in PD. Moreover, CETSA, molecular docking, and molecular dynamics simulations (MDs) were performed for further validation. ResultsNetwork pharmacology analysis identified 17 potential targets affected by AS in PD. GO and KEGG analyses suggested the biological roles of these targets, demonstrating that AS interacts with 149 pathways in PD. Notably, the NOD-like receptor signaling pathway was identified as a key pathway mediating AS's effect on PD. In vivo studies demonstrated that AS alleviated motor dysfunction and reduced the loss of dopaminergic neurons in MPTP-induced PD mice. In vitro experiments demonstrated that AS substantially decreased IL-1β release in BV2 cells, attributing this to the modulation of the NLRP3 signaling pathway. CETSA and molecular docking studies indicated that AS forms a stable complex with NLRP3. MDs suggested that ARG578 played an important role in the formation of the complex. ConclusionIn this study, we first predicted that the potential target and pathway of AS's effect on PD could be NLRP3 protein and NOD-like receptor signaling pathway by network pharmacology analysis. Further, we demonstrated that AS could alleviate symptoms of PD induced by MPTP through its interaction with the NLRP3 protein for the first time by in vivo and in vitro experiments. By binding to NLRP3, AS effectively inhibits the assembly and activation of the inflammasome. These findings suggest that AS is a promising inhibitor for PD driven by NLRP3 overactivation.

Role of zonisamide in advanced Parkinson’s disease: a randomized placebo-controlled study

BackgroundZonisamide (ZNS) has shown some efficacy in motor symptoms of PD; however, more evidence is lacking, and its effects on nonmotor symptoms (NMSs) and quality of life (QoL) remain to be investigated. This randomized double-blinded placebo-controlled crossover study investigated the effect of ZNS on motor and NMS symptoms and QoL in advanced PD.MethodsPD patients with Hoehn and Yahr stage ≥ 2 (“On” state) and at least 2 h off time daily were randomized to groups: ZNS 25 mg, ZNS 50 mg and placebo. Groups were assessed at baseline and at the 1- and 3-month follow-ups. The primary endpoint was the change in the total MDS-UPDRS III “On”, while the secondary endpoint was the change in the total and parts I and IV MDS-UPDRS, Nonmotor Symptoms Scale and Parkinson’s disease questionnaire-39 at the final assessment.ResultsSixty-nine patients were assessed for efficacy at the 1-month follow-up, and 58 patients were assessed at the 3-month follow-up. The primary endpoint showed significant improvement in the ZNS 25 mg group compared to the placebo group (p = 0.009). At the final assessment, the ZNS 25 mg group showed significant improvement of total and part VI MDS-UPDRS, bradykinesia, tremor and functional impact of fluctuations compared to placebo. There was no change in dyskinesia, NMSs, QoL or side effects except for sedation.ConclusionZNS has a favourable effect on motor symptoms in patients with wearing off as adjunctive therapy with other dopaminergic drugs, with no exacerbation of dyskinesia and a limited impact on NMSs and QoL.Trial registrationClinicaltrials.gov, NCT04182399, in 24/11/2019.

A neuromechanical model characterizing the motor planning and posture control in the voluntary lean in Parkinson’s disease

Parkinson’s disease targets patients’ cognitive and motor abilities, including postural control. Many studies have been carried out to introduce mathematical models for a better understanding of postural control in such patients and the relation between the model parameters and the clinical assessments. So far, these studies have addressed this connection merely in static tests, such as quiet stance. The aim of this study is to develop a model for voluntary lean, and as such, identify the model parameters for both PD patients and healthy subjects from experimental data. The proposed model comprises planning and control sections. The model parameters for the planning section were extracted from the time response characteristics. Parameters for the control section were identified based on the spatial characteristics of the center-of-pressure (COP) response using an optimization process. 24 PD patients along with 24 matched healthy subjects participated in the study. The results showed a significant difference between the two groups in terms of temporal parameters for the planning section. This difference emphasizes bradykinesia as an essential symptom of PD. Also, differences were found for the postural control section. In all directions, the proportional gain of the feedback controller was significantly larger in PD patients; however, the gain of the feedforward controller was significantly smaller in PD patients. Furthermore, the control gains were strongly correlated with the clinical scales (Functional Reach Test and Unified Parkinson's Disease Rating Scale) in certain directions. In conclusion, the new model helps to better understand and quantify some PD symptoms in voluntary lean tasks.

