Unified Parkinson's Rating Scale Research Articles

Clinical significance of MRI-measured olfactory bulb height as an imaging biomarker of idiopathic Parkinson's disease.

This study aimed to determine whether the olfactory bulb height (OBH) measured using magnetic resonance imaging (MRI) has clinical utility as an imaging biomarker in the evaluation of patients with idiopathic Parkinson's disease (iPD) through its correlation with movement impairment. This retrospective study included cognitively intact patients with suspected parkinsonism. All participants underwent T2-weighted imaging to measure OBH. Logistic regression was used to determine whether OBH was an independent risk factor for distinguishing iPD patients from disease controls, and its relation with clinical parameters related to motor impairment, including clinical laterality, modified Hoehn and Yahr (HY) stage, and Unified Parkinson's Disease Rating Scale (UPDRS) III score, was investigated. Based on the final clinical diagnosis, 79 patients with iPD and 16 disease controls were included. The mean OBH was significantly smaller in iPD than in disease controls (p < 0.0001). OBH was a significant independent predictor of iPD, with a cutoff of 1.52 mm. In the comparison among the ipsilateral, contralateral side of iPD with clinical laterality, and disease control group, the OBH of the disease control group was significantly larger than both the ipsilateral and contralateral sides (P < 0.05). However, there was no significant difference in OBH between the ipsilateral and contralateral sides (p > 0.05). OBH according to HY stage was significantly smaller in HY stage 2-3 groups than in the disease control group (p < 0.001). The correlation analysis between UPDRS III and OBH showed a mild negative correlation (r = -0.32, p = 0.013). MRI-measured OBH is decreased in iPD regardless of age and sex and may be correlated with the progression of motor symptoms in the iPD.

Biomarker Assessment in Parkinson’s Disease Dementia and Dementia with Lewy Bodies by the Immunomagnetic Reduction Assay and Clinical Measures

Background: Plasma biomarker assays provide an opportunity to reassess whether Alzheimer’s disease, Parkinson’s disease dementia (PDD), and dementia with Lewy bodies (DLB) plasma biomarkers are diagnostically useful. Objective: We hypothesized that immunomagnetic reduction (IMR) of plasma biomarkers could differentiate between patients with PDD and DLB and healthy patients when combined with established clinical testing measures. Methods: Plasma samples from 61 participants (12 PDD, 12 DLB, 37 controls) were analyzed using IMR to quantify amyloid-β 42 (Aβ42), total tau (t-tau), phosphorylated tau at threonine 181 (p-tau181), and α-synuclein (α-syn). Receiver operating characteristic curve (ROC) analysis was used to obtain sensitivity, specificity, and area under the ROC curve. Biomarker results were combined with clinical measures from the Unified Parkinson’s Disease Rating Scale (UPDRS), Montreal Cognitive Assessment, and Hoehn-Yahr stage to optimize diagnostic test performance. Results: Participants with PDD had higher α-syn than those with DLB and healthy participants and were distinguishable by their biomarker products Aβ42×p-tau181 and Aβ42×α-syn. Patients with DLB had higher p-tau181 than those with PDD and healthy participants and were distinguishable by their concentrations of α-syn×p-tau181. Plasma α-syn plus UPDRS versus either test alone increased sensitivity, specificity, and AUC when healthy patients were compared with those with PDD and DLB. Combined clinical examination scores and plasma biomarker products demonstrated utility in differentiating PDD from DLB when p-tau181 was combined with UPDRS, α-syn was combined with UPDRS, and α-syn×p-tau181 was combined with UPDRS. Conclusions: In this pilot study, IMR plasma p-tau181 and α-syn may discriminate between PDD and DLB when used in conjunction with clinical testing.

