Unified Parkinson's Disease Rating Scale Scores Research Articles

Effect of repetitive transcranial magnetic stimulation combined with balance training on improving balance function in patients with Parkinson’s disease: A randomized controlled trial

BACKGROUND: An increasing amount of research has supported the positive role of repetitive transcranial magnetic stimulation(rTMS) in improving functional impairments in Parkinson’s patients. PURPOSE: To explore the effectiveness of using rTMS n and Balance Apparatus training to improve the balance function of Parkinson’s patients. METHODS: Patients were divided into 3 groups of 20 patients in each. All patients received routine rehabilitation training. The rTMS group received low-frequency rTMS therapy, while the balance apparatus group incorporated balance apparatus exercises. The observation group received both interventions. The three groups of patients were assessed at baseline and after 8 weeks of treatment using the Unified Parkinson’s Disease Rating Scale (UPDRS) motor section, Berg balance scale (BBS), Time up and go test (TUGT), and Activities-Specific Balance Confidence (ABC) scales. Additionally, all participants were tested for movement ellipse area, and Average Trace Error (ATE) using the balance apparatus. RESULTS: The observation group achieved better treatment results. The UPDRS score was better than that of the balance apparatus group after treatment, and the ABC score was superior to other two group. Moreover, the observation group outperformed the other two group in terms of motion length, and open-eye elliptical area, with statistical significance. CONCLUSION The combined application of TMS and Balance Apparatus training effectively improves enhances balance function, and boosts self-confidence in balance perception among Parkinson’s patients.

CHRONOTYPE AND DAILY FUNCTIONING OF PATIENTS WITH DIFFERENT MOTOR SUBTYPES OF PARKINSON DISEASE

Introduction. Sleep and circadian rhythm disturbances can occur at any stage of Parkinson disease (PD) and significantly affect quality of life. Chronotypes of patients with PD are associated with different phenotypes, in particular with the motor subtype. Thus, we hypothesized that patients with different motor subtypes of PD may have differences in the distribution of chronotypes and patterns of daily activity. Methods and materials. We conducted clinical research on the basis of the Centre for Parkinson Disease and Neurodegenerative Diseases of the Department of Neurological Diseases of Poltava State Medical University. PD was verified according to the recommendations of the International Movement Disorders and Parkinson's Disease Society. The motor subtype of PD was determined by the Stebbin method, which is based on the calculation of the Stebbins coefficient by the sum of the Unified PD Rating Scale scores. The examined patients were divided into 3 groups according to the motor subtype of PD: group 1 (n = 38) - patients with PD subtype with the predominance of postural instability and gait disorders (PIGD); group 2 (n = 26) - patients with PD subtype with the predominance of tremor and mixed subtype; control group (n = 30) - conditionally healthy individuals without CNS lesions. Circadian patterns were analyzed using the Munich Chronotype Questionnaire (MCTQ). Results. It was found that in PD patients sleep onset and time of getting out of bed was later (p<0.001 and p=0.042, respectively), sleep latency was longer (p<0.001), sleep duration was shorter (p=0.001), the mid-sleep corresponded to a later time (p<0.001). Patients with the PIGD subtype had a later time of getting out of bed (p=0.038), longer sleep inertia (p<0.001), shorter sleep duration (p<0.001), and later mid-sleep time (p=0.028). We have shown the tendency of patients with PD, mostly in the PIGD subtype, to later chronotypes (p<0.001). Light exposure indirectly moderately correlated with mid-sleep in all study groups. It was found that both the motor subtype (p<0.001) and the level of light exposure during the day (p<0.001) statistically significantly affect the mid-sleep. Conclusion. Thus, we have found that patients with PD differ from age-matched controls without neurodegenerative diseases by chronotype and circadian pattern of functioning. The motor subtype of the disease is associated with circadian differences, namely, the PIGD subtype is associated with shorter sleep duration, a predisposition to a later chronotype, and longer sleep inertia.

