Parkinson's Disease Symptom Progression Research Articles

Importance of health history analysis in Parkinson's disease

The objective of this research article is to investigate the impact of various health history factors on the risk of developing Parkinson's disease (PD). From the medical history we can identify PD Symptoms and this also help to detect the progression of PD symptoms. By conducting statistical analyses, the study seeks to identify independent risk and protective factors for Parkinson's disease (PD), considering variations in impact across genders and BMI categories. IntroductionIn the diagnosis of PD the analysis of previous health history is very rare in practice while the main diagnosis have been done through the different motor and non-motor symptoms taking in consideration besides the cardinal symptoms of PD for identification and determination the stages of PD. Here we have analyzed the impact of 56 different diseases, symptoms, and surgeries which a subject may have experienced in their life before PD, considered as a health history. MethodsThe behavioral impact for each types of health history have been analyzed statistically with 31,265 subjects including PD, and Control. In this analysis we have calculated the variation of impact for both the Male, and Female, as well as subjects BMI. Results98.12 % PD patients, where 97.63 % Male PD, and 98.71 % Female PD were found with at least one health history record. Coronary heart disease odds ratio (OR) 2.15 (1.85–2.51), Colon Cancer OR 2.11 (1.45–3.05), Cranial brain surgery OR 6.21 (5.11–7.56) have the higher risks to PD. Having the history of Asthma OR 0.66 (0.6–0.72), Anemia OR 0.56 (0.51–0.63), Cirrhosis in Liver OR 0.7 (0.57–0.86), Cosmetic surgery OR 0.7 (0.64–0.77), and Gastritis OR 0.78 (0.71–0.87) have been found to be protective to PD. The risk of developing PD varies between male, and female including subjects BMI for each individual health history types. The diseases which reduce the oxygen saturation in blood like, anemia, asthma, and thalassemia act as protective to PD. ConclusionsIn this study we have analyzed fifty six diseases which include surgeries as a health history of PD patients. Study suggests that a thorough health history could greatly aid in understanding the onset and progression of Parkinson's disease (PD).

Paradigm shift in Parkinson's disease: using continuous telemonitoring to improve symptoms control. Results from a 2-years journey.

Conventional care in Parkinson's disease (PD) faces limitations due to the significant time and location commitments needed for regular assessments, lacking quantitative measurements. Telemonitoring offers clinicians an opportunity to evaluate patient symptomatology throughout the day during activities of daily living. The progression of PD symptoms over a two-year period was investigated in patients undergoing traditional evaluation, supplemented by insights from ambulatory measurements. Physicians integrated a telemonitoring device, the PDMonitor®, into daily practice, using it for informed medication adjustments. Statistical analyses examining intra-subject changes for 17 subjects revealed a significant relative decrease of -43.9% in the device-reported percentage of time spent in "OFF" state (from 36.2 to 20.3%). Following the 24-month period, the majority of the subjects improved or exhibited stable symptom manifestation. In addition to positively impacting motor symptom control, telemonitoring was found to enhance patient satisfaction about their condition, medication effectiveness, and communication with physicians. Considering that motor function is significantly worsened over time in patients with PD, these findings suggest a positive impact of objective telemonitoring on symptoms control. Patient satisfaction regarding disease management through telemonitoring can potentially improve adherence to treatment plans. In conclusion, remote continuous monitoring paves the way for a paradigm shift in PD, focusing on actively managing and potentially improve symptoms control.

Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson's Disease.

Motor and nonmotor symptoms occur in early Parkinson's disease (PD), or even in the prodromal stage. Many of these symptoms can be addressed by allied health therapies, including physical therapy, occupational therapy, speech therapy, and psychological therapies. However, referrals to these services early in the disease are low. We provide a review summarizing the efficacy of proactive allied health interventions on motor and nonmotor symptoms and daily function in prodromal and early disease. We also highlight areas for additional research and provide recommendations to improve care for individuals with early PD within each discipline. We recognize the overlapping roles of the allied health disciplines and support integrated or transdisciplinary care beginning soon after diagnosis to help stem the tide in the progression of PD symptoms and disability.

