PDD Group Research Articles

Comparison of PDD-TURBT alone versus white light TURBT plus intravesical BCG therapy: A propensity-score matching study

BackgroundAlthough photodynamic-diagnosed transurethral resection of bladder cancer (PDD-TURBT) and Bacillus Calmette-Guérin (BCG) intravesical instillation are the two representative therapies for non-muscle invasive bladder cancer (NMIBC), no studies directly compare their efficacy. We evaluated the outcome of PDD-TURBT alone compared with white light TURBT with intravesical BCG therapy and analyzed the efficacy of both therapies depending on the characteristics of the tumors. MethodsWe retrospectively analyzed intermediate- and high-risk NMIBC patients treated with PDD-TURBT alone (the PDD group) or white light TURBT with BCG therapy (the white light group) using propensity score matched analysis. ResultsIn the propensity score matched cohort, the 1-, 2-, and 3-year recurrence-free survival rates for the PDD group were 77.6 %, 64.1 %, and 48.1 %, respectively, compared to 84.6 %, 75.1 %, and 75.1 % for the white light group (p = 0.44, 0.27, 0.17, respectively). The difference in recurrence rates between the two groups tended to become more pronounced over time, although there was no significant difference. In the univariate and multivariate analysis, recurrence, multiplicity, and tumor grade were the significant prognostic factors of recurrence in the PDD group (p = 0.010, 0.047, 0.048, respectively). Long-term RFS was similar in the PDD and white light groups when the population was limited to the primary and single tumors, suggesting that PDD-TURBT alone may be sufficient in this spectrum of patients. ConclusionsPDD-TURBT alone is insufficient to control the long-term recurrence of bladder cancer but can be effective in selected cases such as primary and single tumors.

Photodynamic diagnosis-assisted transurethral resection of bladder tumor for high-risk non-muscle invasive bladder cancer improves intravesical recurrence-free survival (BRIGHT study).

In a primary analysis of data from the BRIGHT study (UMIN000035712), photodynamic diagnosis-assisted transurethral resection of bladder tumor (PDD-TURBT) using oral 5-aminolevulinic acid hydrochloride reduced residual tumors in high-risk non-muscle invasive bladder cancer (NMIBC). We aimed to evaluate the effectiveness of PDD-TURBT for intravesical recurrence after a second transurethral resection for high-risk NMIBC. High-risk NMIBC patients initially treated with PDD-TURBT (PDD group) were prospectively registered between 2018 and 2020. High-risk patients with NMIBC who were initially treated with white-light TURBT (WL group) were retrospectively registered. Intravesical recurrence-free survival after the second transurethral resection was compared between the PDD and WL groups using propensity score matching analysis. In total, 177 patients were enrolled in the PDD group, and 306 patients were registered in the WL group. After propensity score matching (146 cases in each group), intravesical recurrence within 1 year was significantly less frequent in the PDD group than in the WL group (p = 0.004; hazard ratio [HR] 0.44, 95% confidence interval [CI]: 0.25-0.77). In subgroup analysis, PDD-TURBT showed a particularly high efficacy in reducing intravesical recurrence within 1 year, especially in cases of tumors measuring less than 3 cm (p = 0.003; HR 0.31, 95% CI: 0.14-0.67), absence of residual tumor at second transurethral resection (p = 0.020; HR 0.37, 95% CI: 0.16-0.86), and no postoperative intravesical Bacillus Calmette-Guérin therapy (p < 0.001; HR 0.27, 95% CI: 0.13-0.58). PDD-TURBT may reduce short-term intravesical recurrence in patients with high-risk NMIBC.

Comprehensive analysis of perioperative hypotension in photodynamic diagnosis-assisted transurethral resection of bladder tumor with 5-aminolevulinic acid.

Intraoperative hypotension remains a serious adverse event of photodynamic diagnosis-assisted transurethral resection of bladder tumor with oral administration of 5-aminolevulinic acid. We conducted a re-analysis of perioperative hypotension in photodynamic diagnosis-assisted transurethral resection of the bladder tumor with oral 5-aminolevulinic acid to ascertain its safety. A total of 407 cases who underwent transurethral resection of bladder tumors in our institution were reviewed (274 cases for the PDD group with photodynamic diagnosis and 133 for the white light (WL) group without). A classification of hypotension severity was devised to identify risk factors for clinically troublesome hypotension. The distribution of hypotension severity in each of the PDD and WL groups was compared. Additionally, the patient background and perioperative data by hypotension severity were compared only in the PDD group. More patients with moderate and severe hypotension were noted in the PDD group. The renal function was lower with increasing hypotension severity in the PDD group. More patients on general anesthesia were included in the mild and moderate hypotension group, whereas more patients on spinal anesthesia were included in the severe hypotension group. Furthermore, the frequency of side effects other than hypotension tended to increase with hypotension severity. Renal function impairment and the other adverse effects of 5-aminolevulinic acid may be risk factors for severe hypotension. Mild or moderate hypotension may be caused by general anesthesia and severe hypotension may be caused by spinal anesthesia. To elucidate specific risk factors, further case-control studies are warranted.