Effects of supplementary Da Dingfeng Zhu therapy on patients with Parkinson's disease of liver-kidney yin deficiency pattern

BackgroundThis study aimed to verify whether the combined use of Da Dingfengzhu and Western medicine in treating Parkinson's disease (PD) can lead to therapeutic efficacy and symptom alleviation, thereby achieving a complementary and synergistic effect. MethodsIn this study, 158 patients were initially enrolled, with 116 eligible patients randomly divided into a control and an observation group. The control group received levodopa/benserazide and pramipexole, while the observation group received Da Dingfengzhu combined with levodopa/benserazide and pramipexole for 12 weeks. Baseline patient characteristics, adverse reactions, and blood samples were collected at baseline and 12 weeks post-treatment. The Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess symptom severity at baseline, four weeks into treatment, and 12 weeks post-treatment. ResultsAdverse reactions during treatment were similar in both groups, suggesting that the combined therapy in the observation group did not increase adverse effects. Both groups showed improvements in UPDRS scores, with the observation group displaying more significant symptom alleviation at 4 and 12 weeks. Moreover, the observation group exhibited more pronounced increases in serum neurotrophic factor-3 and dopamine levels and greater reductions in oxidative stress and inflammatory response markers. ConclusionIn conclusion, the combination of Da Dingfengzhu with levodopa/benserazide and pramipexole for treating PD shows significant clinical potential and is worthy of broader application.

Structural Network Efficiency Predicts Conversion to Incident Parkinsonism in Patients With Cerebral Small Vessel Disease.

To investigate whether structural network disconnectivity is associated with parkinsonian signs and their progression, as well as with an increased risk of incident parkinsonism. In a prospective cohort (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort study) consisting of 293 participants with small vessel disease (SVD), we assessed parkinsonian signs and incident parkinsonism over an 8-year follow-up. In addition, we reconstructed the white matter network followed by graph-theoretical analyses to compute the network metrics. Conventional magnetic resonance imaging markers for SVD were assessed. We included 293 patients free of parkinsonism at baseline (2011), with a mean age 68.8 (standard deviation [SD] 8.4) years, and 130 (44.4%) were men. Nineteen participants (6.5%) developed parkinsonism during a median (SD) follow-up time of 8.3 years. Compared with participants without parkinsonism, those with all-cause parkinsonism had higher Unified Parkinson's Disease Rating scale (UPDRS) scores and lower global efficiency at baseline. Baseline global efficiency was associated with UPDRS motor scores in 2011 (β = -0.047, p < .001) and 2015 (β = -0.84, p < .001), as well as with the changes in UPDRS scores during the 4-year follow-up (β = -0.63, p = .004). In addition, at the regional level, we identified an inter-hemispheric disconnected network associated with an increased UPDRS motor score. Besides, lower global efficiency was associated with an increased risk of all-cause and vascular parkinsonism independent of SVD markers. Our findings suggest that global network efficiency is associated with a gradual decline in motor performance, ultimately leading to incident parkinsonism in the elderly with SVD. Global network efficiency may have the added value to serve as a useful marker to capture changes in motor signs.

Type, Timing, Frequency, and Durability of Outcome of Physical Therapy for Parkinson Disease

Parkinson disease (PD) is a neurodegenerative syndrome affecting approximately 1% of the population older than 60 years, and a major goal of treatment is preservation of physical function through physical therapy (PT). Although PT outcomes for PD are well documented, aggregate information on the parameters of PT are needed to guide implementation. To evaluate current evidence on the types, timing, frequency, duration, and outcomes of PT regimens applied for PD. PubMed, Embase, Medline, and the Web of Science Core Collection were searched for articles published from January 1, 2000, to August 10, 2022. Search terms included terms related to Parkinson disease, PT interventions, and PT-related outcomes. Included studies were peer-reviewed randomized clinical trials available in English of any PT intervention for patients with PD that included PT-related outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Two reviewers extracted data and assessed quality using the Cochrane Risk of Bias Tool. Data were analyzed using a random-effects model. A meta-analysis compared outcomes of nonstandard PT vs standard PT and standard PT vs no intervention for Unified Parkinson's Disease Rating Scale (UPDRS) score and measures of gait and balance. A total of 46 trials with 3905 patients were included (range of mean ages, 61-77 years). Ten trials (22%) compared 2 types of nonstandard PT interventions; 26 (57%), nonstandard PT vs standard PT; and 10 (22%), PT vs no intervention. The most common nonconventional PT intervention was aquatic physiotherapy (5 trials [11%]). Durations of PT regimen ranged from 2 to 12 weeks in 39 trials (85%), and PT was most commonly performed with frequencies of either twice or 3 times weekly (27 [59%]). In most trials (39 [85%]), PT session length ranged from 30 to 60 minutes. Across trials, PT outcomes were reported for gait (14 trials [30%]), balance (10 [22%]), quality of life (3 [9%]), and cognition (1 [2%]). Approximately half of the trials (22 [48%]) documented durability of some level of benefit after completion of the prescribed regimen. Meta-analysis showed no significant difference for PT vs no intervention in UPDRS scores (standardized mean difference [SMD], -1.09; 95% CI, -2.50 to 0.33) or for nonstandard PT vs standard PT in measures of gait (SMD, 0.03; 95% CI, -0.53 to 0.59), balance (SMD, 0.54; 95% CI, -0.03 to 1.12), and UPDRS score (SMD, -0.49; 95% CI, -1.04 to 0.06). Meta-analytic regression of moderators revealed no significant differences in outcomes by frequency of PT per week (SMD, 0.17; 95% CI, -0.03 to 0.36). The findings suggest that although a wide range of types and regimens of PT for PD have been tested, comparative effectiveness of different models of care and implementation strategies as well as long-term durability of their outcomes remain undetermined.