A combined method of optimized learning vector quantization and neuro-fuzzy techniques for predicting unified Parkinson's disease rating scale using vocal features

Parkinson's Disease (PD) is a common disorder of the central nervous system. The Unified Parkinson's Disease Rating Scale or UPDRS is commonly used to track PD symptom progression because it displays the presence and severity of symptoms. To model the relationship between speech signal properties and UPDRS scores, this study develops a new method using Neuro-Fuzzy (ANFIS) and Optimized Learning Rate Learning Vector Quantization (OLVQ1). ANFIS is developed for different Membership Functions (MFs). The method is evaluated using Parkinson's telemonitoring dataset which includes a total of 5875 voice recordings from 42 individuals in the early stages of PD which comprises 28 men and 14 women. The dataset is comprised of 16 vocal features and Motor-UPDRS, and Total-UPDRS. The method is compared with other learning techniques. The results show that OLVQ1 combined with the ANFIS has provided the best results in predicting Motor-UPDRS and Total-UPDRS. The lowest Root Mean Square Error (RMSE) values (UPDRS (Total)=0.5732; UPDRS (Motor)=0.5645) and highest R-squared values (UPDRS (Total)=0.9876; UPDRS (Motor)=0.9911) are obtained by this method. The results are discussed and directions for future studies are presented.i.ANFIS and OLVQ1 are combined to predict UPDRS.ii.OLVQ1 is used for PD data segmentation.iii.ANFIS is developed for different MFs to predict Motor-UPDRS and Total-UPDRS.

Proximity to residential and workplace pesticides application and the risk of progression of Parkinson's diseases in Central California

BackgroundPesticide exposure has consistently been associated with Parkinson's disease (PD) onset. Yet, fewer epidemiologic studies have examined whether pesticides influence PD motor and non-motor symptom progression. ObjectivesUsing a geographic information system tool that integrates agricultural pesticide use reports and land use records to derive ambient exposures at residences and workplaces, we assessed associations between specific pesticides previously related to PD onset with PD symptom progression in two PD patient cohorts living in agricultural regions of California. MethodsWe calculated the pounds of pesticide applied agriculturally near each participant's residential or occupational addresses from 1974 to the year of PD diagnosis, using a geographic information system tool that links the California Pesticide Use Reports database to land use data. We examined 53 pesticides selected a priori as they have previously been associated with PD onset. We longitudinally followed two PD patient cohorts (PEG1 N = 242, PEG2 N = 259) for an average of 5.0 years (SD ± 3.5) and 2.7 years (SD ± 1.6) respectively and assessed PD symptoms using the movement disorder specialist-administered Unified Parkinson's disease Rating Scale part III (UPDRS), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Weighted time-to-event regression models were implemented to estimate effects. ResultsTen agricultural pesticides, including copper sulfate (pentahydrate), 2-methyl-4-chlorophenoxyacetic acid (MCPA) dimethylamine salt, tribufos, sodium cacodylate, methamidophos, ethephon, propargite, bromoxynil octanoate, monosodium methanearsonate (MSMA), and dicamba, were associated with faster symptom progression. Among these pesticides, residential or workplace proximity to higher amounts of copper sulfate (pentahydrate) and MCPA (dimethylamine salt) was associated with all three progression endpoints (copper sulfate: HRs = 1.22–1.36, 95 % CIs = 1.03–1.73; MCPA: HRs = 1.27–1.35, 95 % CIs = 1.02–1.70). ConclusionsOur findings suggest that pesticide exposure may not only be relevant for PD onset but also PD progression phenotypes. We have implicated ten specific pesticide active ingredients in faster PD motor and non-motor decline.

"Survey of Caregivers’ Care Burden Perception Relating to Excretion-Related Actions of Parkinson’s Disease Patients"

Background: Parkinson's disease (PD) is a progressive disease, and competence in performing activities of daily living declines during its progression, increasing caregiver’s care burden perception. Care in relation to excretion-related actions is frequently required against the background of motor and non-motor symptoms, and the contents of nursing care vary, including movement and dressing. Therefore, in this study, the care burden perception in relation to excretion related actions was investigated and classified by severity and intra-day changes in symptoms.Methods: The analysis included 25 caregivers of patients who had joined the Gunma Prefecture Branch of the Japan Parkinson’s Disease Association. The questionnaire items addressed care burden perceptions relating to nine excretion related actions. Responses were classified by whether the caregiver's movement was easy (ON) or difficult (OFF). The analysis involved placing the subjects in three groups (1/2, 3, and 4) based on the Hoehn and Yahr severity scale.Results: An increase in care burden perception due to the progression of symptoms was confirmed. In addition, although the difference between ON and OFF was not significant, care burden perception tended to be higher with OFF.Conclusions: Care burden perception increased with PD symptom progression, suggesting a tendency towardmore significant effects of intra-day symptom variation. This may constitute helpful information when considering rehabilitation linked to reducing caregiver’s care burden perception in connection with PD and/or reorganization/refitting of the domestic environment.Registration No. Ethical Review Board, Takasaki University of Health and Welfare (approval no. 2952).

