Severity Of Parkinsonian Symptoms Research Articles

Addressing voice recording replications for tracking Parkinson's disease progression.

Tracking Parkinson's disease symptom severity by using characteristics automatically extracted from voice recordings is a very interesting and challenging problem. In this context, voice features are automatically extracted from multiple voice recordings from the same subjects. In principle, for each subject, the features should be identical at a concrete time, but the imperfections in technology and the own biological variability result in nonidentical replicated features. The involved within-subject variability must be addressed since replicated measurements from voice recordings can not be directly used in independence-based pattern recognition methods as they have been routinely used through the scientific literature. Besides, the time plays a key role in the experimental design. In this paper, for the first time, a Bayesian linear regression approach suitable to handle replicated measurements and time is proposed. Moreover, a version favoring the best predictors and penalizing the worst ones is also presented. Computational difficulties have been avoided by developing Gibbs sampling-based approaches.

Cross-Cultural Differences of the Non-Motor Symptoms Studied by the Traditional Chinese Version of the International Parkinson and Movement Disorder Society- Unified Parkinson's Disease Rating Scale.

Given the importance of ethnic differences in the evaluation of various aspects of symptoms in patients with Parkinson's disease (PD), we present the formal procedure for completing the traditional Chinese translation of the International and Parkinson and Movement Disorder Society/UPDRS (MDS-UPDRS) and highlight the discrepancy in nonmotor symptoms (NMS) between patients in Eastern and Western countries. A total of 350 native Chinese-speaking PD patients were recruited from multiple hospitals in Eastern countries; they completed the MDS-UPDRS. The translation process was executed and factor analysis was performed to determine the structure of the scale. Chi-squared and t tests were used to compare frequency and severity of PD symptoms between the Chinese-speaking and English-speaking groups (n = 876). NMS and motor symptoms were more severe in the Western population (Part I: t(1205) = 5.36, P < 0.0001; and Part III: t(1205) = 7.64, P < 0.0001); however, the prevalence of cognitive dysfunction and impairments in activities of daily living were more frequent in the Eastern patients. The comparative fit index was 0.93 or greater, and the exploratory factor analysis revealed compatible results between the translated scale and the original version. The traditional Chinese version of the MDS-UPDRS can be designated as an official translation of the original scale, and it is now available for use. Moreover, NMS in PD constitute a major issue worldwide, and the pattern of NMS among the Chinese population is more marked in terms of cognition-based symptoms and activities of daily living.

Evaluation of severity of predominantly non-dopaminergic symptoms in Parkinson's disease: The SENS-PD scale

IntroductionIn spite of the multisystem nature of Parkinson's disease (PD), the formal assessment of its impairments is focused on symptoms predominantly reflecting degeneration of dopaminergic neurons. The aim of this study was to develop a valid and reliable rating scale of predominantly non-dopaminergic (PND) symptoms, which can be used as an additional measure of severity and progression of PD. MethodsUsing data of the PROPARK (N = 396) and ELEP (N = 365) cohorts, three items were selected from each of six selected PND domains (cognitive impairment, depressive symptoms, excessive daytime sleepiness, psychotic symptoms, autonomic dysfunction and Postural-Instability-and-Gait-Difficulty), based on item–total correlations. Hereafter, we evaluated reliability and validity of the resulting scale. ResultsThe 18-item PND scale showed to be reliable and valid. Cronbach's alpha was 0.83. Principal component analysis using the six domain scores resulted in one factor, justifying the calculation of a sum score. Correlation coefficients of the sum score with severity of non-motor symptoms (non-motor part of MDS–UPDRS), motor symptoms (SPES/SCOPA scale), and Hoehn and Yahr stage were 0.63, 0.41 and 0.48, respectively (p < 0.001). ConclusionWe developed a short, reliable and valid scale to evaluate severity of PND symptoms in PD. The score is expected to be largely insensitive to dopaminergic effects and may therefore more accurately reflect severity and progression of the underlying disease than currently used dopamine-sensitive measures. In combination with assessment of predominantly dopaminergic (motor) symptoms, a broad yet concise evaluation of PD is obtained, which better captures the widespread clinical consequences of the multisystem disease.