A meta-analysis of the effect of multidisciplinary comprehensive care on health-related quality of life and Unified Parkinson's Disease Rating Scale in Parkinson's disease.

According to many reports, multidisciplinary comprehensive care alleviates Parkinson's disease (PD) more frequently than any other standard care, though the results were found to vary greatly. A systematic literature search up to July 2022 was performed and 1234 related studies were evaluated. The chosen studies comprised 1115 subjects with PD who participated in baseline trials; 633 of them were under multidisciplinary comprehensive care, while 482 were under standard care. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CIs) were calculated to measure the results of multidisciplinary comprehensive care for PD by the contentious and dichotomous approaches with a random or fixed influence model employed. The use of multidisciplinary comprehensive care resulted in significantly better health-related quality of life (HRQL) (MD: -3.17; 95% CI: -5.98--0.35, p = 0.03) and Unified Parkinson's Disease Rating Scale (UPDRS) score (MD: -5.25; 95% CI: -10.14--0.37, p = 0.04) compared to the standard care for subjects with PD. Nevertheless, no significant difference was found between multidisciplinary comprehensive care and standard care for subjects with PD regarding medication dosage (MD: 0.31; 95% CI: -0.72-1.34, p = 0.56) and caregiver strain (MD: -0.51; 95% CI: -1.69-0.67, p = 0.40). Outpatient multidisciplinary comprehensive care models may improve patient-reported HRQL and UPDRS score; nevertheless, no significant difference was found in terms of medication dosage and caregiver strain compared to the standard care for subjects with PD. The small sample size of 2 out of 7 analyzed studies and the small number of studies in certain comparisons requires attention when analyzing the results.

Utility of movement disorder society-unified Parkinson's disease rating scale for evaluating effect of subthalamic nucleus deep brain stimulation.

The Movement Disorders Society (MDS)-Unified Parkinson's Disease Rating Scale (UPDRS) is increasingly used to assess motor dysfunction before and after subthalamic nucleus deep brain stimulation (STN-DBS). We, therefore, investigated whether the MDS-UPDRS can detect longitudinal changes in motor function after STN-DBS in the same way as UPDRS. We examined 21 patients with Parkinson's disease (PD) (mean age 59.2 ± 10.6 years, mean disease duration 12.0 ± 3.0 years) who underwent STN-DBS and whose motor functions were assessed by the UPDRS and MDS-UPDRS before, 3 months after, and 1 year after STN-DBS. We then evaluated the consistency between the scores of Parts II and III of the UPDRS and MDS-UPDRS during the off phase using Lin's concordance coefficient (LCC) and a Bland-Altman plot. The scores of Parts II and III of both the UPDRS and MDS-UPDRS were significantly decreased 3 months and 1 year after STN-DBS during the off phase. Scores of the UPDRS and MDS-UPDRS showed significant positive correlations before and after STN-DBS. We calculated estimated MDS-UPDRS scores from the UPDRS scores using a regression line and calculated the LCC between the MDS-UPDRS and the estimated MDS-UPDRS scores. The LCC value was 0.59-0.91, which suggests a relatively high consistency between the UPDRS and MDS-UPDRS. The Bland-Altman plot showed that differences between both scores were basically within ±1.96 standard deviations of the difference. The present preliminary study indicated that the utility of the MDS-UPDRS in evaluating motor function before and after STN-DBS demonstrates its potential equivalency to the UPDRS.