Living with Parkinson's disease: The benefits of community programming

Backgroundand purpose. Parkinson's Disease (PD) is a common neurodegenerative disorder that has significant physical, mental and financial costs for individuals and families. It is necessary to examine ways to improve the lives of individuals living with PD. Materials and methodsThrough the use of a thematic analysis, this study examined the benefits that participants in a community PD program experienced, and the barriers that prohibited individuals from participating. ResultsParticipants of the community PD program reported that participating in the program gave them a sense of community/belonging, increased knowledge about PD, a sense of hope/improved outlook on life, and physical improvements. Two main barriers preventing individuals from participating in the program was a lack of transportation and a fear of seeing PD symptom progression in others. ConclusionResults highlight that community PD programs can aid in improvements in quality of life related to exercise, an improved outlook, and support.

Prognostic factors of Rapid symptoms progression in patients with newly diagnosed parkinson’s disease

Tracking symptoms progression in the early stages of Parkinson's disease (PD) is a laborious endeavor as the disease can be expressed with vastly different phenotypes, forcing clinicians to follow a multi-parametric approach in patient evaluation, looking for not only motor symptomatology but also non-motor complications, including cognitive decline, sleep problems and mood disturbances. Being neurodegenerative in nature, PD is expected to inflict a continuous degradation in patients' condition over time. The rate of symptoms progression, however, is found to be even more chaotic than the vastly different phenotypes that can be expressed in the initial stages of PD. In this work, an analysis of baseline PD characteristics is performed using machine learning techniques, to identify prognostic factors for early rapid progression of PD symptoms. Using open data from the Parkinson's Progression Markers Initiative (PPMI) study, an extensive set of baseline patient evaluation outcomes is examined to isolate determinants of rapid progression within the first two and four years of PD. The rate of symptoms progression is estimated by tracking the change of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score over the corresponding follow-up period. Patients are ranked according to their progression rates and those who expressed the highest rates of MDS-UPDRS total score increase per year of follow-up period are assigned into the rapid progression class, using 5- and 10-quantiles partition. Classification performance against the rapid progression class was evaluated in a per quantile partition analysis scheme and in quantile-independent approach, respectively. The results shown a more accurate patient discrimination with quantile partitioning, however, a much more compact subset of baseline factors is extracted in the latter, making a more suitable for actual interventions in practice. Classification accuracy improved in all cases when using the longer 4-year follow-up period to estimate PD progression, suggesting that a prolonged patient evaluation can provide better outcomes in identifying rapid progression phenotype. Non-motor symptoms are found to be the main determinants of rapid symptoms progression in both follow-up periods, with autonomic dysfunction, mood impairment, anxiety, REM sleep behavior disorders, cognitive decline and memory impairment being alarming signs at baseline evaluation, along with rigidity symptoms, certain laboratory blood test results and genetic mutations.

Predicting rapid progression of Parkinson's Disease at baseline patients evaluation.

The rate of Parkinson's Disease (PD) progression in the initial post-diagnosis years can vary significantly. In this work, a methodology for the extraction of the most informative features for predicting rapid progression of the disease is proposed, using public data from the Parkinson's Progression Markers Initiative (PPMI) and machine learning techniques. The aim is to determine if a patient is at risk of expressing rapid progression of PD symptoms from the baseline evaluation and as close to diagnosis as possible. By examining the records of 409 patients from the PPMI dataset, the features with the best predictive value at baseline patient evaluation are found to be sleep problems, daytime sleepiness and fatigue, motor symptoms at legs, cognition impairment, early axial and facial symptoms and in the most rapidly advanced cases speech issues, loss of smell and affected leg muscle reflexes.

Electrophysiology and Optical Coherence Tomography to Evaluate Parkinson Disease Severity

To evaluate correlations between visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and the severity of Parkinson disease (PD). Forty-six PD patients and 33 age and sex-matched healthy controls were enrolled, and underwent VEP, PERG, and OCT measurements of macular and RNFL thicknesses, and evaluation of PD severity using the Hoehn and Yahr scale to measure PD symptom progression, the Schwab and England Activities of Daily Living Scale (SE-ADL) to evaluate patient quality of life (QOL), and disease duration. Logistical regression was performed to analyze which measures, if any, could predict PD symptom progression or effect on QOL. Visual functional parameters (best corrected visual acuity, mean deviation of visual field, PERG positive (P) component at 50 ms -P50- and negative (N) component at 95 ms -N95- component amplitude, and PERG P50 component latency) and structural parameters (OCT measurements of RNFL and retinal thickness) were decreased in PD patients compared with healthy controls. OCT measurements were significantly negatively correlated with the Hoehn and Yahr scale, and significantly positively correlated with the SE-ADL scale. Based on logistical regression analysis, fovea thickness provided by OCT equipment predicted PD severity, and QOL and amplitude of the PERG N95 component predicted a lower SE-ADL score. Patients with greater damage in the RNFL tend to have lower QOL and more severe PD symptoms. Foveal thicknesses and the PERG N95 component provide good biomarkers for predicting QOL and disease severity.