Decreased resting-state functional connectivity and brain network abnormalities in the prefrontal cortex of elderly patients with Parkinson's disease accompanied by depressive symptoms.

This study aimed to explore the brain network characteristics in elderly patients with Parkinson's disease (PD) with depressive symptoms. Thirty elderly PD patients with depressive symptoms (PD-D) and 26 matched PD patients without depressive symptoms (PD-NOD) were recruited based on HAMD-24 with a cut-off of 7. The resting-state functional connectivity (RSFC) was conducted by 53-channel functional near-infrared spectroscopy (fNIRS). There were no statistically significant differences in MMSE scores, disease duration, Hoehn-Yahr stage, daily levodopa equivalent dose, and MDS-UPDRS III between the two groups. However, compared to the PD-NOD group, the PD-D group showed significantly higher MDS-UPDRS II, HAMA-14, and HAMD-24. The interhemispheric FC strength and the FC strength between the left dorsolateral prefrontal cortex (DLPFC-L) and the left frontal polar area (FPA-L) was significantly lower in the PD-D group (FDR p < 0.05). As for graph theoretic metrics, the PD-D group had significantly lower degree centrality (aDc) and node efficiency (aNe) in the DLPFC-L and the FPA-L (FDR, p < 0.05), as well as decreased global efficiency (aEg). Pearson correlation analysis indicated moderate negative correlations between HAMD-24 scores and the interhemispheric FC strength, FC between DLPFC-L and FPA-L, aEg, aDc in FPA-L, aNe in DLPFC-L and FPA-L. In conclusion, PD-D patients show decreased integration and efficiency in their brain networks. Furthermore, RSFC between DLPFC-L and FPA-L regions is negatively correlated with depressive symptoms. These findings propose that targeting DLPFC-L and FPA-L regions via non-invasive brain stimulation may be a potential intervention for alleviating depressive symptoms in elderly PD patients.

Specific gut microbiome and metabolome changes in patients with continuous ambulatory peritoneal dialysis and comparison between patients with different dialysis vintages.

In recent years, the role of gut microbiota and derived metabolites in renal disease has attracted more attention. It has been established that the gut microbiota is a potential target for medical interventions in renal disease including chronic kidney disease (CKD), acute kidney injury (AKI) and renal calculus. Emerging evidence has related dialysis treatment to the microbial composition and function of the intestines, and there are many reports related to HD, but few studies have been related to PD. Previous studies have found that PD patients have intestinal flora disturbances, so we speculate that intestinal flora and its metabolites may be the regulatory factors in long-term therapy of PD. And as far as we know, there have been no studies characterized the gut microbiota in PD patients of different dialysis vintages. It is a cross-sectional study based on clinical data and biological samples of 72 patients with CAPD, 13 patients with ESRD and 13 healthy volunteers. The intestinal microecological characteristics of CAPD patients were comprehensively evaluated by combining the intestinal microflora structure, enterotoxin and receptor (serum LPS and LBP), intestinal barrier function index (serum D-Lactate), intestinal uremic toxin (serum IS, PCS, TMAO), fecal SCFAs and other multi-dimensional and multi-omics studies. Furthermore, the changes of intestinal microecology in CAPD patients of different dialysis vintages (≥ 3 and < 12 months, ≥ 12 and < 24 months, ≥ 24 and < 60 months, ≥ 60 months) were further explored, and the correlations between intestinal microecology indicators and some clinical indicators were analyzed. Fecal and serum samples were collected from PD patients (PD group, n = 72), ESRD patients (ESRD group, n = 13) and healthy volunteers (Normal group, n = 13). Fecal samples were subjected to microbiome (16S rDNA) and SCFA (GC-MS) analyses. Serum samples were subjected to LPS, LBP, D-lactate, IS, PCS, and TMAO (ELISA) analyses. The diversity and richness of intestinal flora in CAPD patients were lower than those in healthy people and ESRD patients, and the microflora structure was different. Anaerobes of Blautia and facultative anaerobes and aerobic bacteria with Bacilli and Lactobacillales those in Firmicutes are the main intestinal flora in CAPD patients. The abundance of Bacteroidaceae, Bacteroides, Faecalibacterium and other dominant bacteria in the intestinal tract of CAPD patients decreased. Proteobacteria, Enterobacteriaceae and Escherichia-Shigella increased their colonization (LDA > 4). In CAPD patients of different dialysis vintages, there was no significant change in the diversity and richness of microflora, and the microflora structure of PDC group was significantly different from that of PDD, which the abnormal expansion of enterobacter group was more prominent in PDC and the abundance of Bacteroides group was relatively higher in PDD. Intestinal barrier damage, intestinal uremic toxin accumulation and short-chain fatty acid reduction were observed in CAPD patients, such as the serum level of D-Lactate, PCS and TMAO were significantly higher than that in the Normal group (P < 0.05),and the fecal levels of BA and CA were significantly lower (P < 0.05). The intestinal microecological disorder of PDC group, while that of PDD group showed a better trend. Such as the PDC group had a significantly higher serum level of LPS, D-Lactate and TMAO (P < 0.01), and significantly lower serum level of LBP (P < 0.01), and lower fecal levels of AA and BA (P > 0.05) than the PDD group. The intestinal microecology and metabolic system of CAPD patients had changes compared with healthy people and ESRD non-dialysis patients, and there were differences in CAPD patients with different dialysis vintages. PD patients on dialysis for more than 60 months showed a better trend in the intestinal microecology than patients with 24∼36 months, which suggested that the intestinal microecology of PD patients had a certain ability of self-regulation and remodeling under the management of standardized system and it is necessary to strengthen the monitoring of the intestinal status and the occurrence of related complications in PD patients on dialysis of 24∼36 months of dialysis vintage. It is initially considered that the mechanism of intestinal microecology is a potential target for intervention in the diagnosis and treatment of CAPD and incorporating intestinal microecosystem monitoring into the long-term management of CAPD patients is a new strategy.