Motor Symptoms in Early- versus Late-Onset Alzheimer's Disease.

Age at onset was suggested as one possible risk factor for motor dysfunction in Alzheimer's disease (AD). We investigated the association of motor symptoms with cognition or neurodegeneration in patients with AD, and whether this association differs by the age at onset. We included 113 amyloid positive AD patients and divided them into early-onset AD (EOAD) and late-onset AD (LOAD), who underwent the Unified Parkinson's Disease Rating Scale (UPDRS)-Part III (=UPDRS) scoring, Mini-Mental State Examination (MMSE)/Clinical Deterioration Rating Sum-of-Boxes (CDR-SOB), and magnetic resonance image (MRI). Multiple linear regression was used to evaluate the association of UPDRS and MMSE/CDR-SOB or MRI neurodegeneration measures, and whether the association differs according to the group. The prevalence of motor symptoms and their severity did not differ between the groups. Lower MMSE (β= -1.1, p < 0.001) and higher CDR-SOB (β= 2.0, p < 0.001) were significantly associated with higher UPDRS. There was no interaction effect between MMSE/CDR-SOB and AD group on UPDRS. Global or all regional cortical thickness and putaminal volume were negatively associated with UPDRS score, but the interaction effect of neurodegeneration and AD group on UPDRS score was significant only in parietal lobe (p for interaction = 0.035), which showed EOAD to have a more pronounced association between parietal thinning and motor symptoms. Our study suggested that the severity of motor deterioration in AD is related to the severity of cognitive impairment itself rather than age at onset, and motor symptoms might occur through multiple mechanisms including cortical and subcortical atrophy.

Clinical significance of serum lncRNA H19, GAS5, HAR1B and linc01783 levels in Parkinson's disease.

<p>Long noncoding RNAs (lncRNAs) are highly expressed in the brain and alterations in their levels have been shown in many neurodegenerative disorders. Evidence has shown that lncRNAs play role in the onset and progression of Parkinson&rsquo;s disease (PD) and it can be used as a potential therapeutic target. Our purpose was to detect whether the serum levels of four candidate lncRNAs H19, GAS5, HAR1B and LINC01783 are related with the clinical findings and treatment of PD or not.&nbsp;</p>. <p>83 patients and 50 healthy controls were included in this study. We assessed how severe the disease is, by using Hoehn Yahr (HY) staging and Unified PD rating scale (UPDRS). Venous blood samples were taken from the participants. Serum samples were centrifuged and stored at -80&deg;C until analysis. Expression levels of these lncRNAs were analyzed by a real-time PCR instrument after RNA isolation and complementary DNA synthesis in the laboratory.</p>. <p>There was no significant difference between PD patients and healthy controls in these lncRNAs&rsquo; serum levels. Just as sociodemographic characteristics, also onset type and right or left predominance of the disease, its duration and treatment did not differ in lncRNA levels. Solely, there was a significant negative correlation between GAS5 and HY and UPDRS scores. Patients with family history of PD had significantly higher levels of LINC01783.</p>. <p>Serum lncRNA GAS5 level may be a possible biomarker for disease severity in PD patients.&nbsp;</p>.

Effect of combined scalp and body acupuncture on Parkinson's disease: A randomized clinical trial: 头针联合体针对帕金森病运动症状的治疗效应:随机临床研究

