Total Unified Parkinson's Disease Rating Scale Score Research Articles

Characteristics and influencing factors of 11C-CFT PET imaging in patients with early and late onset Parkinson's disease.

This study aims to explore the difference between 11C-methyl-N-2β-carbomethoxy-3β-(4-fluorophenyl)-tropanel (11C-CFT) positron emission tomography (PET) imaging in the early-onset Parkinson's disease (EOPD) and late-onset Parkinson's disease (LOPD), and to analyze the correlation between 11C-CFT PET imaging and disease duration, Hoehn & Yahr (H&Y) stage, motor symptoms, and non-motor symptoms in patients with idiopathic Parkinson's disease (PD), so as to explore its application value in assessing the severity of Parkinson's disease. A total of 113 patients with idiopathic PD were included in this study. The patients were divided into EOPD and LOPD groups according to the age of 60 years, of which 58 were early-onset and 55 were late-onset. All patients underwent 11C-CFT PET imaging and manually sketched regions of interest (ROI) to delineate the caudate nucleus, anterior putamen, and posterior putamen ROI layer-by-layer, and the corresponding values were recorded. Clinical data [age of onset, disease duration, H&Y stage, total Unified Parkinson's Disease Rating Scale (UPDRS) score, UPDRS III score, tremor score, postural instability/gait difficulty (PIGD) score, rigidity score, bradykinesia score, and Montreal Cognitive Assessment (MoCA) score] were collected from all patients. The differences in striatal 11C-CFT uptake between patients with EOPD and LOPD were compared, and the correlation between striatal 11C-CFT uptake and the clinical data of patients with idiopathic PD was evaluated. The caudate nucleus 11C-CFT uptake was higher in EOPD than in the LOPD group (t = 3.002, p = 0.003). 11C-CFT uptake in the caudate nucleus in patients with PD was negatively correlated with the age of onset, H&Y stage, disease duration, total UPDRS score, UPDRS III score, rigidity score, and bradykinesia score (p < 0.05). The anterior and posterior putamen 11C-CFT uptake was negatively correlated with H&Y stage, disease duration, total UPDRS score, UPDRS III score, PIGD score, rigidity score, and bradykinesia score (p < 0.05). 11C-CFT PET provides an objective molecular imaging basis for the difference in disease progression rates between patients with EOPD and LOPD. Secondly, 11C-CFT PET can be used as an important objective indicator to assess disease severity and monitor disease progression.

Brain proton magnetic resonance spectroscopy in patients with Parkinson's disease.

Background: The accuracy of current laboratory and imaging studies for diagnosis and monitoring of Parkinson's disease (PD) severity is low and diagnosis is mainly dependent on clinical examination. Proton magnetic resonance spectroscopy (MRS) is a non-invasive technique that can assess the chemical profile of the brain. In this study, we evaluated the utility of proton MRS in diagnosis of PD and determination of its severity. Methods: Patients with PD and healthy age-matched controls were studied using proton MRS. The level of N-acetylaspartate (NAA), total creatine (Cr), and total choline (Cho), and their ratios were calculated in substantia nigra (SN), putamen (Pu), and motor cortex. PD severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale. Results: Compared to 25 healthy controls (18 men, age: 59.00 ± 8.39 years), our 30 patients with PD (24 men, age: 63.80 ± 12.00 years, 29 under treatment) showed no significant difference in the metabolite ratios in SN, Pu, and motor cortex. Nigral level of NAA/Cr was significantly correlated with total UPDRS score in patients with PD (r = -0.35, P = 0.08). Moreover, patients with PD with Hoehn and Yahr scale score ≥ 2 had a lower NAA/Cr level in SN compared to patients with a lower stage. Conclusion: This study shows that 1.5 tesla proton MRS is unable to detect metabolite abnormalities in patients with PD who are under treatment. However, the NAA/Cr ratio in the SN might be a useful imaging biomarker for evaluation of disease severity in these patients.

