Unified Parkinson's Disease Rating Scale Motor Scores Research Articles

Parkinson Hastalığının İlerlemesini Tahmin Etmek: Ses Girişlerinden Yararlanan İnvazif Olmayan Bir Yöntem

Parkinson's Disease (PD) is a complex neurodegenerative condition with a global impact, demanding precise disease progression prediction to facilitate effective treatment strategies. To assess PD symptoms, the Unified Parkinson's Disease Rating Scale (UPDRS) is widely adopted, encompassing both motor and non-motor assessments. This research delves into voice inputs as a non-intrusive method to predict total UPDRS and motor UPDRS scores, offering new possibilities for Parkinson's assessment. Feature engineering and data augmentation techniques address challenges related to class imbalance and diverse demographics, including an original imbalanced dataset with more females than males. Additionally, three new datasets are created: oversampled balanced, only-female, and only-male datasets. Ensemble-based stacking model, including random forest and extreme gradient boosting as base models and the gradient boosting regressor as the meta-regressor, demonstrate promising performance and robustness in predicting UPDRS scores, showcasing the efficacy of voice inputs for PD assessment. Furthermore, the feature importance analysis provides insights into crucial contributors influencing predictions. Various performance metrics, such as accuracy, mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE), and R-squared (R2), are used to evaluate the model’s performance. Additionally, by incorporating telemonitoring capabilities, the voice-based approach offers the possibility of remote and continuous PD assessment, allowing for real-time monitoring and early detection. This advancement could significantly improve the quality of life for PD patients and facilitate more personalized and effective treatment plans.

Striatal Dopamine Transporter Uptake, Parkinsonism, and Cognition in Alzheimer's Disease.

The correlates of motor parkinsonism in Alzheimer's disease (AD) remains controversial. We evaluated the effects of nigrostriatal dopaminergic degeneration on parkinsonism and cognition in biomarker-validated patients with AD. This study recruited 116 patients with AD who underwent dual-phase 18 F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane PET, 18 F-Florbetaben PET, 3-Tesla brain MRI, Unified Parkinson's Disease Rating Scale (UPDRS) and neuropsychological tests. The mean cortical thickness in the frontal, temporal, parietal, and occipital cortices, and the dopamine transporter (DAT) uptake in the caudate, anterior/posterior putamen, and substantia nigra were quantified. We investigated the relationship between DAT uptake, mean lobar cortical thickness, UPDRS motor score, and cognition using general linear models (GLMs) after controlling for age, sex, education, intracranial volume, and deep and periventricular white matter hyperintensities. A path analysis was performed for the UPDRS motor score with the same covariates. Path analysis and multivariable GLM for UPDRS motor score showed that lower caudate DAT uptake was directly associated with a higher UPDRS motor score, whereas caudate DAT uptake confounded the association between mean frontal/parietal thickness and UPDRS motor score. Multivariable GLMs for cognitive scores showed that lower caudate DAT uptake was associated with visuospatial/executive dysfunction independent of mean frontal or parietal thickness. Nigrostriatal dopaminergic dysfunction is associated with parkinsonism and visuospatial/executive dysfunction in patients with AD.

CircEPS15, as a sponge of MIR24-3p ameliorates neuronal damage in Parkinson disease through boosting PINK1-PRKN-mediated mitophagy