ObjectiveTo observe the therapeutic effect of combined scalp and body acupuncture on the motor symptoms in Parkinson's disease (PD), and on the score of levodopa equivalent dose (LED). MethodsThis is a randomized, single blind trial. Sixty-six patients with PD were randomized into an acupuncture + medication group (33 patients) and a medication group (33 patients). The patients were aware of allocation and the assessors were blinded to group assignment and therapeutic regimen. Anti-PD drugs were administered in both groups. In the acupuncture + medication group, scalp and body acupuncture therapy was added. Treatments were applied for 8 weeks. In scalp acupuncture, the anterior oblique line of the vertex-temporal (MS6), lateral line 1 of the vertex (MS8), lateral line 2 of the vertex (MS9), and lower-lateral line of the occiput (MS14) were selected. In the body acupuncture, the acupoints included Băihuì (百会GV20), Sìshéncōng (四神聪EX-HN1), and Dàzhuī (大椎GV14), as well as the bilateral Fēngchí (风池GB20), Nèiguān (内关PC6), Hégŭ (合谷LI4), Gānshū (肝俞BL18), Shènshū (肾俞BL23), Yánglíngquán (阳陵泉GB34), Zúsānlĭ (足三里ST36), Fēnglóng 丰隆ST40), Sānyīnjiāo (三阴交SP6), Tàixī (太溪KI3), and Tàichōng ( 太冲LR3). Before and after treatments, the unified Parkinson's disease rating scale (UPDRS), 3rd section of the UPDRS (UPDRS-III), and motor dysfunction rating scale for Parkinson's disease (MDRSPD) were scored in the patients. The therapeutic effect of traditional Chinese medicine (TCM) and LED score were compared between both groups. ResultsThirty-three cases were included in data analysis in each group. After treatment, UPDRS scores were (28.77 ± 8.85) and (36.58 ± 10.16) points, UPDRS-Ⅲ scores were (12.16 ± 1.97) and (17.47 ± 2.93) points and MDRSPD scores were (15.56 ± 3.31) and (19.13 ± 4.87) points in the acupuncture + medication and medication groups respectively. The UPDRS, UPDRS-III, and MDRSPD scores all reduced after treatments in both groups (all P < 0.05). All three scores were lower in the acupuncture + medication group than in the medication group (all P < 0.05). When examining the therapeutic effects of TCM, the total effective rate was 87.88% in the acupuncture + medication group and 75.76% in the medication group (P < 0.05). After treatment, the LED scores were (387.55 ± 146.24) points and (437.42 ± 183.16) points in the acupuncture + medication and medication groups, respectively. The LED dose differences before and after treatment for the acupuncture + medication and medication groups were (40.36 ± 16.33) points and (95.88 ± 35.79) points, respectively. The LED scores in both groups were higher than the pre-treatment scores (P < 0.05). However, the post-treatment LED score was lower in the acupuncture + medication group than in the medication group (P < 0.05), as was the dose difference before and after treatment (P < 0.05).No relevant adverse reaction was found in each group. ConclusionIn addition to anti-PD medication, the scalp and body acupuncture may effectively relieve the motor symptoms of PD and improve the control of LED score.

Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity.

Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings. We conducted a retrospective review of PD patients who underwent DBS of the subthalamic nucleus at one US tertiary care center between 2014 and 2018. Pre-operative patient characteristics and post-operative programming data at various intervals were collected. Disease severity was measured using the Unified Parkinson's Disease Rating Scale score (UPDRS) as well as levodopa equivalent dose (LED). Correlation analyses were conducted looking for associations between pre-operative disease severity and post-operative programming parameters. Fifty-six patients were analyzed. There was no correlation between disease severity and any of the corresponding programming parameters. Pre-operative UPDRS scores on medication were similar to post-operative scores with DBS. Settings of amplitude, frequency, and pulse width increased significantly from 1 to 6months post-operatively. Stimulation volume, inferred by the distance between contacts used, also increased significantly over time. Interestingly, we found that patients with more advanced disease responded to electrical stimulation similarly to patients with less advanced disease. These data provide foundational knowledge of DBS programming parameters used in a single cohort of PD patients over time.

Benefits of task-specific movement program on en bloc turning in Parkinson's disease: A randomized controlled trial.