Supervised learning for automatic emotion recognition in Parkinson’s disease through smartwatch signals

People with Parkinson’s Disease (PwPD) usually experience several neuropsychiatric signs such as anxiety, depression, and negative emotions that contribute to disability and worsening of quality of life. Notwithstanding, the assessment of these symptoms are largely underrated, subjective and difficult due to a large overlapping with other PD symptoms, like hypomimia and bradikinesia. The aim and novelty of the current work is to study and validate a method for automatic emotion recognition in PwPD during daily living through autonomic signals acquired by acceptable and low-cost consumer technology. The best shallow learning algorithm and the best minimal feature set are individuated. 11 PwPD and 8 subjects with no history of neurological injury or illness were enrolled in the study. Participants were asked to watch video clips purposely selected to arouse emotions, and annotate arousal and valence of emotions triggered by video clips, while their heart rate, skin conductance, and temperature were recorded by a smartwatch. Smartwatch data was used for features extraction, while participants’ reported arousal and valence were used as gold-standard to train machine learning algorithms for emotion classification (low/high arousal, positive/negative valence). Different feature sets and different algorithms (i.e. decision tree (DT), random forest (RF), support vector machine (SVM), and multilayer perceptron (MLP)) were evaluated to find the best solution for each group of participant. In each group of participants, it was possible to find a combination of feature set and algorithm to reach a classification accuracy greater than 90%. The Random Forest reached the best performance in both groups and for both valence and arousal. For each classification task (valence or arousal, PwPD or controls), the best model was selected and the minimal feature set was found by performing a recursive feature elimination based on the Shapley value. A lower accuracy of appraisal emerged for arousal compared to valence. Obtained results showed the feasibility of automatic emotion recognition in PwPDs through autonomic signals. Autonomic dysfunction in PwPDs may explain the lower arousal accuracy. The findings warrant confirmation from trials on larger samples and there are open issues to be deepened in future work.

(278) Peyronie's Disease Among Men Who Have Sex With Men: Perceptions, Characteristics, and Psychosocial factors

Abstract Introduction Peyronie’s Disease (PD) is a condition characterized by the development of fibrous scar tissue causing penile curvature and often painful erections. From a sexual health perspective, PD is commonly researched in heterosexual men; however, there is a paucity of data assessing the impact that PD has on men who have sex with men (MSM) population. Objective This prospective survey study sought to collect data on how PD affects MSM from a biopsychosocial and sexual perspective and compare this population’s experience with non-MSM. Methods An anonymous online survey was deemed IRB exempt and administered to the following online platforms: Reddit to include r/PeyroniesSupport, r/lgbtstudies, r/sex, and on Facebook to the Peyronie’s Disease Support group in July 2023. Participants were asked demographic info, sexual orientation, type of sexual intercourse, family history of PD, history of trauma, immune disease, PD symptoms, partner and self-bother, degree of curvature, care seeking, medical interventions, impact on mental health, disease progression, as well as the Peyronie’s Disease Questionnaire (PDQ) survey. Descriptive statistics were performed. Results Thirty-six men completed the survey, nine being MSM (11.8% “men and others” and 14.7% “strictly men"). Reported sexual interactions included anal (50%), vaginal (77%), and oral (79%) intercourse. History of penile trauma occurred in 32% of respondents. None of the respondents reported a family history of PD, and two subjects disclosed autoimmune diseases. The most common symptoms, experienced by 91% of subjects, were “shortening and/or narrowing of the penis,” followed by: erectile dysfunction (69%), difficulty with sexual intercourse (44%), painful erections (31%), and painful sexual intercourse or masturbation (28%). 85% of surveyed men and 100% of MSM stated PD negatively impacts their mental health. Assessment of partner satisfaction revealed women express greater disapproval (12%) compared to men (3%). The majority of men (91%) reported seeing a urologist with only 35% seeing one regularly and 50% being MSM. A negative experience with a urologist was reported in 40% of MSM and 20% of non-MSM. Degrees of reported curvature were: 77% with less than or equal to 45 degrees, 6% between 46-60 degrees, and 18% between 61-90 degrees. Greater than 60% and 27% were offered medical and surgical interventions, respectfully. 62% reported their PD has remained stable. Conclusions In conclusion, the results of this survey suggest that PD may have a greater negative effect on mental health and experience with a urologist for MSM. However, non-MSM are more likely to experience partner disapproval. Overall, the characteristics of PD do not grossly vary between MSM and non-MSM but the psychosocial aspect may possess greater consequences for MSM. More data is needed on this understudied population affected by PD. Disclosure No.