Acupuncture at stellate ganglion combined with western medication for orthostatic hypotension in Parkinson's disease: a randomized controlled trial

To observe the effect of acupuncture at stellate ganglion on orthostatic hypotension (OH) in Parkinson's disease (PD), and explore its action mechanism. A total of 68 patients with OH in PD were randomly divided into a combination group (34 cases, 2 cases dropped out, 1 case was eliminated) and a western medication group (34 cases, 1 case was eliminated). Both groups received stable dose anti-PD western medication, the western medication group received oral midodrine hydrochloride tablets, 2.5 mg each time, 2 times a day. The combination group was treated with acupuncture at bilateral stellate ganglion on the basis of the western medication group, without retaining needles, once a day, 5 times a week. Both groups were treated for 2 weeks. Supine and orthostatic blood pressure, orthostatic hypotension questionnaire (OHQ) score, TCM syndrome score, unified Parkinson's disease rating scale (UPDRS) score before and after treatment in the two groups were observed, the level of serum norepinephrine (NE) was detected, and the clinical effect was evaluated. After treatment, orthostatic systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the combination group were increased compared with those before treatment (P<0.01), OHQ score, TCM syndrome score, UPDRS score were decreased compared with those before treatment (P<0.01); supine SBP in the western medication group was increased compared with that before treatment (P<0.05), OHQ score was decreased compared with that before treatment (P<0.05); the levels of serum NE in both groups were increased compared with those before treatment (P<0.01). After treatment, orthostatic SBP, orthostatic DBP and the level of serum NE in the combination group were higher than those in the western medication group (P<0.01, P<0.05), the OHQ score, TCM syndrome score, UPDRS score were lower than those in the western medication group (P<0.05, P<0.01). The total effective rate was 87.1% (27/31) in the combination group, which was higher than 63.6% (21/32) in the western medication group (P<0.05). Acupuncture at stellate ganglion can increase the orthostatic blood pressure in patients with OH in PD , improve clinical symptoms, and the mechanism may be related to the up-regulation of NE.

The Effectiveness and Safety Analysis of Duloxetine in Treating Comorbid Depression in Parkinson's Disease: A Retrospective Study.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms, including depression, which significantly impacts the quality of life of affected individuals. This study aims to investigate the real-world effectiveness and safety of duloxetine in treating comorbid depression in patients with Parkinson's disease and to compare its outcomes with traditional treatment approaches. This study included adult patients diagnosed with Parkinson's disease combined with depression from December 2020 to December 2023. Based on the use of duloxetine, the cohort was divided into a traditional treatment group and a duloxetine group (traditional treatment combined with duloxetine). Patients with incomplete medical records, concurrent antidepressant therapy, or major psychiatric or neurological disorders were excluded. Retrospective data, including demographic information, treatment adherence, and various assessment scores, were collected from medical records by trained research staff. In total, 106 patients were analyzed, with 50 patients receiving traditional treatment and 56 patients receiving duloxetine. The duloxetine group exhibited significantly lower scores than the traditional treatment group in the Unified PD Rating Scale (p = 0.015), Hamilton Depression Rating Scale (p = 0.013), Beck Depression Inventory (p = 0.031), Parkinson's disease Questionnaire-39 (p = 0.006), and Clinical Global Impression-Improvement (p < 0.001) scores. In motor function assessment, the duloxetine group demonstrated improvements in kinetic tremor scores (p = 0.017), gait speed (p < 0.001), Timed Up and Go Test performance (p < 0.001), dyskinesia severity (p = 0.017), and rigidity (p = 0.019) compared to the traditional treatment group. Additionally, the duloxetine group exhibited better cognitive function across various assessments, including the Symbol Digit Modalities Test (p = 0.024), Stroop Color-Word Test (p = 0.048), and Montreal Cognitive Assessment (p = 0.024). Duloxetine is associated with superior efficacy in improving motor and non-motor symptoms, overall clinical status, and cognitive function. These findings support the potential utility of duloxetine as a comprehensive treatment option for comorbid depression in Parkinson's disease.

Clinical efficacy of low-intensity pulsed ultrasound in Parkinson's disease with cognitive impairment.