ABSTRACT Despite growing evidence that has declared the importance of circRNAs in neurodegenerative diseases, the clinical significance of circRNAs in dopaminergic (DA) neuronal degeneration in the pathogenesis of Parkinson disease (PD) remains unclear. Here, we performed rRNA-depleted RNA sequencing and detected more than 10,000 circRNAs in the plasma samples of PD patients. In consideration of ROC and the correlation between Hohen-Yahr stage (H-Y stage) and Unified Parkinson Disease Rating Scale-motor score (UPDRS) of 40 PD patients, circEPS15 was selected for further research. Low expression of circEPS15 was found in PD patients and there was a negative positive correlation between the circEPS15 level and severity of PD motor symptoms, while overexpression of circEPS15 protected DA neurons against neurotoxin-induced PD-like neurodegeneration in vitro and in vivo. Mechanistically, circEPS15 acted as a MIR24-3p sponge to promote the stable expression of target gene PINK1, thus enhancing PINK1-PRKN-dependent mitophagy to eliminate damaged mitochondria and maintain mitochondrial homeostasis. Thus, circEPS15 rescued DA neuronal degeneration through the MIR24-3p-PINK1 axis-mediated improvement of mitochondrial function. This study reveals that circEPS15 exerts a critical role in participating in PD pathogenesis, and may give us an insight into the novel avenue to develop potential biomarkers and therapeutic targets for PD. Abbreviations: AAV: adeno-associated virus; DA: dopaminergic; FISH: fluorescence in situ hybridizations; HPLC: high-performance liquid chromatography; H-Y stage: Hohen-Yahr stage; LDH: lactate dehydrogenase; MMP: mitochondrial membrane potential; MPTP/p: 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/probenecid; NC: negative control; PD: Parkinson disease; PINK1: PTEN induced kinase 1; PBS: phosphate-buffered saline; ROS: reactive oxygen species; SNpc: substantia nigra pars compacta; TEM: transmission electron microscopy; UPDRS: Unified Parkinson’s Disease Rating Scale-motor score

The Effects of Group Therapeutic Singing on Cortisol and Motor Symptoms in Persons With Parkinson's Disease.

The inclusion of music into the treatment plan for persons with Parkinson's disease (PD) may be a viable strategy to target multiple motor symptoms. However, potential mechanisms to explain why music has an impact on multiple motor symptoms in persons with PD remain understudied. The purpose of this study was to examine the acute effects of 1 h of group therapeutic singing (GTS) on physiological measures of stress and clinical motor symptoms in persons with PD. We posit that improvement in motor symptoms after GTS may be related to stress reduction. Seventeen participants with PD completed 1 h of GTS and eight participants completed 1 h of a quiet reading (control session). Cortisol was collected via passive drool immediately before and after the singing and control session. The Unified Parkinson's Disease Rating Scale (UPDRS) Part-III (motor examination) was also video-recorded immediately before and after the singing and control session and scored by two raters masked to time and condition. Secondary outcome measures for quality of life, depression, and mood were collected. Results revealed no significant change in cortisol or motor UPDRS scores, as well as no significant relationship between cortisol and motor UPDRS scores. There was a trend for the singing group to report feeling less sad compared to the control group after the 1-h session (effect size = 0.86), and heart rate increased in the singing group while heart rate decreased in the control group after the 1-h session. These results suggest that an acute session of GTS is not unduly stressful and promotes the use of GTS for persons with PD. Multiple mechanisms may underlie the benefits of GTS for persons with PD. Further exploring potential mechanisms by which singing improves motor symptoms in persons with PD will provide greater insight on the therapeutic use of music for persons with PD.

The role of pramipexole in the treatment of patients with depression and Parkinson's disease: A meta-analysis of randomized controlled trials.

The aim of this report was to evaluate the clinical efficacy and safety of pramipexole therapy for patients with depression and Parkinson's disease (dPD), in order to confer a reference for clinical practice. Randomized controlled trials (RCTs) of pramipexole for dPD published up to June 2020 were retrieved. Standardised mean difference (SMD), risk ratio (RR), and 95 % confidence interval (CI) were calculated. The outcomes included efficacy, Hamilton depression rating scale (HAMD) score, unified Parkinson's disease rating scale (UPDRS) scores, self-rating depression scale (SDS) score, self-rating anxiety scale (SAS) score or adverse events. Eighteen RCTs with 1789 participants were included. Clinical efficacy in pramipexole treatment group was significantly better than control group (RR 1.26, 95 % CI 1.20-1.33, P < 0.00001). Compared with control group, the pooled effects of pramipexole therapy on depression were (SMD -1.90, 95 % CI -2.58 to -1.23, P < 0.00001) for HAMD score, (SMD -3.94, 95 % CI -4.73 to -3.15, P < 0.00001) for SDS score, pramipexole therapy also decreased SAS score markedly (P < 0.0001). Compared with control group, the pooled effects of pramipexole on motor UPDRS score and activities of daily living UPDRS score were statistically significant (P < 0.01). Furthermore, pramipexole therapy didn't increase the number of any adverse events in dPD patients (RR 0.72, 95 % CI 0.37-1.41, P = 0.34). Pramipexole therapy can alleviate depressive symptoms and motor dysfunction in dPD patients, and there were no more side effects associated with drug intervention. These findings should be further validated by high-quality and well-designed RCTs.