Effect of Tiaoshen Patting Therapy Combined with Zhichan Granule on Patients with Parkinson's Disease

<bold>Objective</bold> To observe the clinical effect of Tiaoshen patting therapy combine with Zhichan granule on tremor, stiffness and postural instability on patients with Parkinson's disease. <bold>Methods</bold> A total of 228 patients with Parkinson's disease who were treated in the Shanghai Municipal Hospital of Traditional Chinese Medicine and it's medical consortium, which were randomly divided into Western medicine treatment group, traditional Chinese and Western medicine treatment group and combined treatment group,with 76 cases in each group. The Western medicine treatment group received health education about PD and Dobasazide tablets, three times a day, seven days a week, continuous treatment for 12 weeks; the traditional Chinese and Western medicine treatment group received Zhichan granule on the basis of the Western medicine treatment group, two times a day, seven days a week, continuous treatment for 12 weeks; the combined treatment group received Tiaoshen patting therapy on the basis of the traditional Chinese and Western medicine treatment group, 30 minutes a time, one time a day, three days a week, continuous treatment for 12 weeks. Before treatment, after treatment for eight weeks and after treatment for 12 weeks, Unified Parkinson Disease Rating Scale (UPDRS) and UPDRS-Ⅲ were used to evaluate PD severity and motor symptoms; Parkinson's disease non-motor symptoms questionnaire (NMS Quest) was used to evaluate the non motor symptoms of patients; 39 item Parkinson's disease quality of life questionnaire (PDQ-39) was used to evaluate the quality of life of patients; the differences of adverse reactions in the three groups were evaluated. <bold>Results</bold> Compared with before treatment, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for eight weeks decreased significantly (<italic>P</italic>&lt;0.05), and the total score of UPDRS and UPDRS-Ⅲ in the three groups after treatment for 12 weeks decreased significantly (<italic>P</italic>&lt;0.05); the scores of NMS Quest and PDQ-39 in the traditional Chinese and Western medicine treatment group after treatment for 12 weeks decreased significantly, the scores of NMS Quest and PDQ-39 in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the Western medicine treatment group at the same time, the total score of UPDRS and UPDRS-Ⅲ in the traditional Chinese and Western medicine treatment group and the combined treatment group after treatment for 8,12 weeks decreased significantly (<italic>P</italic>&lt;0.05), the NMS Quest score in the traditional Chinese and Western medicine treatment group after treatment for 8 weeks decreased significantly, the PDQ-39 score in the traditional Chinese and Western medicine treatment after treatment for 12 weeks decreased significantly, and the NMS Quest and PDQ-39 scores in the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the traditional Chinese and Western medicine treatment group at the same time, the total UPDRS score, UPDRS-Ⅲ score, NMS Quest score and PDQ-39 score of the combined treatment group after treatment for 8,12 weeks decreased significantly, the difference was statistically significant (<italic>P</italic>&lt;0.05). There was no significant difference in the incidence of adverse reactions in the three groups (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Tiaoshen patting therapy combined with Zhizhan granule can improve the motor symptoms, non motor symptoms and quality of life of PD patients, which is safe and worthy of clinical application.

Efficacy of Repetitive Trans-spinal Magnetic Stimulation for Patients with Parkinson's Disease: a Randomised Controlled Trial.

We evaluated the effect of repetitive trans-spinal magnetic stimulation (rTSMS) in patients with Parkinson's disease (PD) in a randomised, single-blind study. Participants were hospitalised and administered a single trial of rTSMS or sham treatment 2days a week for 4weeks. In addition, all participants underwent rehabilitation 5days a week for 4weeks. The primary outcome was the difference between the two groups in the mean change from baseline to post-training in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS). Secondary endpoints included the differences between the two groups in the mean change on the UPDRS part III (motor) score and the Timed Up and Go (TUG) score. Eligible participants were randomly assigned to either the rTSMS group (n = 50) or sham group (n = 50). The between-group difference in mean change in the total UPDRS score was 10.28 (95% confidence interval (CI), 4.42 to 16.13; P = 0.014) immediately after intervention from baseline, 5.04 (95% CI, - 5.41 to 15.50; P = 0.024) 3months after intervention from baseline and 2.38 (95% CI, 7.18 to 11.85; P = 0.045) 6months after intervention from baseline. Significant differences between groups in UPDRS part III and TUG scores were maintained more strictly than those in the UPDRS total score. These results strongly indicate that rTSMS promotes the effect of rehabilitation on motor function in patients with PD.

The effects of arm crank training on aerobic capacity, physical performance, quality of life, and health-related disability in patients with Parkinson's disease.