Low-intensity pulsed ultrasound (LIPUS), is a new technique for invasive brain stimulation and modulation that has emerged recently, but the effects in Parkinson's disease with cognitive impairment (PD-CI) have been less observed. In this study, we collected 56 patients with PD-CI who were continuously treated with LIPUS for 8 weeks, and observed the clinical efficacy of LIPUS on PD-CI patients by comparing with the Sham stimulation continuous treatment. Fifty-six PD-CI patients were divided into the Sham group (given Sham stimulation on top of conventional medication, n = 28) and the LIPUS group (given LIPUS stimulation on top of conventional medication, n = 28), and both groups continued treatment for 8 weeks. Post-treatment efficacy and pre- and post-treatment cognitive function [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA)], emotional state [Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI)], quality of life [Unified Parkinson's Disease Rating Scale (UPDRS), 39-item Parkinson's Disease Questionnaire (PDQ-39)], and serologic indices [5-hydroxytryptamine (5-HT), norepinephrine (NE), and dopamine (DA)] were compared. The total effective rate of the LIPUS group was higher versus that of the Sham group. In both groups, MMSE and MoCA scores increased; BDI and BAI scores decreased; UPDRS and PDQ-39 scores were reduced; the levels of 5-HT, NE, and DA were elevated. The above changes were more pronounced in the LIPUS group (all P < 0.05). The application of LIPUS on PD-CI could ameliorate patients' cognitive function, emotional state and quality of life, and regulate and optimize neurotransmitter expression levels.

Correlations of gray matter volume with peripheral cytokines in Parkinson's disease

IntroductionPeripheral cytokine levels may affect specific brain volumes. Few studies have examined this possible relationship. ObjectiveIn a case–control study, we used magnetic resonance imaging (MRI) voxel-based morphological analysis techniques to examine the relationship between gray matter volume changes and cognitive, motor and emotional dysfunction as well as between gray matter volume changes and peripheral blood cytokine levels. MethodA total of 134 subjects, comprising 66 PD patients and 68 healthy controls, were recruited. Peripheral venous blood was collected to measure the concentrations of 12 cytokines, including IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, IFN-α, IFN-γ, and TNF-α. All the subjects also underwent MRI, where 3D-T1-weighted MR images were used for the analysis. In addition, the Montreal Cognitive Assessment (MoCA), Mini-Mental Status Examination (MMSE), Unified Parkinson's disease Rating Scale (UPDRS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) scores were assessed in PD patients. Statistical parameter mapping 12 software was used for the statistical analysis of the images. ResultCompared with control patients, PD patients presented decreased gray matter volume (GMV) in the bilateral frontal lobe, temporal lobe, parietal lobe, occipital lobe, insula, and right cerebellar lobule VIII. Regional GMV in the temporal lobe, parietal lobe, and cerebellum was correlated with MoCA, MMSE, UPDRS, HAMA, and HAMD scores in PDs. In addition, the regional GMV in PDs was correlated with the concentrations of cytokines, including IL-4, IL-6, IFN-γ, and TNF-α. The IL-6 concentration was negatively correlated with the UPDRS-IV score. ConclusionPD patients exhibit gray matter atrophy in a wide range of brain regions, which are symmetrically distributed and mainly concentrated in the frontal and temporal lobes, and these changes may be linked to motor disorders and neuropsychiatric manifestations. Cytokine concentrations in peripheral blood are correlated with regional gray matter volume in PDs, and the IL-6 level affects gray matter volume in the left precentral gyrus and the manifestation of motor complications.

Test-retest and inter-rater reliability and construct validity of the 2-minute step test in individuals with Parkinson's disease

ObjectiveTo evaluate the test-retest and inter-rater reliability and construct validity of the 2-minute step test (2MST) in individuals with Parkinson's disease (PD). MethodsTwo previously trained examiners applied the 2MST in two moments. Clinical measurements of PD were obtained using the following instruments: Berg Balance Scale (BBS), Unified Parkinson's Disease Rating Scale (UPDRS), modified Hoehn and Yahr Scale (H&Y), gait speed and cadence, 5-time Sit-to-Stand Test (5TSST) and Timed Up and Go (TUG). For reliability, the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. For construct validity, Pearson's and Spearman's correlation coefficient were used. The agreement between the measurement in person and via recorded video was assessed by means of Bland-Altman plots. ResultsThe 2MST showed adequate test-retest reliability (ICC = 0.80, SEM = 10.59, MDC = 29.35) and excellent inter-rater reliability (ICC = 0.93, SEM = 4.49, MDC = 12.46). There was acceptable agreement between assessments made with in person and via video. A correlation magnitude above 0.50 was found between 2MST and gait speed, and a correlation magnitude between 0.30 and 0.50 with BBS, gait cadence, UPDRS and TUG. ConclusionThe 2MST presents adequate test-retest and inter-rater reliability and a valid construct to evaluate the aerobic endurance of individuals with PD.