En bloc turning highlights a lack of rotational intersegmental coordination, which commonly impacts turning ability in people with Parkinson's disease (PD). Whilst this turning deficit responds fairly well to medical treatment, it may be further mitigated by performing specific exercise training. Thus, the present study aimed to examine the effects of a 4-week exercise program, which focused on task-specific movements (TSM program) on turning ability and clinical outcomes in people with PD. Twenty-two adults (67±6years) with early-to-mid-stage idiopathic PD were randomly assigned to an experimental group (EG; n=11) or a control group (CG; n=11). The exercise group (EG) group received a 60-min per session TSM program for 4weeks (a total of 15 sessions), while the CG group performed their routine rehabilitation program (a total of 12 sessions). Inertial measurement units were used to measure turning kinematics including; onset latency of body segments and stepping characteristics. Clinical outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS), functional reach test (FRT), and fall efficacy scale international (FES-I). Assessments were conducted at baseline and after 4weeks. In the EG, turning kinematics, UPDRS scores, FRT, and FES-I scale, were improved at the end of the 4-week program compared with the CG (all p<0.05). A 4-week TSM program could be a promising alternative rehabilitation program for improving "en bloc" turns and clinical outcomes in PD patients.

Targeting gut-brain axis through scalp-abdominal electroacupuncture in Parkinson’s disease

BackgroundEvidence suggests that the pathogenesis of Parkinson’s disease (PD) is initiated in the gut rather than in the brain. Thus, targeting the gut in early stages may have the potential to halt disease progression and alleviate symptoms. Various acupuncture techniques have been used to treat patients with PD and have shown promising results. However, previous acupuncture techniques focused on the brain and motor symptoms. We aimed to determine if targeting PD patients’ gut-brain axis through electroacupuncture could be an effective, safe, and low-cost therapeutic option for management of non-motor and motor symptoms. MethodsThirty patients with mild to moderate PD were randomised into an intervention (n = 15) and a control group (n = 15). The intervention group received electroacupuncture twice a week for 30 min based on conventional drug treatment for 8 weeks. Conventional drug treatment was continued in the control group. The primary outcomes were changes in the score of clinical scales including the Non-motor Symptom Rating Scale (NMSS), PD Sleep Scale (PDSS), Bristol Stool Function Scale (BSFS), and Patient Associated Constipation and Quality of Life Scale (PAC-QOL). The secondary outcomes were the Unified PD Rating Scale (UPDRS) and Modified Hoehn-Yahr Staging Scale scores. Stool samples from the intervention group were collected before and after the procedure and were sent for gene sequencing. Adverse effects and personal impressions of the patients were noted during the course of the trial. ResultAn 8-week course of scalp-abdominal electroacupuncture treatment was effective in improving the NMSS, PDSS, and UPDRS scores in patients with PD. Further, there was statistical significance in the two subdomains of NMSS, namely sleep/fatigue and miscellaneous, further implying the efficacy of acupuncture on sleep disturbance. However, although the current acupuncture treatment was gut targeted, it had no effect on BSFS or PAC-QOL. Apart from improved UPDRS motor scores and activities of daily living scores, acupuncture had no significant impact on scores of mentation, behaviour, mood, and therapy complications. Acupuncture did not alter the Hoehn and Yahr stage. Significant alterations in gut bacterial composition were detected in nine taxa at the genus level. The relative abundances of the genera Bacteroides and Parasutterella were significantly increased after the intervention, whereas the abundances of the genera Dialister, Hungatella, Barnesiella, Megasphaera, Allisonella, Intestinimon, and Moryella were significantly lower. ConclusionAn 8-week scalp-abdominal electroacupuncture treatment may be a complementary and alternative vehicle for PD patients. We detected nine taxa at the genus level which were significantly altered after treatment, emphasising the role of the gut-brain axis in the process.

Effects of Ten Different Exercise Interventions on Motor Function in Parkinson's Disease Patients-A Network Meta-Analysis of Randomized Controlled Trials.

Objective: The aim of this study was to evaluate ten exercise interventions (YOGA: yoga training, RT: resistance training, AQU: aquatic training, TAI: Taiji Qigong training, TRD: treadmill training, VR: virtual reality training, DANCE: musical dance training, WKT: walking training, CYC: cycling training, BDJ: Baduanjin Qigong training) on motor function in Parkinson’s disease (PD) patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, and CNKI, only randomized controlled trials (RCTs) were collected to study the effects of the ten exercise interventions on motor function in patients with Parkinson’s disease. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool. Results: The RCTs were collected between the earliest available date and April 2022. Sixty RCTs were included and the total sample size used in the study was 2859. The results of the network meta-analysis showed that DANCE can significantly improve patients’ Berg Balance Scale (BBS) (SUCRA = 78.4%); DANCE can significantly decline patients’ Unified Parkinson’s Disease Rating Scale score (UPDRS) (SUCRA = 72.3%) and YOGA can significantly decline patients’ Timed-Up-and-Go score (TUGT) (SUCRA = 78.0%). Conclusion: Based on the network meta-analysis and SUCRA ranking, we can state that dance, yoga, virtual reality training and resistance training offers better advantages than other exercise interventions for patients’ motor function.