Gender gap in deep brain stimulation for Parkinson’s disease: preliminary results of a retrospective study

Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment of PD for both women and men. However, discussions have been reported about the impact of STN-DBS surgery in PD. The aim of our study is to identify differences between men and women in terms of pre- and post-DBS symptoms and try to explain the possible causes. In the current study, we evaluated the gender impact on STN-DBS in PD at the Department of Neurosurgery of University of Naples “Federico II” from 2013 to 2021. Motor and non-motor symptoms were evaluated. To compare the data before and after surgery and between the genders, Wilcoxon-Mann–Whitney tests were performed. A total of 43 patients with PD were included; of them, 17 (39%) were female. Baseline evaluation revealed no gender differences in the age of onset (p = 0.87). Not significant differences were noted in the Unified Parkinson’s Disease Rating Scale (UPDRS) pre-surgery score, but if we consider UPDRS subscores of motor examination, significant clinical improvement was reported in both male and female in terms of UPDRS pre- and post-surgery (p < 0.001). STN-DBS is a highly effective treatment for motor and non-motor symptoms of PD for both women and men but our study hints towards gender-specific outcomes in motor domains. Improving our knowledge in this field can allow us to implement strategies to identify new directions in the development of an adequate treatment of PD in terms of surgical intervention and in consideration of the gender.

Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative.

There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed. To evaluate feasibility, acceptability and safety of Home Based Care. We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews. Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment. We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.

Pose-based tremor type and level analysis for Parkinson's disease from video.

Current methods for diagnosis of PD rely on clinical examination. The accuracy of diagnosis ranges between 73 and 84%, and is influenced by the experience of the clinical assessor. Hence, an automatic, effective and interpretable supporting system for PD symptom identification would support clinicians in making more robust PD diagnostic decisions. We propose to analyze Parkinson's tremor (PT) to support the analysis of PD, since PT is one of the most typical symptoms of PD with broad generalizability. To realize the idea, we present SPA-PTA, a deep learning-based PT classification and severity estimation system that takes consumer-grade videos of front-facing humans as input. The core of the system is a novel attention module with a lightweight pyramidal channel-squeezing-fusion architecture that effectively extracts relevant PT information and filters noise. It enhances modeling performance while improving system interpretability. We validate our system via individual-based leave-one-out cross-validation on two tasks: the PT classification task and the tremor severity rating estimation task. Our system presents a 91.3% accuracy and 80.0% F1-score in classifying PT with non-PT class, while providing a 76.4% accuracy and 76.7% F1-score in more complex multiclass tremor rating classification task. Our system offers a cost-effective PT classification and tremor severity estimation results as warning signs of PD for undiagnosed patients with PT symptoms. In addition, it provides a potential solution for supporting PD diagnosis in regions with limited clinical resources.