Prevalence, risk factors, and clinical correlations of underweight in Chinese newly diagnosed and drug-naïve patients with Parkinson's disease.

Studies have shown that patients with Parkinson's disease (PD) will experience weight loss during the progression of the illness, which suggests an increased rate of underweight. However, few studies have addressed underweight in early de novo population. This study aimed to examine the prevalence, risk factors, and clinical correlations of underweight in Chinese newly diagnosed and drug-naïve patients with PD. A total of 245 inpatients with newly diagnosed PD and 213 age-, sex-, and education-matched healthy controls were enrolled in Ningbo. BMI, demographics, supine and upright blood pressure, Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) together with fasting blood glucose, low-density lipoprotein, total cholesterol, uric acid (UA), and homocysteine were collected in all subjects. Hoehn and Yahr (HY) rating and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were also measured in patients. Overall, 35 (14.3%) patients were underweight and 14 (6.6%) controls were underweight. Binary regression analyses showed that low MoCA (p = 0.035), ΔSBP and ΔDBP values (both p < 0.001) were risk factors for underweight. Furthermore, correlation analysis indicated that BMI was associated with HY grade, UPDRS motor, HAMA, HAMD, MoCA, ΔSBP, ΔDBP, and UA values, stepwise multiple regression revealed significant correlations between BMI and ΔSBP (p < 0.001), ΔDBP (p = 0.001), MoCA (p = 0.002), UPDRS motor (p = 0.005), and HAMD scores (p = 0.014). Our study showed that the prevalence of underweight was significantly higher in Chinese newly diagnosed and drug-naïve patients with PD than in the healthy population, and several clinical variables were risk factors for underweight.

Sex differences in underweight and body mass index in Chinese early de novo patients with Parkinson's disease.

ObjectiveThere have been studies investigating sex differences in clinical manifestation of Parkinson's disease (PD). However, sex differences in underweight and body mass index (BMI) in de novo PD patients lacked systematic study. We aimed to compare sex differences in clinical features and related factors of underweight and BMI in Chinese de novo PD patients.Materials and MethodsA total of 253 untreated PD inpatients and 218 controls were recruited from Ningbo. BMI, demographics, Montreal Cognitive Assessment (MoCA), supine and upright blood pressure, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), homocysteine (HCY), uric acid, glycated hemoglobin, and lipid parameters were examined. Patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and Hoehn and Yahr (HY) Rating Scale.ResultsFemale patients had a significantly lower incidence of underweight and higher BMI than male patients, and there were sex differences in serum lipids, HCY levels, and depression severity. Binary regression analysis showed that only in male patients was underweight associated with the UPDRS motor score and lower ΔSBP and ΔDBP values (all p < .05). Further multiple regression analysis indicated, in addition to the correlations between BMI and ΔSBP and ΔDBP values in both sexes (all p < .001), BMI was also associated with MoCA and lower UPDRS motor scores in male patients and lower HAMD scores in female patients.ConclusionOur study suggests that there are significant sex differences in the prevalence of underweight, BMI, and factors associated with underweight and BMI among de novo PD patients.

Predictive ability of functional tests for postural instability and gait difficulty in Parkinson's disease.

The objective of this study is to identify clinical determinants for postural instability and gait difficulty in persons with Parkinson's disease (PD). Ninety-one persons (68 males; 74.7%) with PD were studied. Their mean age was 68.73±8.74years. The average time since diagnosis was 7.69±5.23years. The average Hoehn and Yahr stage was 2.43±0.44. Age, gender, disease duration, disease severity and motor impairment were recorded. Participants were asked to perform timed clinical mobility tests that included a 5-step test, turns, forward walk, backward walk, and a sideways walk. The mobility tests were investigated for their contribution to predict the postural instability and gait difficulty (PIGD) score (falling, freezing, walking, gait and postural stability) of the Unified Parkinson Disease Rating Scale (UPDRS). PIGD score was significantly correlated with age, disease duration, Hoehn and Yahr score, comorbidity, UPDRS motor score, gait speed of forward, backward and sideways walks, and time to turn. PIGD score was marginally significantly correlated with timed 5-step test. After controlling for age, disease duration, disease severity, comorbidity, and motor impairment, sideway gait speed (β=-0.335; p=0.024), timed 5-step test (β=-0.397; p=0.003) and time to turn (β=0.289; p=0.028) significantly predicted postural instability and gait difficulty. Walking sideways, 5-step test, and turning are significant predictors of PIGD score. These simple mobility tests can be quickly applied in clinical practice to determine postural instability and gait problems in persons with PD.