Aerobic exercise training contributes to improvement of cardiopulmonary capacity, mobility, neurological function, and quality of life. To investigate the effects of arm crank ergometer training on aerobic capacity, quality of life, and Parkinson's disease (PD)-related disability METHODS: Seventeen patients with PD were recruited to study. Assessments were performed at baseline and at the end of an 8-week arm crank ergometer (ACE) training program (3days/week; 1h per session, 50-70% VO2peak) with patients acting as their own control. Outcome measures included aerobic capacity assessment, 6-min walk test (6MWT), timed up and go test (TUG), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), Beck Depression Index (BDI), the Falls Efficacy Scale (FES), and Montreal Cognitive Assessment (MoCA). At the end of the study, an increase of 30.49% in aerobic capacity was observed. Statistically significant improvements were found for the 6MWT (p = 0.001), TUG test (p = 0.001), UPDRS total score (p = 0.002), quality of life assessed with PDQ-39 (p = 0.006), BDI (p = 0.001), and FES scores (p = 0.002) after an 8-week ACE training. No significant effect on MoCA was found (p = 0.264). An 8-week ACE training led to significant improvement in aerobic capacity, physical performance, and PD-related disabilities.

Corneal nerve fiber loss relates to cognitive impairment in patients with Parkinson\u2019s disease

Cognitive impairment in Parkinson’s disease (PD) adversely influences quality of life. There is currently no available biomarker to predict cognitive decline in PD. Corneal confocal microscopy (CCM) has been used as a non-invasive tool for quantifying small nerve damage in PD. The present study investigated whether corneal nerve measures were associated with cognitive function in PD. Patients with PD were classified into those with normal cognitive function (PD-CN), mild cognitive impairment (PD-MCI), and dementia (PDD). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) were quantified with CCM and compared with a control group. Sixty-five PD patients and thirty controls were studied. CNFD was decreased and CNBD was increased in PD patients compared to controls (P < 0.05). CNBD and CNBD/CNFD ratio was higher in PD-CN compared to controls. CNFD was positively correlated with the Montreal cognitive assessment (MoCA) score (r = 0.683, P < 0.001), but negatively associated with unified Parkinson disease rating scale (UPDRS)-part III (r = −0.481, P < 0.001) and total UPDRS scores (r = −0.401, P = 0.001) in PD patients. There was no correlation between CNFD and Levodopa equivalent daily dose (LEDD) (r = 0.176, P = 0.161). CNFD, CNBD, CNFL, and CNBD/CNFD ratio was lower with increasing Hoehn and Yahr stage. PD patients show evidence of corneal nerve loss compared with controls and corneal nerve parameters are associated with the severity of cognitive and motor dysfunction in PD. CCM could serve as an objective in vivo ophthalmic imaging technique to assess neurodegeneration in PD.

White Matter Hyperintensities, Dopamine Loss, and Motor Deficits in De Novo Parkinson's Disease.

White matter hyperintensities, prevalent in patients with Parkinson's disease (PD), significantly affect parkinsonian motor symptoms. The objective of this study was to investigate the relationship between white matter hyperintensities and nigrostriatal dopamine depletion and their interaction or mediating effects on motor symptoms in patients with drug-naive early-stage PD. This cross-sectional study enrolled 501 patients with de novo PD who initially underwent [18 F] N-(3-fluoropropyl)-2β-carbonethoxy-3β-(4-iodophenyl) nortropane positron emission tomography and brain magnetic resonance imaging scans between April 2009 and September 2015 in a tertiary-care university hospital. We quantified dopamine transporter availability in each striatal subregion and assessed the severity of periventricular and lobar white matter hyperintensities using the Scheltens scale. The relationship between white matter hyperintensities, dopamine transporter availability in the posterior putamen, and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores was assessed using multivariate linear regression and mediation analyses. Periventricular and frontal white matter hyperintensities were generally associated with dopamine transporter availability in striatal subregions after adjusting for age at symptom onset, sex, disease duration, and vascular risk factors. There was an interaction effect between periventricular white matter hyperintensities and dopamine transporter availability in the posterior putamen for the axial motor score. The effect of white matter hyperintensities on UPDRS total score and bradykinesia subscore was indirectly mediated by dopamine transporter availability in the posterior putamen, whereas the axial sub-score was directly affected by white matter hyperintensities. This study suggests that the detrimental effect of white matter hyperintensities on parkinsonian motor symptoms is more relevant and independent for axial motor impairments in the status of mildly decreased striatal dopamine transporter availability. © 2021 International Parkinson and Movement Disorder Society.

Isradipine Versus Placebo in Early Parkinson Disease: A Randomized Trial.