Terpene-augmented novasomal gels for the sustainment of rasagiline mesylate delivery; A new approach for treating Parkinson's disease induced by rotenone in rats

Rasagiline mesylate (RSM) is a potent anti-Parkinson's Disease (PD) drug; nevertheless, it has limited oral bioavailability due to hepatic first pass metabolism. RSM is a highly hydrophilic drug hurdled by several barriers to reach the central nervous system (CNS). This study aimed to prepare RSM-loaded novasomal gels for the transdermal delivery of the drug to CNS. Novasomes were prepared by ethanol injection method using terpenes as penetration enhancers. Design Expert® software was applied to select the optimum formulation by varying the type of terpene, amount of cholesterol, besides surface active agents (SAA): free fatty acid (FFA) ratio. The desirability calculations revealed that the optimum formulation composed of cholesterol (60 mg), SAA:FFA ratio (1:1) in the presence of eugenol. Particle size, zeta potential and entrapment efficiency of the optimum formulation were 265.90 ± 2.40 nm, −33.45 ± 0.49 mV and 83.09 ± 0.42%, respectively. TEM showed spherical well-defined nanovesicles. The optimum novasomal formulation was incorporated into gel system composed of 2% HPMC and 2% CMC. In vivo study revealed the feasibility of reversing PD symptoms regarding the behavioral, biochemical and histopathological analyses in rotenone-induced Parkinsons' rat model. A marked elevation in the number of crossovers, grooming score, frequency of rearing, gripe strength, and dopamine level besides a reduction in interleukin-17 and NLRP-3 inflammasome level when compared to positive control group were detected. No histopathological alterations were detected in examined brain sections of treated rats. In conclusion, the obtained results suggest that RSM-loaded novasomal gel formulations are promising carriers for the transdermal delivery of hydrophilic drugs like RSM.

Sexual dysfunction in men with young onset Parkinson's disease.

Sexual dysfunction (SD) is a common, yet under-reported non-motor symptom of PD. Common sexual symptoms among male PD patients include erectile dysfunction, premature ejaculation, and decreased sexual desire. Few research papers have examined sexual dysfunction in PD, especially in YOPD male patients, and there is no Indian research study on sexual dysfunction in YOPD. In this study, we determined the frequency of sexual dysfunction in men with YOPD, and its correlation with other motor and NMS. This prospective cross-sectional study was conducted on YOPD males who presented to the Department of Neurology, NIMHANS, Bangalore, India, from May 2021 to April 2023. The diagnosis of YOPD was made based on MDS criteria for IPD 2015. Sexual functions were evaluated by ASEX, PEDT, QUIP-RS, and sex hormone assay. The patients also underwent other motor and non-motor assessments. Statistical analysis was done using SPSS version 22.0. The study was funded by the PDMD fund. This study included 62 male YOPD patients. The mean age of cases was 44.74 ± 8.54years. The mean duration of symptoms was 8.45 ± 6.23years. 43.5% of the cases of PD were Akinetic rigid type. By ASEX Score grading, 46.8% of the cases had erectile dysfunction and 71% of the cases of YOPD had premature ejaculation by PEDT Score grading. 9.7% of the cases had hypersexuality by QUIP-RS.Duration of YOPD was a better predictor of Erectile Dysfunction and premature ejaculation when compared with other variables. SD was related to anxiety and depression and it had a negative impact on the patient's health-related quality of life (HR-QoL). SD should be investigated and treated as an integral part of the neurological assessment in YOPD.

Clinical prediction of GBA carrier status in Parkinson’s disease

IntroductionGiven the unique natural history of GBA-related Parkinson’s disease (GBA-PD) and the potential for novel treatments in this population, genetic testing prioritization for the identification of GBA-PD patients is crucial for prognostication, individualizing treatment, and stratification for clinical trials. Assessing the predictive value of certain clinical traits for the GBA-variant carrier status will help target genetic testing in clinical settings where cost and access limit its availability. MethodsIn-depth clinical characterization through standardized rating scales for motor and non-motor symptoms and self-reported binomial information of a cohort of subjects with PD (n = 100) from our center and from the larger cohort of the Parkinson’s Progression Marker Initiative (PPMI) was utilized to evaluate the predictive values of clinical traits for GBA variant carrier status. The model was cross-validated across the two cohorts. ResultsLeveraging non-motor symptoms of PD, we established successful discrimination of GBA variants in the PPMI cohort and study cohort (AUC 0.897 and 0.738, respectively). The PPMI cohort model successfully generalized to the study cohort data using both MDS-UPDRS scores and binomial data (AUC 0.740 and 0.734, respectively) while the study cohort model did not. ConclusionsWe assessed the predictive value of non-motor symptoms of PD for identifying GBA carrier status in the general PD population. These data can be used to determine a simple, clinically oriented model using either the MDS-UPDRS or subjective symptom reporting from patients. Our results can inform patient counseling about the expected carrier risk and test prioritization for the expected identification of GBA variants.

