Journal of Parkinson's disease最新文献

BackgroundThe needs of people with Parkinson's disease (PD) or atypical parkinsonism (AP) change significantly in the final weeks to days of life. A better understanding of this phase can help improve care.ObjectiveTo examine healthcare use and end-of-life care in people with PD.MethodsWe conducted a retrospective study (2022-2023) in three nursing homes, four hospitals, and eleven general practices in the Netherlands. Electronic health records of deceased individuals with PD or AP were reviewed for symptoms, healthcare use, and professional involvement.ResultsWe reviewed 189 records (70.4% PD; mean age 80.2; 68.1% male). In the last two weeks of life, patients had an average of 8.4 symptoms, with a higher burden in AP. Palliative sedation was used in 60.4%, most often in nursing homes (up to 78.3%) and among AP patients. Euthanasia occurred in 11 cases (6 PD, 5 AP), mainly in nursing homes and general practices. Antibiotics and pain medications were commonly used; fluid and oxygen therapy were more frequent in hospitals. Most patients were treated by a GP and 3-4 other healthcare professionals, but only 12.7% received support from a palliative care team.ConclusionsPeople with PD and AP face a high symptom burden at the end of life, yet palliative care involvement is limited. The frequent use of palliative sedation and cases of euthanasia reflect the complexity of this care phase. Better integration of palliative expertise and research into symptom management is urgently needed.

Mild cognitive impairment and dementia are common symptoms in people with Parkinson's disease (PwPD) that impair the quality of life of those affected. However, PD-specific concepts for the prevention of cognitive decline are rarely incorporated into routine care. Here, we provide key data on cognitive impairment in PwPD and a framework for primary, secondary, and tertiary prevention in this context. The importance of cognitive reserve as a protective buffer for cognitive decline in PwPD is highlighted. Relevant lifestyle and health-related factors, including cognitive aspects, physical and social activity, diet, hearing loss, and cardiovascular factors, are discussed. Evidence on the efficacy of possible cognition-enhancing interventions in PwPD-pharmacological, cognitive, physical, nutritional, and multidomain interventions-is summarized. On this basis, and the recommendations of the European Task Force for Brain Health Services, a proposal is developed outlining options for preventing cognitive impairment in PwPD that could be implemented in routine care, as well as further developments needed to achieve a best-case scenario. The main pillars of a strategic agenda for this purpose include: (i) regular assessment of cognitive state, overall risk, and risk factors for cognitive decline; (ii) risk communication and education concerning modifiable risk factors with standardized procedures; (iii) risk reduction with multi-domain interventions for secondary prevention; and (iv) cognitive enhancement with cognitive and physical training for tertiary prevention. As the proposal makes clear, the prevention of cognitive impairment in PwPD requires interdisciplinary collaboration organized throughout PD care networks.

Parkinson's disease (PD) is a rapidly developing neurodegenerative disorder characterized by degeneration of dopaminergic neurons in the basal ganglia of the brain. Its prevalence is estimated to exceed 1.2 million cases in the United States by 2030. Emerging evidence suggests that PD may originate in the gut and hence is linked to gastrointestinal (GI) dysfunctions such as inflammatory bowel disease and GI cancers. Colorectal cancer (CRC) is one of the most common cancers seen worldwide. It shares several risk factors with PD, including advancing age, male gender, genetic predispositions, and environmental exposures. Although these shared factors indicate a possible correlation, the studies evaluating this relationship have suggested inconsistent results. Some research proposes an increased risk of CRC in PD patients, potentially due to overlapping genetic and inflammatory pathways. Alternatively, others argue an inverse relationship due to opposing underlying mechanisms of neuro degeneration in PD and cellular proliferation in CRC. This narrative review explores the intricate relationship between PD and CRC and seeks to understand how neurodegenerative and malignant diseases may overlap.