Transcranial magnetic stimulation in Parkinson's disease

This review presents the results of studies investigating the effects of transcranial magnetic stimulation (TKMS) on motor and non-motor symptoms of Parkinson's disease (PD). It has been found that TKMS reduces the severity of both motor and non-motor disorders without causing serious side-effects. Magnetic field therapy can be combined with pharmacological and non-drug therapies, including the use of dopaminergic therapy, antidepressants and anti-dementia drugs, as well as stereotactic operations. It is necessary to continue the study of the influence of TKMS on the severity of PD symptoms using different electromagnetic characteristics.

Severe dopaminergic neuron loss in rhesus monkey brain impairs morphine-induced conditioned place preference.

It is well known that dopamine (DA) is critical for reward, but the precise role of DA in reward remains uncertain. The aim of this study was to determine what percentage of dopaminergic neurons in the primate brain is required for the expression of conditioned reward by measuring the performance of DA-deficient rhesus monkeys in a morphine-induced conditioned place preference (CPP) paradigm. Animals with mild Parkinsonian symptoms successfully developed and retained a morphine preference that was equivalent to control monkeys. However, these monkeys could not maintain the preference as well as controls when they retained severe Parkinsonian symptoms. On the other hand, monkeys initially in a severe Parkinsonian state developed a preference for morphine, but this preference was weaker than that of the controls. Histological results showed that the loss of dopaminergic neurons in monkeys that had severe Parkinsonian symptoms was about 80% in comparison to the control monkeys. All these data suggest that a severely impaired DA system alters rewarding-seeking behavior in non-human primates.

The characteristics of camptocormia in patients with Parkinson's disease: A large cross-sectional multicenter study in Japan

PurposeThe goal of the present study was to clarify the clinical characteristics and laboratory results of parkinsonian symptoms among patients with and without camptocormia. MethodsSeventy-eight Parkinson's disease (PD) patients with camptocormia and 78 PD patients without camptocormia underwent a neurological examination, a blood test, and spinal magnetic resonance imaging (MRI). PD with camptocormia group and PD with non-camptocormia group were matched on age, age at PD onset, and sex. Principal resultsCamptocormia group had significantly higher prevalence of compression fractures, more severe parkinsonian symptoms, and a greater incidence of dementia than those without camptocormia. Serum creatine kinase levels in camptocormia group significantly elevated compared with non-camptocormia group. There were higher prevalence of abnormal findings in spine MRI including compression fractures and paravertebral muscle changes in camptocormia group compared with non-camptocormia group. Major conclusionsCamptocormia is associated with a greater prevalence of compression fractures and associated with greater UPDRS part II, part III score, axial score, and lower MMSE in this cross-sectional study. Thus, it can be concluded that camptocormia in PD is predominantly myopathic.

Non-exercise physical activity attenuates motor symptoms in Parkinson disease independent from nigrostriatal degeneration.

To investigate the relationship between time spent in non-exercise and exercise physical activity and severity of motor functions in Parkinson disease (PD). Increasing motor impairments of PD incline many patients to a sedentary lifestyle. We investigated the relationship between duration of both non-exercise and exercise physical activity over a 4-week period using the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire and severity of clinical motor symptoms in PD. We accounted for the magnitude of nigrostriatal degeneration. Cross-sectional study. PD subjects, n = 48 (40 M); 69.4 ± 7.4 (56-84) years old; 8.4 ± 4.2 (2.5-20) years motor disease duration, mean UPDRS motor score 27.5 ± 10.3 (7-53) and mean MMSE score 28.4 ± 1.9 (22-30) underwent [(11)C]dihydrotetrabenazine (DTBZ) PET imaging to assess nigrostriatal denervation and completed the CHAMPS questionnaire and clinical assessment. Bivariate correlations showed an inverse relationship between motor UPDRS severity scores and duration of non-exercise physical activity (R = -0.37, P = 0.0099) but not with duration of exercise physical activity (R = -0.05, P = 0.76) over 4 weeks. Multiple regression analysis using UPDRS motor score as outcome variable demonstrated a significant regressor effect for duration of non-exercise physical activity (F = 6.15, P = 0.017) while accounting for effects of nigrostriatal degeneration (F = 4.93, P = 0.032), levodopa-equivalent dose (LED; F = 1.07, P = 0.31), age (F = 4.37, P = 0.043) and duration of disease (F = 1.46, P = 0.23; total model (F = 5.76, P = 0.0004). Non-exercise physical activity is a correlate of motor symptom severity in PD independent of the magnitude of nigrostriatal degeneration. Non-exercise physical activity may have positive effects on functional performance in PD.

Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson's Disease.

Sleep problems are among the most common non-motor symptoms of Parkinson's disease (PD). The PD Sleep Scale 2nd version (PDSS-2) improved the original PDSS by adding more items on different aspects of sleep problems, making it a more robust tool to evaluate the severity of sleep disturbances. However, previous studies on deep brain stimulation (DBS) have not used the PDSS-2. To determine if the PDSS-2 could detect improvement reliably in sleep problems after bilateral subthalamic nucleus DBS for PD. In this prospective study, 25 consecutive patients undergoing DBS implantation were enrolled. Patients were examined twice: 1 week prior to the DBS implantation (baseline) and 12 months postoperatively. Severity of PD symptoms were assessed by the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Presence and severity of sleep disturbances were specifically measured by PDSS-2. Total score of MDS-UPDRS improved from 81 (median, interquartile-range: 63-103) to 55 points (median, IQR: 46-75, p < 0.001). Health-related quality of life, measured by PDQ-39, also improved from 29 (IQR: 18-40) to 15 (IQR: 9-28) points (p = 0.002). Most domains of NMSS also improved. At baseline 13 patients reported sleep problems, but 1 year after DBS implantation only 3 did (p = 0.012). Although only 6 out of 15 items showed a significant decrease after DBS implantation, the total score of PDSS-2 decreased from 24 (IQR: 17-32) to 10 (IQR: 7-18) points (P < 0.001). Based on our results, PDSS-2 can detect improvements in sleep quality reliably after DBS implantation.

On the relationship among different motor processes: a computational modeling approach.

On the relationship among different motor processes: a computational modeling approach.

Reading Comprehension in Parkinson's Disease

Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results. Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning. The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group. Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.

Discharge responses of the optic tract to flash stimuli in Parkinson's disease.

Dopamine has a significant role in retinal processing, and it has been demonstrated that retinal dopamine content is decreased in parkinsonian patients. We measured the latency of the evoked discharges in the optic tract (OT) to flash stimuli during stereotactic pallidal neurosurgery in 25 patients with Parkinson's disease (PD) (13 women and 12 men, age 38–78 years, unified Parkinson's disease rating scale (UPDRS) Motor Score in the Off state 11–54, Hoehn and Yahr stage in the Off state 1.5–5) and investigated the effects of age at surgery, disease duration, levodopa dose, and severity of parkinsonian symptoms on the latency. OT discharges were evoked by monocular flash stimuli delivered from a flashlight with a krypton bulb with a tungsten filament. The luminance at the eye measured ∼4 × 104 cd/m2. The light wavelength of the stimulus was composed of a wide spectrum with its peak at around 800 nm or longer. The latency of OT discharges ranged 49–79 msec, and there was a significant positive correlation between the latencies of evoked activities in the OT to a flashlight and age (r = 0.59, P < 0.001, by Pearson correlation), but no correlation between the latency and the severity of parkinsonian symptoms and between the latency and duration of illness. These results indicate that the delay in visual processing and conduction at the level of the retina and the OT are substantially derived from age-related degenerative changes in the retina and visual pathway which are apparently unrelated to the striatal dopamine deficiency in PD.

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.