Alzheimer’s disease and Parkinson’s disease dementia: Practical tips for physicians

Dementia is a progressive disorder that weakens the intellectual abilities and causes the cognitive, behavioral, and functional decline in occupational and social areas. This research is targeted to extract a profile for the dementia diagnostic and clinical characteristics by evaluating the near-term effects of Alzheimer&amp;rsquo;s disease (AD) and Parkinson&amp;rsquo;s disease dementia (PD-D). A total of 240 individuals, including 60 AD patients, 60 PD-D patients, and 120 healthy controls, were included in the study. Data of individuals treated in a local dementia outpatient clinic between 2013 and 2023 were obtained from the clinic database. AD and PD-D diagnoses were made based on the revised National Institute on Aging and Alzheimer&amp;rsquo;s Association (NIA-AA) criteria and movement disorder society (MDS) clinical diagnostic criteria, respectively. Functional, clinical, and neuropsychological evaluations of the patients were made by the same neurologist. Dementia staging and daily living activities were determined and categorized. In the patient group, functionality and instrumental activities of daily living (ADLs) scores were significantly worse than those of the control group, but there was no difference between the AD and PD-D groups. Calculation, verbal fluency, word list, early learning, and clock drawing test scores were lower in the AD group than in the PD-D group. Apathy, disinhibition, elution, irritability, abnormal motor movements, sleep, and appetite scores were significantly higher in the patient group than in the control group. While depression parameters were not significantly different between all the groups, hallucinations and anxiety parameters were significantly higher in the PD-D group than in the AD group. As an important predictor of independent living and the burden of disease, functional impairment is an important issue in patients with AD compared to those with PD-D. This study also highlights the neuropsychiatric perception disorder in terms of functional loss in AD and significant anxiety disorder for PD-D accompanied by early functional losses.

Specific patterns of coherence and phase lag index in particular regions as biomarkers of cognitive impairment in Parkinson's disease

IntroductionCognitive impairment is a persistent and increasingly reported symptom of patients with Parkinson's disease (PD), significantly affecting daily functioning quality. This study aims to evaluate the functional connectivity of the brain network in patients with Parkinson's disease with various severities of cognitive decline using quantitative electroencephalography (EEG) analysis. MethodsBased on the EEG recorded in the resting state, the coherence and phase lag index were calculated to evaluate functional connectivity in 108 patients with Parkinson's disease divided into three groups according to their cognitive condition: dementia due to PD (PD-D), PD and mild cognitive impairment (PD-MCI) and cognitively normal patients (PD-CogN). ResultsIt was found that there were significantly different coherence values in the PD-D group compared to PD-CogN in different frequency bands. In most cases, there was a decrease in coherence in PD-D compared to PD-CogN. The most specific changes were revealed in the theta frequency band in the temporal right-frontal left and temporal right-frontal right regions. In the alpha frequency band, the most significant decreases were shown in the occipital right-frontal left and occipital left-frontal right areas. There were also statistically significant differences in phase lag index between many areas, especially in the theta frequency range. ConclusionsThese findings indicate that the functional connectivity patterns of coherence and phase lag index – found in a particular frequency band and region – could become a reliable biomarker for identifying cognitive impairment and differentiating its severity in PD patients.