Motor and non-motor predictors of freezing of gait in Parkinson's disease: A retrospective cohort study

IntroductionFreezing of gait (FOG) is a debilitating episodic gait disorder that significantly reduces the quality of life (QoL) in patients with Parkinson's disease (PD). Diagnosing and treating FOG remains a major medical challenge. This study aimed to assess the correlation between FOG and both motor and non-motor clinical characteristics in patients with PD. MethodsIn this retrospective cohort study, 112 patients with PD were divided into two groups using the New Freezing of Gait Questionnaire (NFOG-Q): one group with FOG (PD-FOG, 53 patients) and one group without FOG (PD-nFOG, 59 patients). The severity of PD and FOG was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn-Yahr (H–Y) staging system, and the NFOG-Q. The study also analyzed non-motor symptoms, including sleep disturbances, cognitive impairments, depression, anxiety, apathy, fatigue, and QoL. ResultThe prevalence of FOG was 47.3%. The PD-FOG group exhibited a longer duration of PD (P = 0.002), a higher H–Y stage indicating PD progression (P = 0.003), and elevated anxiety levels (P = 0.003) compared to the PD-nFOG group. According to binary logistic regression analysis, the higher H–Y stage (P = 0.022), anxiety level (P = 0.005), UPDRS part II (P = 0.001), and part III (P = 0.008) were significant predictors for the occurrence of FOG. ConclusionPatients with Parkinson's disease who have a higher Hoehn-Yahr (H–Y) stage, higher UPDRS score, and elevated levels of anxiety are more likely to experience FOG.

Deep Learning for Parkinson's Disease Diagnosis: A Graph Neural Network (GNN) Based Classification Approach with Graph Wavelet Transform (GWT) Using Protein-Peptide Datasets.

Background: An important neurological disorder of Parkinson's Disease (PD) is characterized by motor and non-motor activity of the patients. Empirical condition of the patient: PD assessment uses the Movement Disorder Society Unified Parkinson's Rating Scale part III (MDS-UPDRS-III) measures for identifying the prediction of PD. Due to the unstable value of the measurement, the PD prediction and tracking lead to a lower prediction rate. Methods: To overcome this limitation, this paper proposed the Graph Wavelet Transform (GWT) based weighted feature extraction along with the Graph Neutral Network (GNN) classification. The main contribution of this research is (i) The weighted correlation between the data is calculated by GWT for effective prediction of PD. (ii) Machine learning algorithms were trained to predict Parkinson's disease based on these patterns. In this research, we developed a new model called Graph Neural Network (GNN) to predict PD tremors' MDS-UPDRS-III score using input data. To strengthen PD research and enable the construction of individualized treatment plans, these linked networks work together to methodically examine the data and find significant discoveries. Results: The proposed approach for predicting PD severity (motor- and MDS_UPDRS) has a mean squared error of 0.1796 and a root mean squared error of 0.2845, according to the experimental data. The prediction accuracy is increased by 27.66%, 54.11%, and 0.71%, correspondingly, when compared with the most effective State-of-the-Art methods of DNN, ANFIS + SVR, and Mixed MLP models. Conclusion: In conclusion, this proves that the proposed strategy is more effective at making predictions.

Parkinson’s Disease Medications Prescribing and Falls Assessment in Older Persons Movement Disorder Clinic

Abstract Background Parkinson’s Disease is a progressive neurodegenerative movement disorder. It is the second most common neurodegenerative condition after Alzheimer’s. The movement disorder clinic for Older Persons is well established in the Mater Hospital for years. Patients are followed regularly, and multiple domains are assessed including UPDRS (Unified Parkinson’s Disease Rating Scale), medications, and falls. Methods A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment. A retrospective audit of patient’s clinic letters was performed for a sample of 48 patients over a 5months period. Inclusion criteria was; idiopathic Parkinson's Disease and ≥ 65 years old. Exclusion criteria was; atypical parkinsonism and virtual consultations. The audit had two sections; medications profile and falls assessment. Results Of the total number of 48 patients audited, 65% were females and 35% were males. The majority (83%) of patients were ≥75yrs of age, and 17% age 65-75yrs, with mean age of 83years old. 68.8% didn’t have the year of diagnosis documented. 88% were on levodopa/decarboxylase inhibitor, 29% on MAOB-I (6% only on it as first line), 17% on dopamine agonist, 2% on Amantadine. 83% of the patients had assessment of falls reflected on history taking and lying (sitting)/standing BP documentation. Of which 60% had no falls, and 21% had evidence of postural drop. Conclusion Most of the patients attending the clinic were 75 years of age or older. Levodopa combined with a decarboxylase inhibitor was the most commonly used medication in this cohort of patients. The majority of patients had falls assessments conducted and documented. However, for most patients, the year of diagnosis was not recorded.