Studies suggest that dihydropyridine calcium-channel blockers may be associated with reduced risk for Parkinson disease (PD). To assess the effect of isradipine, a dihydropyridine calcium-channel blocker, on the rate of clinical progression of PD. Multicenter, randomized, parallel-group, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT02168842). 57 Parkinson Study Group sites in North America. Patients with early-stage PD (duration <3 years) who were not taking dopaminergic medications at enrollment. 5 mg of immediate-release isradipine twice daily or placebo for 36 months. The primary outcome was change in the Unified Parkinson's Disease Rating Scale (UPDRS) parts I to III score measured in the antiparkinson medication "ON" state between baseline and 36 months. Secondary outcomes included time to initiation and use of antiparkinson medications, time to onset of motor complications, change in nonmotor disability, and quality-of-life measures. 336 patients were randomly assigned (mean age, 62 years [SD, 9]; 68% men; disease duration, 0.9 year [SD, 0.7]; mean UPDRS part I to III score, 23.1 [SD, 8.6]); 95% of patients completed the study. Adjusted least-squares mean changes in total UPDRS score in the antiparkinson medication ON state over 36 months for isradipine and placebo recipients were 2.99 (95% CI, 0.95 to 5.03) points versus 3.26 (CI, 1.25 to 5.26) points, respectively, with a treatment effect of -0.27 (CI, -3.02 to 2.48) point (P= 0.85). Statistical adjustment for antiparkinson medication use did not change the findings. Secondary outcomes showed no effect of isradipine treatment. The most common adverse effects of isradipine were edema and dizziness. The isradipine dose may have been insufficient to engage the target calcium channels associated with neuroprotective effects. Long-term treatment with immediate-release isradipine did not slow the clinical progression of early-stage PD. National Institute of Neurological Disorders and Stroke.

Does physiotherapy plus cognitive training improve balance in Parkinson's disease? Randomized clinical trial.

Abstract Aims: Postural instability is intrinsically related to cognitive dysfunctions in Parkinson's disease (PD), which supports the importance of multimodal treatments. The purpose of this study was to investigate the effectiveness of adding cognitive training to motor physiotherapy in comparison with motor physiotherapy in the balance of individuals with PD. Methods: randomized clinical trial, where the individuals were randomized to two treatments: Physiotherapy Group (PG; n=29; M=12; HY= 2.5 [2-3]) executed balance training; Physiotherapy plus Cognitive Training Group (PCG; n=29; 10M; HY= 2.5 [1.5-3]), balance training plus a cognitive training at the end of the therapy. Evaluation instruments: Balance Evaluation Systems Test (BESTest); Unified Parkinson Disease Rating Scale (UPDRS). Results: The intragroup analysis revealed that both groups presented improved balance and UPDRS total score after execution of the protocols, but without statistically significant intergroup differences. The effect sizes were small for all the comparisons. Conclusion: There was no difference between the proposed treatments (PCG and PG). However, both interventions benefitted the individuals' balance and signs and symptoms of PD, when considered the time effect.

Pain Assessment in Indian Parkinson's Disease Patients Using King's Parkinson's Disease Pain Scale.

Background:Pain is a common symptom in Parkinson's disease (PD) patients. Scales to rate pain in PD are marred by several flaws, either not being available in other languages or not specific for PD.Objectives:To assess the frequency of pain among bilingual Indian PD patients using “King's Parkinson's disease pain scale” (KPPS) and to validate it.Methods:We randomly administered KPPS in Hindi/English to all consecutive bilingual persons with PD. The results were appropriately analyzed.Results:A total of 119 PD patients were enrolled with a mean age of 64.34 (± 9.57) years. Median Hoehn and Yahr stage was 2 (42.85%). Pain was present in 62 (52.1%) PD patients. The most common type was musculoskeletal (74.19%). The mean total KPPS score was 16.02 ± 10.57. KPPS score was significantly higher in women and correlated positively with unified Parkinson's disease rating scale (UPDRS) part 2 and 4 scores (r = 0.27 and r = 0.25). Risk factors for pain were female gender, higher H and Y stage, total UPDRS score, and individual UPDRS part 3 and 4 scores. Difficulty falling asleep (P = 0.01), frequent awakenings (P = 0.01), diminished smell sensation (P = 0.003), diminished speech volume (P = 0.02), gait freezing (P = 0.03), and falls (P = 0.001) correlated with the presence of pain. The interclass correlation coefficient between the Hindi and English versions of KPPS was 0.835, while Bland–Altman analysis showed 96.7% agreement suggesting excellent correlation and validation.Conclusions:KPPS is an easy tool for characterization, scoring, and follow-up of pain in PD patients. The Hindi version has good agreement with the original English version.