Clinical correlates of periodic limb movements in sleep in parkinson’s disease in Egypt

Introduction: Patients with Parkinson’s disease (PD) are prone to sleep disturbances and disorders, with a prevalence of 78–98% (Norlinah et al., 2009). One of the common sleep disturbances that might occur in PD is periodic limb movement disorder (PLMD) which have been found to be more common in PD than in controls (Freedom, 2007). Both RLS and PLM are sensitive to dopamine and dopamine agonists being drugs of choice for these disorders (Chaudhuri et al., 2006). Objective: The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson’s disease (PD) and their impact on nocturnal sleep and correlation with severity of parkinsonian symptoms. 36 Parkinson’s disease (PD) patients were enrolled from involuntary movement outpatient clinic in Ain Shams University hospital and submitted to clinical assessment by unified Parkinson disease scale (UPDRS) part III, Hamilton depression scale, structured sheet for sleep questionnaire, Pittsburg sleep scale, Epwarth sleepiness scale and polysomnography. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI >15(PLMS +ve) and PLMSI <15 (PLMS −ve). There were 8 (22.2%) PD patients in the PLMS +ve group and 28 (77.8%) patients in the PLMS −ve group. Assessment by UPDRS (III) revealed an association between PLMS + status and greater PD motor symptoms severity, in addition to lower sleep quality reflected by higher scores of PITTSBURG scale in the PLMS +ve. No significant group differences were detected on PSG measures. We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced sleep quality. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.

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 &amp; 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 &amp; 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.

Negative influence of L-dopa on subjectively assessed sleep but not on nocturnal polysomnography in Parkinson's disease

BackgroundSleep disorders are highly prevalent among patients with Parkinson's disease (PD). Chronic medication with L-dopa may be one of the factors that contributes to poor sleep quality. The aim of this study was to assess the effects of long term use of L-dopa on objective and subjective measures of sleep quality in PD patients. MethodsTwenty-seven PD patients (mean age 62.5±8.6 years, mean disease duration 7.3±5.9 years, 11 females) underwent nocturnal polysomnography. Their sleep was rated subjectively using the Parkinson's disease sleep scale (PDSS), and their disease severity was assessed using the unified Parkinson's disease severity scale (UPDRS) standard questionnaire. Doses of L-dopa and other medications were correlated with parameters of sleep quality. The polysomnographic recordings were compared with those from 24 age- and gender-matched normal controls. ResultsThe patients showed decreased total sleep time (TST) and sleep efficiency (SE), prolonged sleep onset and REM sleep latency and wake after sleep onset (WASO). Parts I–III of the UPDRS scores correlated with TST, SE andWASO but not with PDSS scores. L-dopa dosage and part IV of the UPDRS correlated with PDSS scores but not with polysomnographic parameters. ConclusionsHigher doses of chronically administered L-dopa correlated with lower sleep quality according to the subjective measures but not according to the polysomnographic parameters, which were related to the severity of PD symptoms. The low sleep quality according to the subjective measurements may result from complications of therapy at high doses of L-dopa.

Clinical Features of Parkinson Disease when Onset of Diabetes Came First: A Case-Control Study

Editors' Note: Comments in Writ e Click this week were all in reference to “Clinical features of Parkinson disease when onset of diabetes came first: A case-control study” by Cereda et al. Drs. Kawabe et al. question whether differences in ischemic brain lesions, hypertension, or statin use may be affecting the results. The authors respond that patients with macrovascular lesions were excluded and that hypertension was similar between groups, while statin use may have been protective to the diabetic group. Drs. Kotagal et al. suggest that the data indicate that diabetes may be specifically related to postural instability and gait difficulty. The authors agree with the possibility and that the question deserves further study. Megan Alcauskas, MD, and Robert C. Griggs, MD. # {#article-title-2} Cereda et al.1 elucidated the relationship between Parkinson disease (PD) and diabetes. The authors concluded that the onset of diabetes before the onset of PD appeared to be a risk factor for more severe PD symptoms. …