Associations of blood UCH-L1 and NfL levels with cognitive dysfunction in Parkinson’s disease patients

ObjectiveUbiquitin carboxy-terminal hydrolase L1 (UCH-L1) and Neurofilament light chain (NfL) are associated with Lewy body formation, Lewy bodies are the main pathological feature of Parkinson's disease (PD). The relationship between UCH-L1 and PD cognition remains unclear, and NfL is an important marker of cognitive impairment. The aim of this study is to investigate the relationship among serum UCH-L1 levels, plasma NfL levels and cognitive dysfunction in PD patients. ResultsThere were significant differences in UCH-L1 and NfL levels among PD patients with normal cognitive function (PD-CN), PD patients with mild cognitive impairment (PD-MCI), and PD-dementia patients (PDD) (P < 0.001; P < 0.001). The PDD group had lower levels of UCH-L1 (Z = 6.721, P < 0.001; Z = 7.577, P < 0.001) and higher levels of NfL (Z = −3.626, P = 0.001; Z = −2.616P = 0.027) than the PD-NC and PD-MCI groups. Serum UCH-L1 levels were positively correlated with MMSE scores, MoCA scores, and its subitems in PD patients (P < 0.001), and plasma NfL levels were negatively correlated with MMSE scores, MoCA scores, and its items (P < 0.01) (except for “abstract”). ConclusionDecreased UCH-L1 levels and elevated NfL levels in the blood are associated with cognitive dysfunction in PD; thus, these proteins are potential biomarkers for the diagnosis of cognitive dysfunction in PD patients.

Patterns of dementia treatment in older adults with Parkinson\u2019s disease using nationwide medical claims data

BackgroundDementia is a common feature in Parkinson’s disease (PD); however, data on dementia treatment patterns in patients with PD are scarce. This study aimed to evaluate the incidence of dementia in individuals with PD and to describe the dementia treatment patterns in the Korean elderly population.MethodsWe conducted a retrospective population-based cohort study using data obtained from the Korean National Health Insurance Service-Senior Cohort (NHIS-SC) database. The dataset comprised more than 500,000 health insurance beneficiaries from January 1, 2002 to December 31, 2015. We estimated the incidence of patients newly diagnosed with dementia during this observational period, compared patient demographics, and analyzed the exposure to anticholinergic drugs among PD patients with (PD + D) and without (PD-D) dementia. Furthermore, the duration to dementia diagnosis and patterns of dementia treatment were evaluated.ResultsA cohort of 28,537 patients aged 60 years or older who were diagnosed with PD by the NHIS was established. Within this cohort, 8620 patients were eligible study participants according to strict inclusion/exclusion criteria. Of these individuals, 3879 (45.0%) patients were newly diagnosed with dementia; the incidence of dementia in PD was 15.2 per 1000 person-years. The proportion of women was higher in the PD + D (64.6%) than the PD-D group (58.2%) (P < 0.001); furthermore, the use of anticholinergic medication was greater in PD + D (37.6%) than in PD-D (24.0%) patients. The incidence curves for dementia over time were the steepest during the first year and decreased every year thereafter. Approximately 60% of PD patients were diagnosed with dementia during the first 3 years. Regarding the use of anti-dementia drugs, 2539 (65.5%) of 3879 PD + D were prescribed medication. During the observation period, 1799 (70.9%) patients were prescribed only one type of anti-dementia drug. In this monotherapy group, the most commonly prescribed medication was donepezil (1313[73.0%]), followed by rivastigmine (capsule and patch; 246[13.7%]), memantine (187[10.4%]), and galantamine (53[2.9%]).ConclusionsIn Korea, dementia was observed to occur relatively soon after the diagnosis of PD. Anti-dementia medication was prescribed to approximately 66% of PD + D patients, with the majority receiving donepezil as monotherapy.

Gait Analyses of Parkinson’s Disease Patients Using Multiscale Entropy

Parkinson’s disease (PD) is a type of neurodegenerative diseases. PD influences gait in many aspects: reduced gait speed and step length, increased axial rigidity, and impaired rhythmicity. Gait-related data used in this study are from PhysioNet. Twenty-one PD patients and five healthy controls (CO) were sorted into four groups: PD without task (PDw), PD with dual task (PDd), control without task (COw), and control with dual task (COd). Since dual task actions are attention demanding, either gait or cognitive function may be affected. To quantify the used walking data, eight pressure sensors installed in each insole are used to measure the vertical ground reaction force. Thus, quantitative measurement analysis is performed utilizing multiscale entropy (MSE) and complexity index (CI) to analyze and differentiate between the ground reaction force of the four different groups. Results show that the CI of patients with PD is higher than that of CO and 11 of the sensor signals are statistically significant (p &lt; 0.05). The COd group has larger CI values at the beginning (p = 0.021) but they get lower at the end of the test (p = 0.000) compared to that in the COw group. The end-of-test CI for the PDw group is lower in one of the feet sensor signals, and in the right total ground reaction force compared to the PDd group counterparts. In conclusion, when people start to adjust their gait due to pathology or stress, CI may increase first and reach a peak, but it decreases afterward when stress or pathology is further increased.