Effect of depressive symptoms on quality of life in middle-aged and elderly patients with Parkinson's disease: a 4-year follow-up study

Objective To analyze the impact of depressive symptoms on quality of life in patients with Parkinson's disease(PD)based on middle- and long-term follow-up study, and to explore predictors for the reduced quality of life in PD patients. Methods Clinical data of 80 PD patients were searched from the electronic database in our research center.Patients who had complete general information and the following data of unified Parkinson's disease rating scale(UPDRS), Hoehn and Yahr scale(HY), mini-mental state examination(MMSE), Hamilton depression rating scale(HAMD), Hamilton rating scale for anxiety(HAMA), the 39-item Parkinson's disease questionnaire(PDQ-39), etc.after one-year follow-up were included in this study.The differences in quality of life were analyzed and compared among the non-depression group(n=38), depression remission group(n=22)and depression group(n=20). A follow-up visit was conducted after four years.The disease progression and decline in quality of life were compared between the depression and non-depression groups according to the baseline value of the Hamilton Depression Rating Scale.According to the change in PDQ-39 value, cluster analysis was used to reclassify patients into fast-decline group and slow-decline group.Logistic regression analysis was used to determine independent risk factors for the decline of quality of life. Results At the end of 1 year follow-up, the quality of life was decreased in the depression group as compared with the baseline(P=0.017), and the score of PDQ-39 was higher in the depression group than in the non-depression group and depression remission group.At the end of 4-year follow-up, UPDRS total score, UPDRSⅢ score, HY stage and PDQ-39 score were increased as compared with the baseline, the quality of life decreased more significantly, and the disease progressed faster in the depression group than the other two groups(P<0.05). The differences in the disease course, total score of UPDRS, HY stage and HAMD score were statistically significant between the fast-decline group and slow-decline group(P=0.001, 0.039, 0.003 and <0.001, respectively). Logistic regression analysis showed that disease course(OR=1.254, P=0.020), and baseline HAMD score(OR=1.450, P=0.003)were the independent risk factors for the decline of quality of life. Conclusions The quality of life of PD patients is worse in the depression group than in the depression remission group and non-depression group.In PD patients with depressive symptoms, the illness progression is faster, and the quality of life is decreased more significantly.The disease course and depression can predict the decline of quality of life in PD patients. Key words: Parkinson's disease; Depression; Quality of life; Follow-up studies

Cross-sectional and longitudinal associations between total and regional white matter hyperintensity volume and cognitive and motor function in Parkinson's disease.

BackgroundWhite matter hyperintensities (WMH) are frequently observed on T2-weighted brain magnetic resonance imaging studies of healthy older adults and have been linked with impairments in balance, gait, and cognition. Nonetheless, few studies have investigated the longitudinal effects of comorbid WMH on cognition and motor function in Parkinson's disease.MethodsThe Lesion Segmentation Tool for Statistical Parametric Mapping was used to obtain total lesion volume and map regional WMH probabilities in 29 PD and 42 control participants at two study visits 18 months apart. Both cross-sectional and longitudinal comparisons were made between composite scores in the domains of executive function, memory, and language, and Unified Parkinson's Disease Rating Scale (UPDRS) scores.ResultsWe found no difference between disease and control groups in total WMH volume or progression during the study. Greater regional and global WMH at baseline was more strongly associated with lower executive function in PD subjects than in controls. Increased regional WMH was also more strongly associated with impaired memory performance in PD relative to controls. Longitudinally, no associations between cognitive change and total or regional WMH progression were detected in either group. A positive relationship between baseline regional WMH and total UPDRS scores was present in the control group, but not PD. However, greater WMH increase was associated with a greater increase in UPDRS motor sub-scores in PD.ConclusionsThese findings suggest that although PD patients do not experience greater mean WMH load than normal aged adults, comorbid WMH do exacerbate cognitive and motor symptoms in PD.