Repurposing celecoxib as adjuvant therapy in patients with Parkinsonian disease: a new therapeutic dawn: randomized controlled pilot study.

The clinical presentations of Parkinson's disease (PD), a chronic neurodegenerative condition, include bradykinesia, hypokinesia, stiffness, resting tremor, and postural instability. Recently, neuroinflammation is involved in pathogenesis of PD. Application of nonsteroidal anti-inflammatory drugs captured attention to treat these neuroinflammation. To investigate the possible effectiveness of celecoxib in patients with PD treated with conventional treatment. Sixty outpatients who fulfilled the inclusion requirements for PD were enrolled in this randomized, prospective, and controlled study. The patients were allocated into two groups at random (n = 30); the control group received standard PD treatment, consisting of levodopa/carbidopa, and the celecoxib group received standard PD treatment plus celecoxib. A neurologist evaluated each patient at the beginning of the treatment and after 6months. Assessment of Unified Parkinson's disease rating scale (UPDRS) for each patient. Before and after treatment, α -synuclein (α-Syn), tumor necrosis factor alpha (TNF-α), Toll like receptors-4 (TLR-4), nuclear factor erythroid 2-related factor 2 (Nrf-2) and brain-derived neurotropic factor (BDNF) were assessed. Paired and unpaired t tests were used to assess statistical significance within and between groups respectively. The celecoxib group exhibited a significant and statistical reduction in the level of measured parameters by unpaired t test as followed: TLR-4 (p = 0.004), TNF-α (p = 0.042), and α-Syn (p = 0.004) apart from a significant increase in BDNF (p = 0.0005) and Nrf-2 (p = 0.004), in comparison with the control group. Also, UPDRS was significantly decreased in celecoxib group (p < 0.05). Celecoxib could be a promising adjuvant therapy in managing patients with PD. NCT05962957.

Retrospective analysis of diet and gut microbiota diversity and clinical pharmacology outcomes in patients with Parkinsonism syndrome

BackgroundParkinson's disease (PD) is a global neurodegenerative ailment impacting millions, causes significant degeneration of dopaminergic neurons in the substantia nigra. Emerging research underscores the gut microbiota's role in PD onset. Yet, investigations in Chinese demographics are lacking. This study thus targets a retrospective examination of gut microbiota variety and clinical aspects in Chinese PD patients. MethodsWe retrospectively analyzed 50 PD patients' clinical data (admitted May 2021–April 2022) and compared their gut microbiota composition and abundance via 16S rDNA V3-V4 region sequencing against 50 healthy controls. The study also explored links between disease severity and PD patients' gut microbiota. ResultsWe found that the gut microbiota diversity was increased in PD patients. Specifically, phyla Firmicutes, Actinobacteria, and Proteobacteria were more abundant, whereas Bacteroidetes was less abundant compared to controls. Gut microbiota diversity did not vary between early-vs. late-onset PD, tremor-dominant vs. non-tremor-dominant, or constipation-associated vs. non-constipation-associated subtypes. The abundance of Firmicutes was positively correlated with UPDRS (Unified Parkinson's Disease Rating Scale) III score, NMSS (Non-Motor Symptoms Scale) score, Wexner score, and PDQ-39 (Parkinson's Disease Questionnaire-39) score; the abundance of Actinobacteria was positively correlated with UPDRS III, NMSS, Wexner, and PDQ-39 scores; and the abundance of Bacteroidetes was negatively correlated with UPDRS III, NMSS, Wexner, and PDQ-39 scores. At the family level, the abundance of Bifidobacteriaceae, Enterobacteriaceae, and Porphyromonadaceae was positively correlated with UPDRS III, NMSS, and PDQ-39 scores. ConclusionCompared with healthy individuals, PD patients have increased gut microbiota diversity, and the abundance of Bifidobacteriaceae, Enterobacteriaceae, and Porphyromonadaceae is associated with the severity of both motor and non-motor symptoms in PD patients.