Effect of BF839 + earthworm protein supplement on motor and some non-motor symptoms of Parkinson's disease: a randomized clinical trial.

Some studies have found that probiotics have the potential to treat PD, and earthworm protein is a traditional Chinese medicine used for the treatment of PD. The purpose of this study was to evaluate the safety and efficacy of Bacteroides fragilis 839 (BF839) + earthworm protein supplement as an adjunctive therapy for PD and to observe changes in the gut microbiota. Forty-six patients with PD were recruited for a 12-week 1:1 randomized, double-blind, placebo-controlled clinical trial to evaluate changes in motor and some non-motor symptom scores and detect metagenomic changes in the gut microbiota. From baseline to 12 weeks, compared with placebo, the trial group showed significant reductions in the United Parkinson's Disease Rate Scale (UPDRS) total score (-7.74 ± 5.92 vs. -1.83 ± 4.14, p < 0.001), UPDRS part I (-0.72 ± 0.81 vs. -0.20 ± 0.72, p = 0.026), UPDRS part II (-2.50 ± 2.24 vs. -0.22 ± 1.98, p = 0.001), UPDRS part III (-3.43 ± 3.42 vs. -1.33 ± 2.65, p = 0.024), and UPDRS part IV (-1.13 ± 1.19 vs. -0.15 ± 0.57, p = 0.001). Significant reductions in the Hamilton Depression Scale-24 score (-3.91 ± 3.99 vs. +1.15 ± 3.42, p < 0.001), Self-Rating Anxiety Scale scores (-7.04 ± 5.71 vs. -1.23 ± 2.34, p < 0.001), and Constipation scoring system scores (-8.59 ± 4.75 vs. 0.27 ± 1.24, p < 0.001), were also noted. In the trial group, one patient experienced mild eczema and one suffered low blood pressure, which could not be conclusively attributed to supplementation. Compared to the placebo group, the trial group showed a marked increase in Enterococcus faecium and a decrease in Klebsiella. This study is the first to report that probiotics plus earthworm protein can remarkably improve the motor and some non-motor symptoms of PD without serious adverse effects. However, further clinical trials and exploration of the underlying mechanisms are required. Clinical trial registry http://www.chictr.org.cn/, Identification No: ChiCTR2000035122.

Associations between cognitive screening performance and motor symptoms in Parkinson's disease:a systematic review and meta-analysis.

Despite a body of research examining relationships between motor symptoms and cognitive dysfunction in PD, no prior study has undertaken a systematic review of the magnitude of the relationship between motor symptoms and cognitive screening performance in PD. This study was a systematic review and meta-analysis of the relationship between cognitive screening performance, as assessed by the Montreal Cognitive Assessment (MoCA), and motor symptoms of PD. After the systematic screening, 20 studies were included, and meta-regressions using mixed-effects models were conducted. Motor symptoms across included studies were relatively mild, but average MoCA scores were at the established cutoff for risk of dementia in PD. The average disease duration was 5 years. Consistent with hypotheses, more severe motor symptoms were associated with lower MoCA scores (r=-0.22 (95%CI -0.29 to -0.16), p<0.001), indicating worse cognitive functioning. The results indicate a significant negative correlation between MoCA performance and motor symptoms of PD. Average MoCA scores captured early disease-stage cognitive impairment when motor symptoms remained relatively mild. Serial screening for cognitive impairment beginning early in the disease course may be of benefit to ensure that cognitive dysfunction is detected as it arises.