Parkinson's Disease GWAS-linked Park16 Carriers Show Greater Motor Progression: A Longitudinal Study Over 9 Years

Background: Data on the long-term motor outcomes of GWAS-linked Parkinson disease (PD) carriers will be useful for clinical management. Methods: Over a 9-year period, carriers of PARK16 rs11240572 variant and non-carriers were followed up and evaluated using the modified Hoehn and Yahr (H&Y) staging scale and Unified Parkinson's Disease Rating Scale (UPDRS) part III. A longitudinal, linear mixed model was performed to compare the changes of H&Y staging scale, UPDRS motor score and UPDRS sub scores between the two groups. Findings: A total of 156 patients (41 PARK16 carriers and 115 non-carriers) were evaluated and followed up for up to 9 years. Using longitudinal linear mixed model analysis, there was a greater rate of deterioration in the motor function as measured by the UPDRS scores compared to non-carriers after 5 years from the date of diagnosis (p=0.007). In addition, we demonstrated that PARK16 variant carriers had worse gait scores (p=0.033) and greater motor progression than non-carriers after 6 years based on the modified H&Y staging scale (P=0.025). Interpretation: In a 9-year longitudinal study, we demonstrated that PD PARK16 variant carriers exhibited greater motor progression after 5 years of disease compared with non-carriers, suggesting that GWAS-linked gene variants may influence disease progression over time. Closer monitoring and management of these higher risk patients can facilitate better quality of life. Funding Statement: This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme. Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: The Singhealth Centralized Institutional Review Board approved the study. All subjects gave written informed consent

Gait Patterns in Parkinson's Disease with or without Cognitive Impairment.

Background and PurposeCognitive and gait disturbance are common symptoms in Parkinson's disease (PD). Although the relationship between cognitive impairment and gait dysfunction in PD has been suggested, specific gait patterns according to cognition are not fully demonstrated yet. Therefore, the aim of this study was to investigate gait patterns in PD patients with or without cognitive impairment.MethodsWe studied 86 patients at an average of 4.8 years after diagnosis of PD. Cognitive impairment was defined as scoring 1.5 standard deviation below age- and education-specific means on the Korean version of the Mini-Mental State Examination (K-MMSE). Three-dimensional gait analysis was conducted for all patients and quantified gait parameters of temporal-spatial data were used. Relationships among cognition, demographic characteristics, clinical features, and gait pattern were evaluated.ResultsCognitive impairment was observed in 41 (47.7%) patients. Compared to patients without cognitive impairment, patients with cognitive impairment displayed reduced gait speed, step length, and stride length. Among K-MMSE subcategories, “registration,” “attention/calculation,” and “visuospatial function” were significantly associated with speed, step length, and stride length. However, age, disease duration, Hoehn-Yahr (HY) stage, or Unified Parkinson's Disease Rating Scale (UPDRS) motor score was not significantly related to any gait analysis parameter.ConclusionsOur present study shows that cognitive impairment is associated with slow and short-stepped gait regardless of HY stage or UPDRS motor score, suggesting that cognitive impairment may serve as a surrogate marker of gait disturbance or fall in PD patients.

Longitudinal assessment of falls in patients with Parkinson's disease using inertial sensors and the Timed Up and Go test.

ObjectiveTo examine the predictive validity of a TUG test for falls risk, quantified using body-worn sensors (QTUG) in people with Parkinson's Disease (PD). We also sought to examine the inter-session reliability of QTUG sensor measures and their association with the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.ApproachA six-month longitudinal study of 15 patients with Parkinson’s disease. Participants were asked to complete a weekly diary recording any falls activity for six months following baseline assessment. Participants were assessed monthly, using a Timed Up and Go test, quantified using body-worn sensors, placed on each leg below the knee.Main resultsThe results suggest that the QTUG falls risk estimate recorded at baseline is 73.33% (44.90, 92.21) accurate in predicting falls within 90 days, while the Timed Up and Go time at baseline was 46.67% (21.27, 73.41) accurate. The Timed Up and Go time and QTUG falls risk estimate were strongly correlated with UPDRS motor score. Fifty-two of 59 inertial sensor parameters exhibited excellent inter-session reliability, five exhibited moderate reliability, while two parameters exhibited poor reliability.SignificanceThe results suggest that QTUG is a reliable tool for the assessment of gait and mobility in Parkinson’s disease and, furthermore, that it may have utility in predicting falls in patients with Parkinson’s disease.

Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System

Background: Deep brain stimulation (DBS) is the most commonly performed surgery for the debilitating symptoms of Parkinson disease (PD). However, DBS systems remain largely unaffordable to patients in developing countries, warranting the development of a safe, economically viable, and functionally comparable alternative. Objective: To investigate the efficacy and safety of wirelessly programmed DBS of bilateral subthalamic nucleus (STN) in patients with primary PD. Methods: Sixty-four patients with primary PD were randomly divided into test and control groups (1:1), where DBS was initiated at either 1 month or 3 months, respectively, after surgery. Safety and efficacy of the treatment were compared between on- and off-medication states 3 months after surgery. Outcome measures included analysis of Unified Parkinson's Disease Rating Scale (UPDRS) scores, duration of “on” periods, and daily equivalent doses of levodopa. All patients were followed up both 6 and 12 months after surgery. Results: Three months after surgery, significant decrease in the UPDRS motor scores were observed for the test group in the off-medication state (25.08 ± 1.00) versus the control group (4.20 ± 1.99). Conclusions: Bilateral wireless programming STN-DBS is safe and effective for patients with primary PD in whom medical management has failed to restore motor function.

Therapeutic singing as an early intervention for swallowing in persons with Parkinson's disease

ObjectiveFor persons with Parkinson's disease (PD), secondary motor symptoms such as swallow impairment impact the quality of life and are major contributors to mortality. There is a present need for therapeutic interventions aimed at improving swallow function during the early stages of PD. The purpose of this pilot study was to examine the effects of a group therapeutic singing intervention on swallowing in persons with PD with no significant dysphagia symptoms. DesignCohort study. SettingUniversity in the United States. ParticipantsTwenty-four participants with PD. InterventionEight weeks of group therapeutic singing. Main outcome measuresElectromyography (EMG) was used to assess muscle activity associated with swallow pre and post the group singing intervention. Swallow quality of life (SWAL-QOL) and the Unified Parkinson's Disease Rating Scale (UPDRS) were also obtained pre- and post-intervention. ResultsParticipants reported minimal difficulty with swallowing, yet results revealed a significant increase in EMG outcome measures, as well as significant improvement in UPDRS total and UPDRS motor scores. No significant differences were revealed for SWAL-QOL. ConclusionIncreases in EMG timing measures may suggest that group singing results in the prolongation of laryngeal elevation, protecting the airway from foreign material for longer periods of time during swallow. Combined with the improvement in UPDRS clinical measures, therapeutic singing may be an engaging early intervention strategy to address oropharyngeal dysphagia while also benefiting additional clinical symptoms of PD.

Association of serum carotenoid, retinol, and tocopherol concentrations with the progression of Parkinson's Disease.

BACKGROUND/OBJECTIVESA pivotal role of oxidative stress has been emphasized in the pathogenesis as well as in the disease progression of Parkinson's disease (PD). We aimed at investigating serum levels of antioxidant vitamins and elucidating whether they could be associated with the pathogenesis and progression of PD.MATERIALS/METHODSSerum levels of retinol, α- and γ-tocopherols, α- and β-carotenes, lutein, lycopene, zeaxanthin and β-cryptoxanthin were measured and compared between 104 patients with idiopathic PD and 52 healthy controls matched for age and gender. In order to examine the relationship between antioxidant vitamins and the disease progression, multiple group comparisons were performed among the early PD (Hoehn and Yahr stage I and II, N = 47), advanced PD (stage III and IV, N = 57) and control groups. Separate correlation analyses were performed between the measured antioxidant vitamins and clinical variables, such as Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale (UPDRS) motor score.RESULTSCompared to controls, PD patients had lower levels of α- and β-carotenes and lycopene. α-carotene, β-carotene and lycopene levels were significantly reduced in advanced PD patients relative to early PD patients and were negatively correlated with Hoehn and Yahr stage and UPDRS motor score in PD patients. No significant differences were found in serum levels of retinol, α- and γ-tocopherols, and other carotenoids between PD patients and controls. No significant correlations were found between these vitamin levels and clinical variables in PD patients.CONCLUSIONSWe found that serum levels of some carotenoids, α-carotene, β-carotene and lycopene, were lower in PD patients, and that these carotenoids inversely correlated with clinical variables representing disease progression. Our findings suggest that decreases in serum α-carotene, β-carotene and lycopene may be associated with the pathogenesis as well as progression of PD.