The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson’s disease

Parkinson’s disease (PD) is a complex progressive movement disorder leading to motor and non-motor symptoms that become increasingly debilitating as the disease advances, considerably reducing quality of life. Advanced treatment options include deep brain stimulation (DBS). While clinical effectiveness of DBS has been demonstrated in a number of randomised controlled trials (RCT), evidence on cost-effectiveness is limited. The cost-effectiveness of DBS combined with BMT, versus BMT alone, was evaluated from a UK payer perspective. Individual patient-level data on the effect of DBS on PD symptom progression from a large 6-month RCT were used to develop a Markov model representing clinical progression and capture treatment effect and costs. A 5-year time horizon was used, and an incremental cost-effectiveness ratio (ICER) was calculated in terms of cost per quality-adjusted life-years (QALY) and uncertainty assessed in deterministic sensitivity analyses. Total discounted costs in the DBS and BMT groups over 5 years were £68,970 and £48,243, respectively, with QALYs of 2.21 and 1.21, giving an incremental cost-effectiveness ratio of £20,678 per QALY gained. Utility weights in each health state and costs of on-going medication appear to be the key drivers of uncertainty in the model. The results suggest that DBS is a cost-effective intervention in patients with advanced PD who are eligible for surgery, providing good value for money to health care payers.

Optical coherence tomography and electrophysiology to evaluate Parkinson disease severity

AbstractPurpose To evaluate correlations between visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and the severity of Parkinson disease (PD).Methods Forty‐six patients diagnosed with PD were enrolled in this study and underwent VEP, PERG, and Cirrus and Spectralis OCT measurements of macular and RNFL thicknesses, and evaluation of PD severity using the Hoehn & Yahr scale to measure PD symptom progression, the Schwab and England Activities of Daily Living Scale (SE‐ADL) to evaluate patient quality of life (QOL), and disease duration. Logistical regression was performed to analyze which measures, if any, could predict PD symptom progression or effect on QOL.Results Visual functional parameters (best corrected visual acuity, mean deviation of visual field, PERG P50 and N95 component amplitude, and PERG P50 component latency) and structural parameters (Cirrus and Spectralis OCT measurements of RNFL and retinal thickness) were decreased in PD patients compared with healthy controls. OCT measurements were significantly negatively correlated with the Hoehn & Yahr scale, and significantly postively correlated with the SE‐ADL scale. Based on logistical regression analysis, fovea thickness provided by Cirrus OCT predicted PD severity, and QOL and amplitude of the PERG N95 component predicted a lower SE‐ADL score.Conclusion Patients with greater damage in the RPE or in the ganglion cells tend to have a lower QOL and more severe PD symptoms. Foveal thicknesses and the PERG N95 component provide good biomarkers for predicting QOL and disease severity.

Slowing down a “slow” movement disorder: Selegiline’s benefit in treating Parkinson disease

Parkinson disease (PD) is a chronic disorder of the nervous system that is characterized by tremors, slowness of movement, rigidity, and balance problems. There is no single “right way” to treat patients who have early stage PD and mild symptoms. One strategy is to use a medication called selegiline, which has been proven to relieve many symptoms in PD and may help delay the need to add stronger medications. In this issue of Neurology , Dr. Palhagen and his colleagues1 report on a study that evaluated if selegiline slows down the progress of symptoms in patients with PD who need to start the most effective of PD medications, levodopa. More information on PD and levodopa can be found on the next page. Selegiline is a medication in the monoamine oxidase type B (MAO-B) inhibitor family of drugs. MAO is a protein in cells that can break down dopamine, the main chemical that is deficient in PD. Therefore, by inhibiting MAO, selegiline helps keep dopamine available for brain cells to use. Selegiline also helps keep any replacement dopamine (created from levodopa) from being broken down. Dr. Palhagen reported on the results of a long study lasting 7 years in which selegiline plus levodopa was compared to placebo (a pill that looks like selegiline but does not contain medication) plus levodopa in a group of patients with PD. The goal of the study was to see what effect early and continued use of selegiline would have in the progression of PD symptoms. Levodopa was started on all patients in either group (selegiline or placebo) who needed a stronger medication because their PD symptoms had worsened over the years. These patients were then followed regularly for the next several years. At each evaluation, the investigators recorded …