Bortezomib, Liposome Doxorubicin and Dexamethasone (PDd) Is Superior in Safety and Not Inferior in Efficiency to Bortezomib, Doxorubicin and Dexamethasone (PAd) As Induction Therapy in New-Diagnosed Multiple Myeloma Patients: An Interim Report from China's Multicenter Study

Purpose:Bortezomib, doxorubicin and dexamethasone (PAd) and bortezomib, liposome doxorubicin and dexamethasone (PDd) are widely used as induction chemotherapy regimens in china in the new-diagnosed multiple myeloma patients before autologous stem cell transplantation or other consolidation therapy. There was no data on the comparison in safety and efficiency between that two regimens, so we design this open-label, randomized, multicenter clinical trial in China's 16 sites. Here is our interim report.Method:Until April 15th 2017, 18 cases with PDd and 22 cases with PAd have finished the whole induction therapy. Incidence of adverse reaction, therapeutic effect evaluation is compared here.Results:There is no significant difference in age, gender, ISS stage, R-ISS stage, D-S stage between the two groups. There is also no differences in the incidence of the M-protein type between the two groups except for IgA type more often in PAd group than PDd group (7/22 vs 1/18, p=0.0537). As the 40 patients finished the 4-cycle induction therapy, effect evaluation by morphology, IFE and FLC shows no difference in sCR, CR, VGPR, PR, SD, PD, as well as in ORR. And minimal residual disease tested by flow-cytometry is also no difference between the two groups. The incidence of leukocytopenia (III-IV°) (1/18 vs 9/22, p=0.0126) and thrombocytopenia (III-IV°)(2/11 vs 11/22, p=0.0162) is lower in PDd group than in PAd group, and no difference is observed in other adverse reactions such as active infection, neutropenia, anemia, febrile neutropenia, hepatic and renal impairment, herpes, ect.Conclusion:There is no difference in the efficiency after 4-cycle induction chemotherapy between the PDd group and PAd group, and PDd regimen show advantages in less incidence in leukocytopenia and thrombocytopenia. DisclosuresNo relevant conflicts of interest to declare.

Mortality rates are higher in lewy body and parkinson's disease dementia compared to Alzheimer's dementia in patients referred into a secondary care mental health service. Why?

AimsWe compared survival in four cohorts of dementia patients– Lewy body (LBD), Parkinson's (PDD), Vascular (VD) and Alzheimer's dementia (AD) - in patients referred into Cambridge and Peterborough NHS Foundation Trust (CPFT) mental health services.Additionally, we investigated reasons for variation in survival in the four cohorts.MethodUsing electronic records we identified retrospective cohorts of patients referred into services from 2013 onwards. Cases of LBD and PDD were identified using text searches, and comparison cohorts with AD or VD identified using ICD10 diagnosis codes ((F00.*) or (F01.*) respectively).We collected referral (date of referral and service referred into), demographic (date of birth and gender) and diagnosis data on the patients in the four cohorts. Dates of death were available, through central NHS reporting to Trusts.We used date of first referral as start of the follow-up and end of follow-up, death or 31/12/19. We used Kaplan-Meier and Cox survival analysis to compare survival in the four cohorts.The cohorts were crossed with Hospital Episode Statistics (HES) data to extract hospital admission diagnoses. We extracted diagnoses of pneumonia due to aspiration and recurrent falls from hospital admissions data using ICD codes (J69.0 and R29.6 respectively). We calculated prevalence of these diagnoses in the dementia groups, in males and females separately.ResultIn Cox analysis (controlling for age at referral, gender and service referred into), the hazard ratio (HR) for death was highest for the PDD group (HR 2.0 (95% CI 1.7–2.4)), followed by LBD (HR 1.4 (95% CI 1.3–1.6)), then VD (HR 1.2 (95% CI 1.0–1.3)), with the AD group as reference. In the same analysis repeated separately for males and females, the highest HR was found in males with PDD (HR 2.3 (95% CI 1.8–2.8)).Referrals to liaison psychiatry were associated with reduced survival compared to other mental health services (HR 1.7 (95% CI 1.5–2.0)).The AD cohort showed the lowest rates of pneumonia due to aspiration and recurrent falls in males and in females. The highest rate of pneumonia due to aspiration was found in the male PDD group (27%).ConclusionIn patients with dementia referred into mental health services, those with AD survive longer compared to other dementia groups, with PDD patients at highest risk of death. Physical frailty including risk of aspiration, is likely to account for some of this difference in survival.