Polestriding Intervention Improves Gait and Axial Symptoms in Mild to Moderate Parkinson Disease

ObjectiveTo evaluate the effects of 12-week polestriding intervention on gait and disease severity in people with mild to moderate Parkinson disease (PD). DesignA-B-A withdrawal study design. SettingOutpatient movement disorder center and community facility. ParticipantsIndividuals (N=17; 9 women [53%] and 8 men [47%]; mean age, 63.7±4.9y; range, 53–72y) with mild to moderate PD according to United Kingdom brain bank criteria with Hoehn & Yahr score ranging from 2.5 to 3.0 with a stable medication regimen and ability to tolerate “off” medication state. InterventionsTwelve-week polestriding intervention with 12-week follow-up. Main Outcome MeasuresGait was evaluated using several quantitative temporal, spatial, and variability measures. In addition, disease severity was assessed using clinical scales such as Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr scale, and Parkinson's Disease Questionnaire-39. ResultsStep and stride lengths, gait speed, and step-time variability were improved significantly (P<.05) because of 12-week polestriding intervention. Also, the UPDRS motor score, the UPDRS axial score, and the scores of UPDRS subscales on walking and balance improved significantly after the intervention. ConclusionsBecause increased step-time variability and decreased step and stride lengths are associated with PD severity and an increased risk of falls in PD, the observed improvements suggest that regular practice of polestriding may reduce the risk of falls and improve mobility in people with PD.

Orthostatic hypotension predicts motor decline in early Parkinson disease

BackgroundOrthostatic hypotension is increasingly reported as a risk factor for development of late-stage disease features in Parkinson disease (PD). Less is known about its significance in individuals with early PD who are often targeted for neuroprotective trials. MethodsUsing data from the CALM-PD trial (n = 275), we explored whether early orthostatic hypotension predicts a decline in the Unified Parkinson's Disease Rating Scale (UPDRS) II (activities of daily living) or UDPRS III (motor) score after 102 weeks. We also explored risk factors for worsening orthostatic hypotension over a nearly 2-year period. ResultsAfter controlling for age, disease duration, gender, study drug, change in mini-mental status exam score, levodopa equivalent dose, and baseline UPDRS II or III score respectively, the degree of orthostatic hypotension at enrollment associated with a worsening in UPDRS motor score (t = 2.40, p = 0.017) at week 102 but not with UPDRS ADL score (t = 0.83, p = 0.409). Worsening in orthostatic hypotension during the study associated with longer disease duration (t = 2.37, p = 0.019) and lower body mass index (BMI) (t = −2.96, p = 0.003). ConclusionsBaseline orthostatic hypotension is a predictor of UPDRS motor decline in individuals with early PD and should be accounted for in clinical trial design. Low BMI may predict orthostatic hypotension in PD.

Urinary dysfunction and motor symptoms in untreated Parkinson's disease

Objectives: The aim of the present study was to determine the associations of motor symptoms in untreated Parkinson's disease (PD) with urinary dysfunction. We therefore examined the association between the overactive bladder symptom score (OABSS) and Unified Parkinson's Disease Rating Scale (UPDRS). Patients and methods: Thirty-one untreated PD patients without dementia (12 men and 19 women with a mean age of 72.0±6.7years) were included in this study. Their urinary tract dysfunctions were rated using the OABSS. The motor symptoms of all patients were also assessed using UPDRS. Results: OABSS had significant correlations with UPDRS motor score (Spearman's rho=0.39, p=0.03) and akinetic-rigid score (Spearman's rho=0.47, p=0.01). However, OABSS showed no significant correlation with tremor score, age, or duration of PD. Conclusions: Higher OABSS was consistently associated with increase in severity of motor disorders, especially akinetic-rigid score, in the study participants.