Subthalamic Stimulation Improves Short-Term Satisfaction with Life and Treatment in Parkinson's Disease.

The effect of subthalamic stimulation (STN-DBS) on patients' personal satisfaction with life and their Parkinson's disease (PD) treatment is understudied, as is its correlation with quality of life (QoL). Therefore, we tested the hypothesis that STN-DBS for PD enhances satisfaction with life and treatment. In a prospective, multicenter study with a 6-month follow-up involving 121 patients, we measured the main outcomes using the Satisfaction with Life and Treatment Scale (SLTS-7). Secondary outcomes included the eight-item PD Questionnaire (PDQ-8), European QoL Questionnaire (EQ-5D-3L), EQ-Visual Analogue Scale (VAS), Non-Motor Symptom Scale (NMSS), Hospital Anxiety and Depression Scale (HADS), and Unified PD Rating Scale (UPDRS). Longitudinal outcome changes, effect sizes (Cohen's d), and correlations between outcome changes were analyzed. SLTS-7 scores improved at the 6-month follow-up, particularly in the domains of 'satisfaction with physical health' and 'satisfaction with treatment'. Change scores correlated strongly (EQ-VAS), moderately (PDQ-8 SI and HADS), and weakly (UPDRS-activities of daily living and EQ-5D-3L) with other scales. Satisfaction with physical health, psychosocial well-being, or treatment was not related to UPDRS-motor examination. This study provides evidence that STN-DBS enhances patients' personal satisfaction with life and treatment. This satisfaction is associated with improvements in the QoL, daily activities, and neuropsychiatric aspects of PD rather than its motor aspects.

Associations between Thyroid Hormones and Cognitive Impairment in Patients with Parkinson's Disease.

This study aims to explore the correlation of serum thyroid hormone levels to cognitive impairments in Parkinson's disease (PD) patients. In this retrospective study, 106 Chinese patients without cognitive impairments and 94 patients with cognitive impairments, including 55 with mild cognitive impairment (PD-MCI) and 39 with PD dementia (PDD), were analyzed. Clinical data regarding the PD assessments, including disease duration, Unified Parkinson's Disease Rating Scale (UPDRS) Part 3 scores, and Hoehn and Yahr (H-Y) staging, were analyzed. Cognitive functions were evaluated using the Montreal Cognitive Assessment score. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), were measured using ELISA. Significantly altered H-Y staging, disease duration, and UPDRS Part 3 scores were observed in PD patients with cognitive impairment compared with those without. Serum levels of FT3 were significantly decreased, while FT4 and TSH levels were significantly elevated in PD patients with cognitive impairment compared with those without. Combined detection of TSH, FT3, and FT4 showed value in distinguishing PD patients with and without cognitive impairment. Furthermore, a comparison of serum levels between PD-MCI and PDD patients revealed significant association between thyroid hormone levels and the degree of cognitive impairment in PD patients. Our findings suggest a relationship between changes in serum thyroid hormone levels and cognitive impairments in PD patients. Thyroid hormone levels, particularly FT3, may serve as potential markers for cognitive dysfunction in PD.

Motor Function Is Associated with Cerebral Small Vessel Disease and Can Predict Mortality and Poor Functional Outcome

Introduction: The primary objective of this study was to elucidate the predictive role of subtle motor impairment evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS) Part III on mortality and functional outcome. The secondary objective was to evaluate the association of motor impairment with small vessel disease (SVD) severity. Methods: We derived data from a Japanese cohort of patients with evidence of SVD who were enrolled from 2015 to 2019, and followed until 2023. The present study included 586 participants who agreed for UPDRS Part III evaluation. The severity of white matter hyperintensities (WMHs) and the presence of lacunes were evaluated. Cox proportional hazard models and multiple logistic regression analysis were used to examine the association between UPDRS Part III score and all-cause death and functional outcome defined by the modified Rankin Scale (mRS) score at the last visit, respectively. Results: The median age was 71 years, and the median UPDRS Part III score was 2. The UPDRS Part III score was associated with the severity of WMH (r = 0.225, p < 0.001) and the number (0, 1, ≥2) of lacunes (p < 0.001). During a mean follow-up period of 4.8 years, 29 patients died. The Cox proportional hazard analysis revealed that high UPDRS Part III scores (≥5) were associated with a higher risk of all-cause death compared to low (score 0) and middle (score 1–4) scores (adjusted hazard ratio 3.04; 95% confidence interval, 1.50–7.34, p = 0.005). In multivariate logistic analysis, high UPDRS Part III scores were associated with poor functional outcome (mRS of ≥3) compared with low and middle scores after adjusting for confounding factors (adjusted odds ratio 1.86; 95% confidence interval 1.02–3.41, p = 0.043). Conclusions: Subtle motor impairment was associated with the severity of WMH and number of lacunes and could predict mortality and poor functional outcome independently of vascular risk factors and severity of WMH and lacunes.