Master swimmers with shoulder pain and disability have altered functional and structural measures.

Supraspinatus tendinopathy and shoulder pain are common in competitive youth swimmers; however, no studies have investigated clinical and structural factors contributing to shoulder pain and disability in master level swimmers. The objectives of this study were: 1) to determine the prevalence of shoulder pain and disability in master level swimmers, 2) to identify the most provocative special tests for shoulder pain, and 3) to determine if shoulder clinical and tissue specific measures, training variables and volume vary between those with and without shoulder pain, dissatisfaction and disability. Cross-sectional. Collegiate swimming facilities. Thirty-nine adult masters level swimmers were evaluated and included in the data analysis. A survey of demographics, training, and pain and disability ratings using the Penn Shoulder Score and Disability of Arm Shoulder Hand sports module. Swimmers underwent a clinical exam including shoulder passive range of motion (PROM), posterior shoulder endurance test (PSET), supraspinatus tendon structure and posterior capsule thickness. One-way ANOVAs were used to compare demographics, clinical and structural findings between those with significant pain, dissatisfaction and disability (+PDD) and those without (-PDD). Fifteen percent of subjects reported pain at rest, 28% with normal activities (eating, dressing), and 69% with strenuous activities (sports) and 50% reported disability. The +PDD group had less shoulder internal rotation (10°), less ER (8°), and completed less yardage per day and per year. There were significant differences in the supraspinatus tendon structure between the +PDD and -PDD groups. Masters swimmers with pain and disability are able to self-limit yardage and likely why they recorded less yardage. The reduced shoulder motion (IR and ER) without posterior capsule differences may be due to rotator cuff muscle/tendon restrictions and the supraspinatus tendon structure may indicate degeneration caused by previous overuse resulting in pain.

Hyperlipidic diet affects body composition and induces anxiety-like behaviour in intrauterine growth-restricted adult mice.

What is the central question of this study? What is the effect in male and female offspring of a protein-deficient diet producing intrauterine growth restriction (IUGR) in maternal mice on morphometric, metabolic and behavioural parameters before and after a challenge with a fat diet? What is the main finding and its importance? Male and female mice presented different growth trajectories after birth. IUGR favoured increased adiposity in male mice, and high-fat diet-induced anxiety-like behaviour in female mice. As there is sexual dimorphism in the response to maternal manipulations, we aimed to analyse the effects of intrauterine growth restriction (IUGR) in both sexes on morphometric, metabolic and behavioural parameters throughout postnatal development, and after challenge with a hyperlipidic diet. Female Swiss mice (n=59) were distributed into two groups (SD: standard diet, n=26; and PDD: isocaloric protein-deficient diet, n=33), 2weeks before mating and during the gestational period. After birth, offspring from SD and PDD dams were cross-fostered and nurtured by SD dams until postnatal day (PND) 28. At PND 60 all animals were challenged with a hypercaloric diet for 4weeks. Offspring birth weight was significantly reduced in the PDD group compared to the SD group (P=0.0001), but only male offspring presented a rapid catch-up during the first 21days of development. Although no differences in body weight were observed between groups after the challenge with the hyperlipidic diet, an increase in the relative perigonadal white adipose tissue (P=0.009) and a decrease in gross gastrocnemius muscle weight (P=0.010) were observed in the PDD males. In relation to behavioural tests, there was an increase in locomotion in both sexes (P=0.0001), and a decrease in female grooming (P=0.006) in the PDD group. Additionally, females from the PDD group showed increased hyperlipidic food intake. In conclusion, IUGR affected both sexes, with females showing prominent behavioural modifications and males presenting altered body composition elicited by a hyperlipidic diet.

Impulse control and related behaviors in Parkinson's disease with dementia.

The objective was to determine the frequency, demographic and clinical correlates [such as age, sex, Parkinson's disease (PD) severity and dopaminergic treatment] of impulse control disorder (ICD) symptoms and related behaviors in patients with PD with (PD-D) and without (PD-ND) dementia. We analyzed historical data from a national, multi-center, cross-sectional database and assessed ICDs and related behaviors with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's Disease administered as a semi-structured interview to patients with PD-D (n=85) and PD-ND (n=444) and their informants. Dopamine agonist therapy use was common and similar in the two groups (78.8% in PD-D vs. 82.9% in PD-ND), but ICDs (23.5% vs. 13.3%, P=0.02), hobbyism-punding (32.9% vs. 10.6%, P<0.001) and dopaminergic medication abuse (8.2% vs. 3.2%, P=0.03) were more common in the PD-D group. The finding that ICDs and related behaviors are more common in patients with PD frequently treated with dopamine agonists who also have comorbid dementia suggests that the neural substrates associated with PD dementia may also predispose to development of compulsive behaviors.