Deep brain stimulation (DBS) can improve Parkinson's disease symptoms; however, its effectiveness depends on selecting optimal settings. DBS parameter selection can be challenging, as objective metrics to guide the process are lacking. This n-of-1 study explored using functional near-infrared spectroscopy (fNIRS) to guide DBS programming. Led by the participant, the study embedded a patient perspective at the center of the project. Multiple DBS settings were tested, and their effects on gait and cortical functional connectivity were measured. The DBS program that best supported gait had the lowest functional connectivity with the left dorsolateral prefrontal cortex as seed. This suggests fNIRS may be used to guide individual optimization of DBS treatment.

Music therapy has emerged as a promising complementary intervention for Parkinson's disease (PD). PARKinSOUND, a non-randomized clinical trial, evaluated the feasibility of a community orchestra intervention for individuals with PD (n = 22), compared to a control group (n = 21). After the intervention, the orchestra group showed a modest improvement in depressive symptoms compared to baseline (Beck Depression Inventory: -0.5, p = 0.049) and controls (-5.5, p = 0.011), while motor scores (MDS-UPDRS III) remained stable. Self-reported overall improvements (PGI-C) were also higher in the orchestra group (p = 0.003). Although placebo effects may partly explain the benefits, these findings suggest emotional benefits and perceived overall improvement, providing insights for future research.

BackgroundPeople with Parkinson's disease (PwPD) have unhealthier movement behaviours (less moderate-to-vigorous physical activity (MVPA) and more sedentary behaviour (SB)), than healthy older adults. Associations across movement patterns and non-motor characteristics are poorly understood.ObjectivesTo investigate associations between relative time spent in MVPA, light-intensity physical activities (LIPA) and SB, and non-motor characteristics among PwPD, and to investigate theoretical changes in non-motor characteristics when time in different movement behaviours is reallocated.MethodsBaseline data from 119 participants in the STEPS randomised controlled trial was used. Movement behaviours were measured by ActiGraph GT3X accelerometers. Compositional data analysis assessed relative time in MVPA, LIPA and SB. Linear regression assessed associations between MVPA, LIPA and SB and self-reported anxiety and depression (HADS), executive function (TMT IV), self-efficacy for exercise (S-ESES) and activities-specific balance confidence (ABC). Isotemporal substitution modelling investigated theoretical changes in outcomes when time in MVPA, LIPA and SB were reallocated.ResultsBetter executive function was associated with more relative time in MVPA and less in LIPA. Higher exercise-self-efficacy was associated with more relative time in MVPA and less in SB. Better balance confidence related to more relative time in MVPA. Reallocating time showed that losing 20 min MVPA had a worse theoretical impact for these outcomes than the benefit of gaining 20 min.ConclusionsThe observed relationships between MVPA and executive function, balance confidence, and exercise-self-efficacy suggests particular importance of maintaining MVPA in PwPD. These findings can be utilized clinically by communicating the importance of maintaining time in MVPA among PwPD.

BackgroundLevodopa-induced dyskinesia (LID) in Parkinson's disease (PD) is linked to exaggerated gamma oscillations. Buspirone, a 5-HT1A receptor agonist, is a potent medication for psychiatric conditions, predominantly prescribed for anxiety treatment.ObjectiveThis study aims to investigate whether buspirone alleviates dyskinesia in LID rat and its effects on pathological oscillatory activity and cortico-striatal functional connectivity.MethodsWe collected motor behavior and electrophysiological data of cortico-striatal from Sham rats, unilateral 6-hydroxydopamine (6-OHDA)-lesioned PD model rats, and rats with LID. We further examined the behavioral and electrophysiological changes in LID rats following buspirone intervention.ResultsPD rats showed increased beta activity and aperiodic components at 10-50 Hz, while LID rats exhibited excessive gamma oscillations and aperiodic activity at 50-150 Hz. Additionally, gamma-band functional connectivity within the cortico-striatal circuit was significantly enhanced during on-state dyskinesia, when rats exhibited abnormal involuntary movements. Administration of buspirone effectively reduced dyskinesia severity, suppressed gamma activity, decreased aperiodic components (50-150 Hz), and disrupted gamma-band functional connectivity without compromising the antiparkinsonian effects of levodopa.ConclusionsExcessive gamma oscillations represent a key electrophysiological marker of dyskinesia. Altered gamma-band connectivity within the cortico-striatal network may contribute to its pathophysiology. Buspirone appears to be a promising candidate for the treatment of LID, potentially offering a novel therapeutic strategy.