Efficacy of rasagiline monotherapy for early Parkinson disease: A systematic review and meta-analysis of randomized controlled trials.

Rasagiline monotherapy is approved in early Parkinson's disease (PD) for motor benefit. However, the efficacy and optimal rasagiline dosage in improving Unified Parkinson's Disease Rating Scale (UPDRS) subscale scores between Japanese and Caucasian individuals remain uncertain. To investigate the efficacy of rasagiline monotherapy and evaluate differences between early PD patients in Eastern and Western countries. The study design involved the meta-analysis of randomized controlled trials identified using electronic databases. The mean difference (MD) in total UPDRS scores indicated no significant difference between the 1 and 2 mg rasagiline (MD = -0.00, 95% confidence interval (CI) = -0.82 to 0.81). Compared with the placebo, the MD of UPDRS part I scores significantly improved in the 1 mg (MD = -0.33, 95% CI = -0.57 to -0.10) but not in the 2 mg. For UPDRS part II scores, the MD significantly improved in the 1 mg (MD = -0.87, 95% CI = -1.48 to -0.27) and 2 mg (MD = -0.98, 95% CI = -1.28 to -0.68). Regarding the UPDRS part III, the MD significantly improved in both (1 mg: MD = -2.41, 95% CI = -3.26 to -1.56; 2 mg: MD = -2.05, 95% CI = -2.64 to -1.46). The most commonly reported adverse events were headaches, back pain, and dizziness, with no statistical difference between the 1 mg rasagiline and placebo groups. Subgroup analysis revealed similar effects between Asian and Western participants. Rasagiline monotherapy at 1 mg per day is recommended for patients with early PD because of the benefits for motor, nonmotor functions, and safety.

Comparison of early-stage SD-OCT findings in patients with primer open angle glaucoma and Parkinson’s disease

AIM: To provide an insight to the common pathophysiology of both most frequent and neurodegenerative diseases by comparing thickness parameters of macula and retinal nerve fiber layer (RNFL) by using spectral-domain optical coherence tomography (SD-OCT) in patients with early stage of Parkinson’s disease (PD), and early stage of primary open angle glaucoma (POAG). METHODS: A retrospective review was conducted of 48 patients with an early stage of POAG, 34 patients with an early stage of PD and 37 age- and gender-matched healthy eyes as a control group. The RNFL and macular thicknesses in the nine macular quadrants according to the ETDRS were measured with an SD-OCT and Mean Deviation (MD) values by a visual field analyzer. POAG patients were selected only MD smaller than -6 dB. Patients with MD values below -6 dB were considered as early-stage glaucoma. PD severity was assessed using Hoehn and Yahr (H&amp;Y) and Unified Parkinson’s Disease Rating Scale (UPDRS). The PD group selected only H&amp;Y Stage I-III patients. RESULTS: Statistically significant difference was determined between all groups RNFL measurements except temporal RNFL (P&lt;0.05). Statistically significant difference was determined between all groups including fovea, mean macula thickness and macula outer quadrant thickness evaluations (P&lt;0.05). There was not any significant difference between thickness evaluation of macula inner quadrant for POAG and PD groups (P&gt;0.05). A weak negative correlation was determined between duration of disease and UPDRS score together with macula and RNFL thickness parameters in PD group. CONCLUSION: Similar thinning was detected by using SD-OCT for thickness parameters of macula and RNFL in early stage of POAG and early stage of PD group. However this thinning was more significant in early stage of POAG group. It can be declared that neurodegeneration on the macula which is caused by glaucoma is more destructive than PD. Thinning on foveal region is remarkable for PD patients.