Combination therapy of scalp electro-acupuncture and medication for the treatment of Parkinson's disease: A systematic review and meta-analysis

Abstract Objective To summarize the current clinical evidence related to the therapeutic effects and safety of adjuvant scalp electro-acupuncture (SEA) treatment for Parkinson's disease in China. Methods Following the PRISMA statement, seven electronic databases were searched to retrieve randomized controlled clinical trials that used SEA combined with medication as the treatment intervention, and medication as the control. RevMan 5.3 was used to analyze outcomes, including the Unified Parkinson's Disease Rating Scale (UPDRS), Webster scale, effectiveness rate, and UPDRS III. Results Nine randomized controlled trials, with certain methodological flaws and risks of bias, were included that involved 474 participants. SEA combined with medication was more effective than medication alone in overall therapeutic effects, as evidenced by total UPDRS scores (mean difference (MD): 7.15, 95% confidence interval [CI] 0.24 to 14.07, P = .04), Webster scores (MD: 1.60, 95% CI 0.20 to 2.99, P = .03), and effectiveness rate (risk ratio: 1.35, 95% CI 1.19 to 1.54, P Conclusion The combination of SEA and medication may be a promising intervention for patients with Parkinson's disease, especially to improve motor function. However, results were inconclusive, and additional studies with rigorous experimental design and larger sample sizes are needed to verify these results.

Does nutritional status affect Parkinson's Disease features and quality of life?

ObjectivesThe aim of this study was to determine the relationship between nutritional status and Parkinson's Disease (PD) features in association with depression, anxiety and quality of life in people with PD.Materials and methodsThis study was conducted on 96 patients with idiopathic PD to whom the following scales were applied: Unified Parkinson’s Disease Rating Scale (UPDRS), 39-item PD questionnaire (PDQ-39), Hospital Anxiety and Depression Score (HADS), Mini Nutritional Assessment (MNA). The scales and measurements were applied to patients at their first assessment. Patients with malnutrition or at risk of malnutrition were assessed by the dietitian and nutrition nurse. These patients received nutritional support through personalized diet recommendations and appropriate enteral nutritional products, considering factors such as age, comorbidity, socioeconomic and cultural conditions. At the end of 6 weeks, the scales and measurements applied during the first visit were again applied to the patients.ResultsA significant and inverse correlation was determined between mental (Spearman r:-0.510, p<0.001), activities of daily living (Spearman r:-0.520, p<0.001), motor (Spearman r:-0.480, p<0.001), complications (Spearman r:-0.346, p<0.001) UPDRS subdivisions and total scores (Spearman r:-0.644, p<0.001) and total MNA score. A significant and inverse correlation was found between all PDQ-39 subdomains and total MNA score (p<0.05). The highest inverse correlations were found in mobility (Spearman r:-0.690, p<0.001) and stigma (Spearman r:-0.570, p<0.001). Both depression (Spearman r:-0.631, p<0.001) and anxiety (Spearman r:-0.333, p<0.001) scores were determined to be inversely correlated with total MNA score. At the 6-week control visit, significantly lower scores were found in all subdivisions and in the total UPDRS score, PDQ-39 score and in the patients' anxiety and depression scores (p<0.05). MNA scores were found to be significantly higher in the assessment performed after 6 weeks of support for patients who had abnormal nutritional status at inception (p<0.001).ConclusionPD motor and nonmotor functions, disease duration and severity are related to nutritional status. Quality of life was also shown to be affected by changes in the nutritional status. These results show that nutritional status assessment should be a standard approach in the PD treatment and follow-up processes.

Short-Term Outcomes of Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson’s Disease - Pilot Study

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with Parkinson's disease (PD), but more studies about gait and functionality are needed. We aimed to understand whether short-term DBS treatment will can relieve the symptoms of PD patients, specifically we examined its effect on motor-cognitive-complication parameters, fine motor skills and daily living activity (DLA) of these patients. Method: Ten patients from Mustafa Kemal University Neurosurgery Department were recruited. The assessments were made twice, first time preoperatively, which was within one week prior to the surgery, second time postoperatively, which was 55-65 days post treatment. The motor scores, DLA scores, mental scores and complication scores were measured with Unified Parkinson's Disease Rating Scale (UPDRS), fine motor skills measured with The nine-hole peg test (9-HPT), balance measured with Berg Balance Scale (BBS) and falling risk measured with Timed Up and Go Test (TUG). Results: 10 patients (5 female, 5 male) aged between 40-60 (mean=49.44±6.69 years) were included in the study. Duration of the disease’s mean was 5.60 years. We found significant difference between pre-op and post-op results in UPDRS DLA, UPDRS motor, UPDRS complication, UPDRS total score and TUG tests (Table 2). There was no significant difference between preop-postop assessment in UPDRS mental, BBS and 9-HPT results (p&gt;0.05). Discussion: Balance, walk and fine motor impairment occurs almost always in Parkinson’s disease and resulting in difficulties with daily living activities. We found that DBS has positive effect on PD complications, balance and walking abilities. PD patients that have falling risk and multiple motor symptoms may have benefit from DBS.