Type-2 diabetes prevalence and severity of Parkinson&amp;apos;s disease at a tertiary hospital

Objective: To study the prevalence of type-2 diabetes mellitus (T2DM) in patients diagnosed with Parkinson&amp;apos;s disease (PD) and determine the impact of managing T2DM on the severity of PD symptoms. Methods: A retrospective cohort review was carried out at King Abdulaziz Medical City, Ministry of National Guards-Health Affairs (KAMC-NGHA) in Jeddah, Saudi Arabia, from February to September 2023. The study included all PD patients who were admitted to KAMC-NGHA. The participants were divided into two groups: those with diabetes mellitus (DM) and those without DM. In the diabetes group, the patients were further classified as controlled and uncontrolled diabetes based on glycated hemoglobin (HbA1C) levels, specifically targeting a threshold of 7.0%. Results: Of the 225 total PD patients, 145 (64.4%) had diabetes, while 80 (35.6%) did not. According to the Hoehn and Yahr (H&amp;Y) scale, stage 5 PD was prevalent in both the diabetic and non-diabetic groups. When comparing controlled and uncontrolled diabetic patients, a statistically significant difference in the severity of PD was found (p = 0.029). Conclusion: The study showed a significant extent of T2DM among PD patients. Moreover, an obvious difference in the severity of PD was spotted in individuals with diabetes, especially when comparing controlled and uncontrolled DM.

Effect of Lycium ruthenicum and Lycium barbarum intake on Parkinson based on microbiology and metabonomics: A randomized pilot trial

This study aimed to explore the clinical effects of intervention with Lycium ruthenicum Murr. (LR) and Lycium barbarum L. (LB) on PD patients, reveal the mechanism by which gut microbiota is involved in the overall metabolism of PD patients. The study examined the effects of LR and LB intake on intestinal microflora, serum/urine metabolites, and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) in 30 PD patients enrolled and randomized into 3 groups. Each received 16 g LR daily or 16 g LB daily or blank control for 6 months. The study found that LR and LB intervention reduced the MDS-UPDRS Ⅰ score and MDS-UPDRS Ⅳ score, although not statistically significant. The abundance of Bacteroides increased and the abundance of Flavobacteriaceae in the LR group decreased compared to the control group. LR may regulate the glycerophospholipid metabolism pathway, and α-linolenic acid metabolism pathway to slow down the progress of PD. After LB intervention, the abundance of Lachnoclostridium increased, the abundance of Blautia, norank_f__Eubacterium_coprostanoligenes_group, Bifidobacterium, Coprococcus and norank_f__Lachnospiraceae decreased in the LB group, and compared to the control group, the abundance of Agathobacter increased, the abundance of Lachnospiraceae and Flavobacteriaceae decreased. The results showed that LB may improve PD symptoms by regulating glycine, serine and threonine metabolism pathways, sphingolipid metabolism pathways, and starch and sucrose metabolism pathways. This study provides evidence support for LR and LB as medicinal and food homologous functional foods to improve PD disorders.

“BEYOND JUST A SINGING GROUP”: PERCEPTIONS OF PARTICIPANTS, CAREGIVERS, AND LEADERS OF PARKINSON’S SINGING GROUPS

Abstract Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease after Alzheimer’s disease, and its prevalence is increasing. There is no cure, so symptom treatment is currently the only method to decrease the disease burden for individuals diagnosed with PD. A common treatment modality option that has been shown to improve both motor and non-motor symptoms in PD is therapeutic singing, often in a group setting. Previous literature has explored perceptions of singing groups for persons with PD (PwPD) and their caregivers (CGs) and has found overall positive experiences and outcomes. No study has sought to understand the perspectives of the leaders of the singing groups. The purpose of this study was to understand the perceptions and experiences of participants in singing groups (n=31), their caregivers (n=8), and those leading the groups (n=10) across several different singing groups in the United States. A qualitative phenomenological methodological framework was used with principles of grounded theory to make meaning from the transcripts. Three main themes emerged from the data: peer support, proactive PD management, and the effects of the pandemic. These findings indicate that even during a global pandemic, all three participant groups experienced positive outcomes resulting from peer support and either experiencing or witnessing effective management of PD symptoms. All three participant groups reported similar perceptions and experiences about their involvement which reinforces the rationale to use singing as a treatment modality for PD.