A - 129 Healthcare Disparity between Dominant English Versus Spanish-Speaking Deep Brain Stimulation Candidates with Parkinson’s Disease

Abstract Objective The existence of healthcare disparities is well documented, although data regarding mental health disparities in pre-surgical deep brain stimulation surgery (DBS) patients with Parkinson’s disease (PD) remains emergent. In this study, we compare mood, apathy, and quality of life (QoL) in dominant English and Spanish-speaking PD-DBS candidates. We hypothesized that presurgical PD-DBS Spanish-speakers would have greater disease burden and lower mood and QoL compared to native English-speakers. Method Demographic and disease specific characteristics including disease duration and severity (Unified Parkinsons Disease Rating Scale (MDS-UPDRS)), mood (Beck Depression Inventory-II (BDI-II), Starkstein Apathy Scale (SAS)), and QoL (Parkinson’s Disease Questionnaire-39 (PDQ-39)) were compared. Data were analyzed using independent t-tests and chi-square tests to identify group differences based on language dominance (English (n = 20), Spanish (n = 20)). Results Spanish-speakers had higher disease burden (MDS-UPDRS “on”: p = 0.018; “off”: p = 0.023), but no other statistical significance in demographic or clinical motor characteristics. There were significant group differences in mood (BDI-II: p = 0.046), PDQ-39 Total and subdomain scores (Total: p = 0.017; ADL: p = 0.005; Mobility: p = 0.007; Emotional Wellbeing: p = 0.029; and Bodily Discomfort: p = 0.007) with Spanish-speakers reporting poorer QoL. No significant group differences were found regarding apathy. Conclusion(s) Spanish-speakers demonstrated greater disease burden and endorsed significantly lower QoL and depression symptoms compared to English speakers. These data add to our understanding of healthcare disparities among presurgical PD-DBS candidates and suggest that underrepresented groups, such as dominant Spanish-speakers, may have less access to early intervention, missed PD symptomology, and/or cultural apprehension about seeking medical care, thus increasing disease burden and impacting QoL over time.

Video-Guided Optimization of Stimulation Settings in Patients with Parkinson's Disease and Deep Brain Stimulation.

Deep brain stimulation (DBS) for Parkinson's disease (PD) often necessitates frequent clinic visits for stimulation program optimization, with limited experience in remote patient management. Due to the resource-intensive nature of these procedures, we investigated a way to simplify stimulation optimization for these patients that allows for the continuous monitoring of symptoms while also reducing patient burden and travel distances. To this end, we prospectively recruited ten patients treated with DBS for PD to evaluate the feasibility of telemedicinal optimization in a home-based setting. Patients recorded daily videos of a modified Unified Parkinson's Disease Rating Scale (UPDRS) III, which experienced DBS physicians located at the clinic assessed to provide instructions on adjusting stimulation settings using a handheld programmer with previously set programs as well as patient amplitude control. This study concluded with significant improvements in participants' motor status as measured by the UPDRS-III (p = 0.0313) compared to baseline values. These findings suggest that remote video-guided optimization of DBS settings is feasible and may enhance motor outcomes for patients.