Clinical features of Parkinson disease when onset of diabetes came first

Recent literature suggests that diabetes is a risk factor for Parkinson disease (PD). We investigated the clinical features of patients with idiopathic PD (IPD) in whom the onset of diabetes came first. We designed a case-control study. From the cohort of all new patients with IPD free of vascular disease (n = 783) admitted and evaluated at our institute over a 3-year period (2007-2010), we included all the patients with a diagnosis of diabetes prior to PD onset (n = 89) and a control group (n = 89) matched (1:1) for gender, body mass index (± 1 kg/m(2)), and duration of PD (± 1 year). The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was the primary endpoint. At study entry, patients with diabetes were similar to controls in terms of most demographic, lifestyle, and general medical features with exception of statins (18% vs 3.4%; p = 0.003). However, diabetes was associated with higher UPDRS motor (22.3 ± 9.0 vs 19.3 ± 7.9; p = 0.019) and activities of daily living (9.7 ± 5.1 vs 8.3 ± 4.3; p = 0.049) scores, more severe Hoehn & Yahr staging (p = 0.009), and higher treatment doses of levodopa (mg/day, 448 ± 265 vs 300 ± 213; p < 0.0001; mg/kg/day, 5.8 ± 4.0 vs 3.8 ± 2.9; p < 0.0001). Onset of diabetes before the onset of PD appears to be a risk factor for more severe PD symptoms. These findings support the hypothesis that diabetes has a role in the etiopathogenesis of PD. Neurologists should be aware of the potential impact of diabetes on overall PD management.

Clinical correlates of periodic limb movements in sleep in Parkinson's disease

ObjectiveThe aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson's disease (PD) and their impact on nocturnal sleep and daytime functioning. MethodsForty-five PD patients (mean age 68.5±8.7years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ≥15 (PLMS+) and PLMSI <15 (PLMS−). ResultsThere were 26 (57.8%) PD patients in the PLMS+group and 19 (42.2%) patients in the PLMS−group. Subjective assessment revealed an association between PLMS+status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures. ConclusionWe observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.

Novel Speech Signal Processing Algorithms for High-Accuracy Classification of Parkinson's Disease

There has been considerable recent research into the connection between Parkinson's disease (PD) and speech impairment. Recently, a wide range of speech signal processing algorithms (dysphonia measures) aiming to predict PD symptom severity using speech signals have been introduced. In this paper, we test how accurately these novel algorithms can be used to discriminate PD subjects from healthy controls. In total, we compute 132 dysphonia measures from sustained vowels. Then, we select four parsimonious subsets of these dysphonia measures using four feature selection algorithms, and map these feature subsets to a binary classification response using two statistical classifiers: random forests and support vector machines. We use an existing database consisting of 263 samples from 43 subjects, and demonstrate that these new dysphonia measures can outperform state-of-the-art results, reaching almost 99% overall classification accuracy using only ten dysphonia features. We find that some of the recently proposed dysphonia measures complement existing algorithms in maximizing the ability of the classifiers to discriminate healthy controls from PD subjects. We see these results as an important step toward noninvasive diagnostic decision support in PD.

Determining the Efficacy of Rasagiline in Reducing Bradykinesia Among Parkinson's Disease Patients: A Review

ABSTRACTBackground: Bradykinesia has a significant impact on the lives of Parkinson's disease (PD) patients. Consequently, treating this symptom is of particular concern for patients and clinicians. A number of studies have documented the efficacy of rasagiline in reducing the severity of PD symptoms. Objective: To summarize studies that specifically examined the impact of rasagiline on bradykinesia symptoms in PD patients across disease severity. Methods: The EMBASE database was searched for relevant articles published between 2000 and November 2010. Results: Three studies were identified that explicitly examined the effect of rasagiline on the bradykinesia subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) motor examination. In each, 1 mg/day rasagiline significantly reduced bradykinesia scores in patients. Conclusion: As a monotherapy or an adjunctive therapy, rasagiline is an effective drug for reducing the severity of bradykinesia in PD patients.