Changes of plasma cGP/IGF-1 molar ratio with age is associated with cognitive status of Parkinson disease.

ObjectiveCognitive impairment is a common feature of Parkinson disease (PD), for which age is a major contributing factor. Insulin‐like growth factor‐1 (IGF‐1) declines with age and contributes to age‐related cognitive impairment in PD. Cyclic glycine‐proline (cGP) is a metabolite of IGF‐1 and normalizes bioavailable IGF‐1. Plasma cGP/IGF‐1 molar ratio that represents bioactive IGF‐1 in circulation, may associate with the cognitive status in PD.MethodsWe examined the association of plasma cGP/IGF‐1 molar ratio with the cognitive scores or age in PD patients with normal cognition (PD‐N, n = 74), mild cognitive impairment (PD‐MCI, n = 71), or dementia (PD‐D, n = 33), and with the cognitive scores in 23 age‐matched healthy controls. Plasma concentrations of IGF‐1, IGF binding protein‐3, and cGP were evaluated using enzyme‐linked immunosorbent assay (ELISA) and high‐performance liquid chromatography‐mass spectrometry (HPLC‐MS), respectively.ResultsThe cGP/IGF‐1 molar ratio was positively correlated with the age of PD‐N group, negatively correlated with the age of PD‐D group, and not associated with the age of PD‐MCI group. Independent of age, the cGP/IGF‐1 molar ratio was positively correlated with the cognitive scores of healthy controls, but not in PD groups.ConclusionOld healthy people with a higher cGP/IGF‐1 molar ratio showed better preserved cognition, possibly due to improved IGF‐1 function. Increased cGP/IGF‐1 molar ratio with age may contribute to cognitive retention in the PD‐N group. The absence or reversal of such association with age in the PD‐MCI and PD‐D groups may indicate the conversion of cognitive status in PD, if confirmed through longitudinal investigations within the individuals with advancing cognitive impairment.

Can behavioral symptoms differentiate cortical from subcortical dementia - A comparative study of behavioral profile of Parkinson’s disease dementia and behavioral variant of frontotemporal dementia

Patients of behavioural variant of frontotemporal dementia (bvFTD) exhibit prominent behavioural abnormalities along with executive dysfunction. Whereas executive dysfunction is also common in subcortical dementias because of disturbance in fronto-subcortical connection, behavioural symptoms are less frequent. To determine the frequencies of behavioural symptomatology of patients with subcortical (Parkinson's disease with dementia or PDD) and frontal cortical dementia (behavioural variant of Frontotemporal dementia or bvFTD) and to find out the discriminating value of behavioural characteristics in differentiating these two group of patients. Patients were consecutively recruited from Cognitive and Movement Disorder Clinics following standard diagnostic criteria. A total 20 bvFTD and 20 PDD patients were recruited. Behavioural symptoms were noted from reliable caregiver following the questionnaire prepared by Bathgate et al. (2000). Whereas eating and vegetative behaviour were more frequent in bvFTD (85% vs 45%, p = 0.018), the neuropsychiatric behaviours were more common in PDD group 80.0% vs 50.0%, p = 0.095). Although didn’t achieve statistical significance, other symptoms found to be discriminating in two condition were (i) sensory behaviour (p = 0.056), (ii) cognitive mediated behaviour (p = 0.794), (iii) affect-social behaviour (p = 0.162), and (iv) compulsion-ritual behaviour (p = 0.33). The behaviour related to environmental dependency were not found prominent in either groups (p = 0.155), although utilization behavior and echopraxia were more common in bvFTD. Behavioural abnormalities were more common in bvFTD group with prominent abnormality in eating & vegetative behaviour, sensory behaviour, cognitive mediated behaviour, affect-social behaviour, compulsion-ritual behaviour and the PDD group showed marked neuropsychiatry behavioural abnormalities.

Beta Amyloid Deposition Is Not Associated With Cognitive Impairment in Parkinson's Disease.