Effects of positive psychology intervention based on the PERMA model on psychological status and quality of life in patients with Parkinson's disease

ObjectiveTo explore the effect of a positive psychology intervention based on the PERMA model on depressive mood and the quality of life of patients with Parkinson's disease (PD). MethodsA total of 60 patients with PD with depression hospitalised between February 2022 and February 2023 were selected using a convenience sampling method. They were divided into a study group (30 cases) and control group (30 cases) using the random number table method. The control group was given routine nursing, whereas the observation group was treated using the PERMA model of positive psychological intervention. The Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Quality-of-Life Questionnaire (PDQ-39), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Positive and Negative Affect Schedule (PANAS), and Connor–Davidson Resilience Scale (CD-RISC) scores were collected and compared before and after the intervention, and patient care satisfaction after the intervention was also recorded and compared. ResultsStatistically significant differences were identified in the UPDRS (t = 4.221, p < 0.001), PDQ-39 (t = 5.331, p < 0.001), HAMD (t = 4.298, p < 0.001), HAMA (t = 3.412, p < 0.001), CD-RISC (t = 3.426, p < 0.001), and PANAS (t = 3.432, t = 4.523, p < 0.001) scores. The UPDRS, PDQ-39, HAMD, HAMA, and negative emotion scores in the study group were lower than those in the control group, whereas the CD-RISC and positive emotion scores in the study group were higher than those in the control group. A significant difference in nursing satisfaction was also determined between the two groups (Z = −2.700, p = 0.012), and this result was higher in the study group (93.33 %) than in the control group (73.33 %). ConclusionA positive psychology intervention using the PERMA model can effectively counter the negative psychological states of depression, anxiety, and negative emotion in patients with PD, thereby significantly improving their quality of life, psychological resilience levels, and patient satisfaction.

Sparse item testing of clinical scales in neurology trials to alleviate burden to patients.

Neurology trials typically rely on composite scales for measuring symptom severity. Completing all items in a long scale can be burdensome for patients, caregivers, and trial personnel. To test the hypothesis that sparse item testing, aided by item-response modelling, can preserve the power for detecting treatment effect in a controlled trial. UPDRS (Unified Parkinson's Disease Rating Scale) Part III (motor examinations) data from a placebo-controlled trial (N = 391) of ropinirole were analysed with a longitudinal item-response model. Symptom severity was estimated directly from item scores as a latent variable, without needing the total score. This enabled sparse item testing. With the symptom severity as a clinical endpoint, the potential power loss for detecting treatment effect due to the sparse testing was assessed by simulation. When each patient took 18 of all 27 tests in UPDRS Part III at each study visit, there was no appreciable power loss. Reducing four visits to three also had negligible effects on power. A threefold reduction of the total tests that each patient needed to do throughout the trial, from 108 to 27, only compromised power slightly, e.g., from 92 to 87% at N = 160. These findings show that using the symptom severity derived from item scores as the endpoint allows sparse testing to drastically reduce trial burden without incurring major power loss. This benefit would multiply for indications like Alzheimer's disease where modern trials often require patients to be tested on multiple scales at several times.

A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease.

There remains significant debate regarding the performance of deep brain stimulation (DBS) procedures for Parkinson disease (PD) under local or general anesthesia. The aim of this meta-analysis was to compare the clinical outcomes between "asleep" DBS (general anesthesia) and "awake" DBS (local anesthesia) for PD. We conducted a comprehensive literature review of all published studies on DBS for PD following PRISMA guideline on PubMed and Cochrane library from January 2004 to April 2023. Inclusion criteria included cohort ≥15 patients, clinical outcomes data which included Unified Parkinson's Disease Rating Scale (UPDRS) score and levodopa equivalent daily dosage (LEDD), and ≥3 months of follow-up. Analysis was conducted using Stata software. There were 18 articles that met inclusion criteria. On meta-analysis, there were no significant differences between awake or asleep DBS with regard to percent change in UPDRS III "off" med/"on" DBS condition (P = .6) and LEDD score (P = .99). On subgroup analysis, we found that the choice of target had no significant effect on improvement of UPDRS III (P = 1.0) or LEDD (P = .99) change for the asleep vs awake operative approach. There were also no statistically significant differences between microelectrode recording (MER) use and no MER use in postoperative UPDRS III (P = 1.0) or LEDD improvement (P = .90) between awake and asleep surgery. There was no significant difference in the primary motor outcomes and LEDD improvement between asleep vs awake DBS. The variables of target selection and MER use had no statistically significant impact on outcome. We find that asleep techniques are both safe and effective compared with the awake technique.