Abnormal Spontaneous Brain Activity in Early Parkinson's Disease With Mild Cognitive Impairment: A Resting-State fMRI Study.

Mild cognitive impairment (MCI) is a common symptom at the baseline of early Parkinson’s disease (PD) diagnosis, but the neural mechanism is unclear. To address the issue, the present study employed resting-state functional magnetic resonance imaging data of 19 drug-naïve PD patients with normal cognition (PD-NC), 10 PD patients with MCI (PD-MCI) and 13 age- and gender-matched healthy controls (HC) from the Parkinson’s progression markers initiative (PPMI) (http://www.ppmi-info.org/), and examined abnormal spontaneous brain activities in the PD-MCI. The pattern of spontaneous brain activity was measured by examining the amplitude of low-frequency fluctuations (ALFF) of blood oxygen level dependent signal. Voxel-wise one-way analysis of covariance and post hoc analyses of ALFF were performed under non-parametric permutation tests in a general linear model among the three groups, with age, gender and data center as additional covariates. Statistical significances in the post hoc analysis were corrected by a small volume correction with a cluster-level threshold of p < 0.05 (n = 10000 permutations, FWE-corrected). Correlations of clinical and neuropsychological assessments [i.e., Unified Parkinson’s Disease Rating Scale (UPDRS) total score, Montreal Cognitive Assessment (MoCA) and cognitive domains] with the regional ALFF were performed in the PD-MCI group. Compared with the HC, both PD groups exhibited reduced ALFF in the occipital area (Calcarine_R/Cuneus_R). Specially, the PD-MCI group additionally exhibited increased ALFF in the opercular part of right inferior frontal gyrus (Frontal_Inf_Oper_R). Comparing with the PD-NC, the PD-MCI group exhibited significantly higher ALFF in the Frontal_Inf_Oper_R and left fusiform gyus (ps < 0.05). The correlation analysis revealed that the ALFF in the Frontal_Inf_Oper_R was positively correlated with the UPDRS total score (p < 0.05), but marginally negatively correlated with the MoCA score. For cognitive domains, the ALFF in the region also showed a significantly negative correlation with the score of SF test (p < 0.01) and a marginally negative correlation with the score of Symbol-Digit Modalities Test. Together, we concluded hyperactivity in the right inferior frontal gyrus in early PD with MCI, suggesting a compensatory recruitment in response to cognitive decline, which may shed light on thought of dementia progression and potentially comprehensive treatment in PD.

Meta-Analysis of Creatine for Neuroprotection Against Parkinson's Disease.

Creatine is an antioxidant agent that showed neuroprotective effects in animal models of Parkinson's disease (PD). Creatine was selected by the National Institute of Neurological Disorders and Stroke as a possible disease modifying agent for Parkinson's disease. Therefore, many clinical trials evaluated the efficacy of creatine for patients with PD. The aim of this systematic review and meta-analysis is to synthesize evidence from published randomized controlled trials (RCTs) about the efficacy of Creatine for patients with PD. We followed PRISMA statement guidelines during the preparation of this systematic review and meta-analysis. A computer literature search for PubMed, EBSCO, web of science and Ovid Midline was carried out. We included RCTs comparing creatine with placebo in terms of motor functions and quality of life. Outcomes of total Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS I, UPDRS II, and UPDRS III were pooled as mean difference (MD) between two groups from baseline to the endpoint. Statistical heterogeneity was assessed by visual inspection of the forest plot and measured by chi-square and I square tests. Three RCTs (n=1935) were included in this study. The overall effect did not favor either of the two groups in terms of: UPDRS total score (MD 1.07, 95% CI [3.38 to 1.25], UPDRS III (MD 0.62, 95% CI [2.27 to 1.02]), UPDRS II (MD 0.03, 95% CI [0.81 to 0.86], or UPDRS I (MD 0.03, 95% CI [0.33 to 0.28]). Current evidence does not support the use of creatine for neuroprotection against PD. Future well-designed, randomized controlled trials are needed.

A review of disease progression models of Parkinson's disease and applications in clinical trials.