Estimation of Severity in Parkinson’s Disease Using Acoustic Features of Phonatory Tasks

Unified Parkinson’s disease rating scale (UPDRS) is a tool popular in the clinical set up for the evaluation of Parkinson's disease (PD) symptoms and severity. However, the physical examination aspect and expertise requirements of the UPDRS assessment makes it subjective, expensive, and inconvenient. Thus, we have investigated the performance of vocal features from three sustained phonetic tasks (/a/, /u/, /m/) in objectively evaluating the motor UPDRS score which will help in the remote monitoring of PD motor symptoms. 26 PD patients (mean age = 72) and 22 control subjects (mean age = 66.91) volunteered the study. The voices were collected from: 1. PD patients in both off and on states of Levodopa medication and 2. control subjects. The Least Absolute Shrinkage and Selection Operator (LASSO) feature selection algorithm was applied to rank the voice features. Regression models using support vector machines (SVM), random forest (RF) and AdaBoost were employed for the objective evaluation of the motor UPDRS score. The parameters mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE) and R2 were employed to assess the performance of the models. The average motor UPDRS score for PD off-state, on-state and controls were 27.31, 20.42 and 2.63 respectively. We observed a better objective estimation of UPDRS score in all the models when using the features from /m/ compared to that from /a/ and /u/. Our study assures the possibility of objective evaluation of motor UPDRS using the vocal features from sustained phonetic tasks in PD patients under Levodopa medication off and on-state..

Re-Analysis of the STEADY-PD II Trial-Evidence for Slowing the Progression of Parkinson's Disease.

Recent examination of the STEADY-PD III isradipine clinical trial data concluded that early-stage Parkinson's disease (PD) participants who had longer exposure to isradipine had a significant delay in their need for symptomatic medication, as well as a lower medication burden at the end of the trial. These findings suggest that greater exposure to isradipine might slow disease progression. To test this hypothesis, the data from the STEADY-PD II isradipine clinical trial, in which an extended-release (ER) formulation of the drug was used, was re-examined. The re-analysis of the STEADY-PD II data was restricted to participants assigned placebo or tolerable isradipine treatment (10 mg isradipine/day or less). The effect of isradipine treatment was assessed by Unified Parkinson's Disease Rating Scale (UPDRS) at the end of the 52-week trial, rather than by last observation carried forward at the beginning of symptomatic therapy. Participant cohorts were well-matched for baseline disability, initial disease progression, and time to initiation of symptomatic therapy. Participants given 10 mg/day ER isradipine had significantly smaller total and part 3 UPDRS scores at the end of the trial than did the placebo cohort. Post hoc adjustment for symptomatic therapy diminished the statistical significance of these differences. In those participants not taking a monoamine oxidase B inhibitor, the progression in UPDRS scores also was significantly reduced. These results are consistent with the recent secondary analysis of the STEADY-PD III clinical trial-suggesting that clinically attainable brain exposure to isradipine may slow early-stage PD progression. © 2021 International Parkinson and Movement Disorder Society.

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.

Cognitive profile in early stage Parkinson disease

Purpose: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor and nonmotor symptoms mainly due to striatal dopamine deficiency. Cognitive dysfunction is one of nonmotor symptoms. The purpose of this study is to determine the cognitive dysfunction with practical screening tests and to investigate relationship between cognitive dysfunction and clinical severity in early stage of PD (EPD) Materials and Methods: EPD patients and healthy control group were included into the study. Mini mental state examination (MMSE), digit span (DS), clock drawing (CD), verbal and visual memory tests were applied to all cases. Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn & Yahr Staging (H&Y) tests were performed to EPD patients. Correlation of neurocognitive tests with UPDRS and H&Y scores were examined in EPD patients. Results: There were 30 EPD patients (11 female/19 male) and 20 healthy controls (10 female/10 male). There was a significant difference only in CD test between EPD and healthy controls. EPD with H&Y stage 1. group had higher score on backward DS, CD, and visual memory tests than EPD with H&Y stage 2. Verbal memory test scores had negatively correlated with UPDRS scores. Conclusion: The first impaired test was CD in EPD compared to control group. Other cognitive tests (backward DS, verbal and visual memory tests) were also impaired with increasing severity of disease. MMSE was not different from the control group and did not change with increasing severity of disease. MMSE alone is not enough for evaluating of EPD, other cognitive tests have to be used.