BackgroundFatigue in Parkinson's disease (PD) is a common, debilitating symptom often overlooked in research and clinical practice. Effective interventions are needed to mitigate its impact on people with PD.ObjectiveThis pilot study evaluated the feasibility of the individual videoconference version of the Packer Managing Fatigue program for people with PD and explored its preliminary effectiveness versus usual care to inform the design of a definitive trial. Here we report on the second objective.MethodsA two-arm, assessor-masked, randomized controlled pilot study recruited participants with PD who experience severe fatigue, have English proficiency, and internet access. Outcome measures included occupational performance, satisfaction with performance, occupational balance, fatigue impact, quality of life, and sleep. Mixed repeated-measures ANOVA and non-parametric tests were used for analysis.ResultsMixed-design ANOVA (N = 25) showed an exploratory trend toward significant for the Time × Group interaction effect differences in satisfaction with performance between groups over time (p = 0.09). Paired t-tests within the intervention group indicated significant improvement in satisfaction with performance (p = 0.04). The effect size for this outcome was moderate. Small to moderate effect sizes were observed for occupational balance, occupational performance, and subscales of the Multidimensional Fatigue Inventory. Other measures showed negligible effects.ConclusionsThe results provide preliminary evidence of the program's benefits for people with PD. Larger, more rigorous studies are needed to confirm its effectiveness. Despite the small sample size and challenges posed by COVID-19, this study offers valuable insights into recruitment strategies and effect sizes to inform future trial designs.

Physical activity (PA) remains critical in the slowing of disease progression in early Parkinson's disease (PD), although the longitudinal follow-up of such studies remain scarce. Using data from an early PD Cohort, we longitudinally examined the impact of unprescribed PA on symptoms of early PD, controlling for demographics and medications. Over five years, the reported PA in early PD declined significantly annually. When maintained, the overall PA had significant association with improved motor symptoms, cognition, and quality of life. Higher PA maintained longitudinally is associated with a slower progression of motor and non-motor symptoms, and predict better quality of life in patients with early PD.

BackgroundAnxiety is a common non-motor symptom in Parkinson's disease (PD) and has previously been associated with changes in cortical thickness of various brain regions.ObjectiveTo identify changes in cortical thickness in PD-related anxiety.Methods148 patients from an ongoing cohort study were included: 30 PD patients with anxiety, 73 PD patients without anxiety and 45 healthy controls. Anxiety was measured with the Parkinson Anxiety Scale (PAS). A 7 T structural MRI scan was performed and used to compare cortical thickness between these groups. Region of interest (ROI) as well as whole-brain analyses were performed to identify differences.ResultsROI analyses revealed a strong negative association between the cortical thickness of the left lingual gyrus and the severity of anxiety in PD patients (R = -0.71; p = 0.006). Additional significant strong negative associations with the severity of anxiety in PD patients were observed in the frontal and cingulate regions (R between -0.56 and -0.65). Whole-brain analysis revealed a significant cluster of cortical thinning in the left anterior cortex and the dorsolateral prefrontal cortex weakly associated with PAS total score across all groups (R = -0.25, p = 0.00201).ConclusionsThis study is the first to report a strong negative association between left lingual gyrus thickness and anxiety severity in PD. Additionally, anxiety in early PD is associated with cortical thinning in the fronto-cingulate region, mainly affecting left sided structures. Future studies should examine whether these cortical changes can predict the anxiety progression patterns or the treatment response in PD patients.