N30 Somatosensory Evoked Potential Is Negatively Correlated with Motor Function in Parkinson's Disease.

ObjectiveThe aim of this study was to investigate frontal N30 status in Parkinson’s disease (PD) and to examine the correlation between the amplitude of frontal N30 and the severity of motor deficits.MethodsThe frontal N30 was compared between 17 PD patients and 18 healthy volunteers. Correlations between the amplitude of frontal N30 and the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score of the more severely affected side was examined.ResultsThe mean latency of the N30 was not significantly different between patients and healthy volunteers (p = 0.981), but the mean amplitude was lower in PD patients (p < 0.025). There was a significant negative correlation between the amplitude of N30 and the UPDRS motor score (r = -0.715, p = 0.013).ConclusionsThe frontal N30 status indicates the motor severity of PD. It can be a useful biomarker reflecting dopaminergic deficits and an objective measurement for monitoring the clinical severity of PD.

Putaminal serotonergic innervation: monitoring dyskinesia risk in Parkinson disease.

To explore serotonergic innervation in the basal ganglia in relation to levodopa-induced dyskinesia in patients with Parkinson disease (PD). A total of 30 patients with PD without dementia or depression were divided into 3 matched groups (dyskinetic, nondyskinetic, and drug-naive) for this study. We acquired 2 PET scans and 3T MRI for each patient using [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile ((11)C-DASB) and N-(3-[(18)F]fluoropropyl)-2-carbomethoxy-3-(4-iodophenyl) nortropane ((18)F-FP-CIT). Then we analyzed binding potentials of the 2 radiotracers at basal ganglia structures and correlations with clinical variables. We observed no difference in (18)F-FP-CIT binding between dyskinetic and nondyskinetic patients, whereas there were differences in (11)C-DASB binding for the caudate and putamen. Binding potential ratios ((11)C-DASB/(18)F-FP-CIT) at the putamen, which indicate serotoninergic fiber innervation relative to dopaminergic fiber availability, were highest in the dyskinetic group, followed by the nondyskinetic and drug-naive PD groups. (11)C-DASB/(18)F-FP-CIT ratios at the putamen and pallidum correlated positively with Unified Parkinson's Disease Rating Scale (UPDRS) total scores and duration of PD, and pallidal binding ratio also correlated with the UPDRS motor scores. Ratios were not dependent on dopaminergic medication dosages for any of the regions studied. Relative serotonergic innervation of the putamen and pallidum increased with clinical PD progression and was highest in patients with established dyskinesia. The serotonin/dopamine transporter ratio might be a potential marker of disease progression and an indicator of risk for levodopa-induced dyskinesia in PD. A prospective evaluation is warranted in the future.

Repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression in Parkinson disease: a meta-analysis of randomized controlled clinical trials.

The objective of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression in patients with Parkinson disease in order to arrive at qualitative and quantitative conclusions about the efficacy of rTMS. We included randomized controlled trials examining the effects of rTMS compared with sham-rTMS or selective serotonin re-uptake inhibitors (SSRIs). The quality of included studies was strictly evaluated. Data analyses were performed using the RevMan5.1 software. Eight studies including 312 patients met all inclusion criteria. The results showed that rTMS could evidently improve the HRSD score compared with sham-rTMS (p < 0.00001). However, we found similar antidepressant efficacy between rTMS and SSRIs groups in terms of HRSD and BDI score (p = 0.65; p = 0.75, respectively). Furthermore, patients who received rTMS could evidently show improvement on the unified Parkinson's disease rating scale (UPDRS), ADL score, and UPDRS motor score compared with sham-rTMS or SSRIs (p < 0.05, p = 0.05, respectively). The subgroup analysis by frequency of rTMS evidenced that the efficacy of low-frequency rTMS was superior to sham-rTMS (p < 0.0001) in terms of the outcome measure according to HAMD scale. Meanwhile, the high-frequency rTMS has the same antidepressant efficacy as SSRIs (p = 0.94). The current meta-analysis provided evidence that rTMS was superior to sham-rTMS and had similar antidepressant efficacy as SSRIs, and may have the additional advantage of some improvement in motor function.