Quantitative disease progression models for neurodegenerative disorders are gaining recognition as important tools for drug development and evaluation. In Parkinson's disease (PD), several models have described longitudinal changes in the Unified Parkinson's Disease Rating Scale (UPDRS), one of the most utilized outcome measures for PD trials assessing disease progression. We conducted a literature review to examine the methods and applications of quantitative disease progression modeling for PD using a combination of key words including "Parkinson disease," "progression," and "model." For this review, we focused on models of PD progression quantifying changes in the total UPDRS scores against time. Four different models reporting equations and parameters have been published using linear and nonlinear functions. The reasons for constructing disease progression models of PD thus far have been to quantify disease trajectories of PD patients in active and inactive treatment arms of clinical trials, to quantify and discern symptomatic and disease-modifying treatment effects, and to demonstrate how model-based methods may be used to design clinical trials. The historical lack of efficiency of PD clinical trials begs for model-based simulations in planning for studies that result in more informative conclusions, particularly around disease modification. © 2016 International Parkinson and Movement Disorder Society.

Metabolic Covariant Network in Relation to Nigrostriatal Degeneration in Carbon Monoxide Intoxication-Related Parkinsonism.

Presence of parkinsonian features after carbon monoxide (CO) intoxication is well known and the severity was found to relate to the pre-synaptic dopaminergic deficits. There is no systemic study to analyse the functional network involved in CO-related Parkinsonism. Forty-five CO-related parkinsonism patients and 25 aged-matched controls completed the 3D T1-weighted imaging and 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Voxel-based morphometry (VBM) was performed to assess the structural and functional brain differences between the patients and controls. Spatial covariant networks responsible for distinguishing patients and controls were constructed using independent component analysis. For validation, the pre-synaptic dopaminergic functional network was established by regression model using striatal TRODAT-1 SPECT as the independent variable. The clinical significance of both networks was determined by correlation with the Unified Parkinson's Disease Rating Scale (UPDRS). Compared with controls, the spatial covariant signals of FDG-PET were significantly lower in the medial and lateral frontal, caudate nucleus, dorsomedial prefrontal areas, and temporal-parietal regions while the spatial intensities correlated significantly with UPDRS total scores. The functional network that correlated with striatum pre-synaptic dopaminergic uptakes included the midbrain, thalamus, caudate, lateral frontal cortex, ventral striatum, ventral, or dorsal anterior cingulate cortex. Both networks overlapped considerably and the topographies reflected structural damage pattern. Our study provides evidence that glucose metabolism in CO-parkinsonism patients pertains to an organized covariant pattern in the cortical regions that is spatially coherent with the cortical map of pre-synaptic dopamine deficits. As the fronto-temporal, striatum, and temporal-parietal areas were involved, the unique metabolic covariant network suggests a different pathophysiology in CO-related parkinsonism.

Efficacy of rasagiline in early Parkinson's disease: a meta-analysis of data from the TEMPO and ADAGIO studies

Aim of the study: To evaluate the efficacy of rasagiline versus placebo in a pooled population of patients with early Parkinson's disease (PD). Materials and methods: TEMPO and ADAGIO were Phase III studies that evaluated the symptomatic efficacy of rasagiline versus placebo in patients with early PD. This meta-analysis included Unified Parkinson's Disease Rating Scale (UPDRS) observations from weeks 12, 24 and 36 in ADAGIO and from weeks 14 and 26 in TEMPO; TEMPO visits were recoded to weeks 12 and 24, respectively. The present analysis includes all patients who received rasagiline 1 mg/day, 2 mg/day or placebo, and had ≥1 post-baseline observations and a subgroup of patients whose baseline UPDRS Total scores were ≥27 (Upper Quartile population). Change from baseline in UPDRS scores were evaluated using mixed models repeated measures analyses. Results: Of the 1578 patients randomized to the two studies, 1546 patients met criteria for inclusion in the meta-analysis. Effects on UPDRS Total, motor and activities of daily living scores were significantly better for both doses of rasagiline compared with placebo at all time periods. The Upper Quartile population included 402 patients with a UPDRS Total score ≥27 at baseline. These patients generally demonstrated a larger magnitude of treatment effect than was seen in the full population. Conclusions: This meta-analysis confirms the efficacy of rasagiline monotherapy over 36 weeks. Although TEMPO and ADAGIO are considered studies of “very early” PD, both contained a sizeable pool of patients with more severe disease. In addition, the meta-analysis showed a larger magnitude of effect in patients with more severe baseline disease.