The extent to which Alzheimer neuropathology, particularly the accumulation of misfolded beta-amyloid, contributes to cognitive decline and dementia in Parkinson's disease (PD) is unresolved. Here, we used Florbetaben PET imaging to test for any association between cerebral amyloid deposition and cognitive impairment in PD, in a sample enriched for cases with mild cognitive impairment. This cross-sectional study used Movement Disorders Society level II criteria to classify 115 participants with PD as having normal cognition (PDN, n = 23), mild cognitive impairment (PD-MCI, n = 76), or dementia (PDD, n = 16). We acquired 18F-Florbetaben (FBB) amyloid PET and structural MRI. Amyloid deposition was assessed between the three cognitive groups, and also across the whole sample using continuous measures of both global cognitive status and average performance in memory domain tests. Outcomes were cortical FBB uptake, expressed in centiloids and as standardized uptake value ratios (SUVR) using the Centiloid Project whole cerebellum region as a reference, and regional SUVR measurements. FBB binding was higher in PDD, but this difference did not survive adjustment for the older age of the PDD group. We established a suitable centiloid cut-off for amyloid positivity in Parkinson's disease (31.3), but there was no association of FBB binding with global cognitive or memory scores. The failure to find an association between PET amyloid deposition and cognitive impairment in a moderately large sample, particularly given that it was enriched with PD-MCI patients at risk of dementia, suggests that amyloid pathology is not the primary driver of cognitive impairment and dementia in most patients with PD.

注意欠陥/多動性障害, 広汎性発達障害児をもつ母親の不安・うつに関する心身医学的検討

Objective : The characteristics of disabilities and social adaptation of children with developmental disabilities were studied in relation to the anxiety and/or depression of their mothers. Subjects : The data of 45 mothers of children with developmental disabilities, evaluated in the outpatient facilities of the Department of Psychosomatic Medicine, Kyusyu University Hospital and affiliated hospitals, was evaluated. All received six months or more of pharmacological treatment or psychotherapy, including 23 mothers of children with attention deficit/hyperactivity disorders (ADHD group) and 22 mothers of children with pervasive developmental disorders (PDD group), as well as a control group of 23 mothers. Method : Evaluation with the SDS depression scale and the STAI anxiety scale was done at baseline and six month after therapeutic intervention. The social adaptation of the children was evaluated using the DSM-IV GAF scale. Results : The results indicated that the ADHD group had a significantly higher degree of anxiety and/or depression (p Language: ja

The effect of antidepressant treatment on the working memory of Parkinson's disease patients with depression

Objective To investigate the impaired characteristics of working memory in Parkinson's disease patients with depression and the recovery status of working memory after antidepressant treatment. Methods Totally 60 cases were enrolled in this study and divided into three groups: 30 Parkinson's disease patients with depression (PD-D), 15 Parkinson's disease patients without depression (PD) and 15 persons without Parkinson's disease as normal controls. All subjects were evaluated with Wechsler Memory Scale (WMS-R) audio-visual span, Tower of Hanoi (TOH) and Wisconsin Card Sorting Test (WCST). 30 PD-D patients were randomly divided into two subgroups: routine treatment subgroup (8 weeks levodopa therapy) and antidepressant combined treatment subgroup (8 weeks levodopa + citalopram therapy). The evaluation of Hamilton Depression Scale (HAMD), WMS-R audio-visual span, TOH and WCST were performed on these two groups before and after treatment. Results ① There were significant differences comparing PD-D and PD groups with the normal control group in scores of WMS-R, TOH and WCST indicators (P<0.05). There were significant differences in WMS-R visual span, accuracy rate and speed of TOH, as well as the percent errors and percent perseverative responses of WCST comparing PD-D group(11.88±5.91, 0.420±0.345, 0.408±0.334, 0.882±0.253, 0.565±0.229) with PD group (15.87±5.21, 0.768±0.167, 0.634±0.232, 0.493±0.161, 0.327±0.122) (P<0.05). ② Before and after treatment in PD-D routine treatment subgroup, there were significant differences in digital memory and audio-visual memory of WMS-R((6.73±3.72, 5.95±3.13) vs (3.77±2.16, 1.91±1.58)), accuracy rate of TOH(0.45±0.26 vs 0.23±0.13), as well as percent errors((-0.58±0.17) vs (-0.37±0.14)), percent perseverative responses((-0.32±0.15) vs (-0.14±0.09)), percent conceptual level responses(0.38±0.09 vs 0.13±0.07) and number of categories completed(3.27±1.56 vs 1.06±0.91) of WCST(P<0.05). ③ After 4-week treatment and 8-week treatment, there were significant differences in HAMD score comparing PD-D antidepressant combined treatment group(16.33±2.72, 10.27±2.66) with PD-D routine treatment group(21.73±2.28, 18.4±2.47) (P<0.05). Conclusion Comparing Parkinson's disease patients without depression, the impaired working memory is more serious and extensive in Parkinson's disease patients with depression. Antidepressant treatment can improve the working memory of Parkinson's disease patients with depression. Key words: Parkinson's disease; Depression; Working memory; Levodopa; Citalopram