Journal of Parkinson's disease最新文献

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.

Exercise is an essential part of the treatment of Parkinson's disease. However, certain symptoms can make exercise difficult. In this viewpoint, we describe an under recognized symptom called running-induced dystonia (RID), which can prevent people with Parkinson's from exercising in their preferred way. We summarize the existing literature and use three case studies to outline potential mechanisms, aggravating and relieving factors and both pharmacological and non-pharmacological therapies to get rid of RID.

BackgroundImpaired gait initiation is a debilitating motor symptom in people with Parkinson's disease (PD). During self-paced (uncued) gait initiation, anticipatory postural adjustments (APAs) are often absent or attenuated, and the first steps are abnormally short. External sensory cues can significantly improve APAs.ObjectiveThe effect of external cueing on lower limb muscle activation during gait initiation, compared to self-initiated steps, was examined in people with PD and healthy older adults (HOA).MethodsGround reaction forces, center of pressure excursions, and lower-limb surface electromyographic profiles (in seven bilateral muscles) were examined in 32 individuals with PD (off-medication) and 10 age-matched HOA during the APA and first step of self-paced or acoustically cued gait initiation.ResultsAnterior (tibialis anterior, vastus lateralis, rectus femoris) and gluteus medius muscles were primarily activated during the early phases of gait initiation, while later phases predominantly involved posterior (soleus, gastrocnemius, biceps femoris) and gluteus medius activations. Cueing facilitated anterior muscles and suppressed posterior muscle activity in both groups, however, activation patterns in PD were not restored to HOA levels. Instead, the PD group had lower early activity during the APA (compared to HOA) and higher late activity.ConclusionsCueing increased anterior muscle activation during gait initiation, rather than evoking a global gain across muscles and timings, demonstrating that cueing predominantly facilitates neural circuitry critical for early APA phases. People with PD showed enhanced late phase activity, probably to compensate for ineffective APAs, and thus have a stronger need to facilitate cue-evoked improvements.

Mancini et al.'s framework for gait assessment in Parkinson's disease (PD) is a valuable contribution, enabling a harmonization of study protocols in this research field and, consequently, a substantial improvement of data interpretation across different cohorts. However, we believe that recommendations concerning data curation and software use should be provided in more detail. To ensure data interoperability and facilitate robust data aggregation from such protocols, appropriate and harmonized data formatting and metadata standards are necessary. We further advocate for the open sharing of gait analysis algorithms, to enhance reproducibility and foster collaborative development.

BackgroundPeripheral neuropathy in Parkinson's disease (PD) may not be an isolated pathological phenomenon but may interact with other non-motor symptoms.ObjectiveTo conduct a comprehensive investigation of the non-motor symptoms observed in PD patients, with a comparative analysis between patients with and without peripheral neuropathy, to explore the relationships between peripheral neuropathy and non-motor symptoms.Methods100 PD patients were recruited from the Neurology Department of Guangdong Provincial People's Hospital. Extensive clinical data were collected, and assessments were performed to evaluate both motor and non-motor symptoms in patients with and without peripheral neuropathy. Spearman's rank correlation analysis was employed to evaluate the association between peripheral neuropathy and non-motor symptoms. Multiple linear regression analysis was conducted to adjust for confounding variables to clarify the impact of peripheral neuropathy on non-motor symptoms.Results57 individuals (57%) were identified as having peripheral neuropathy. Of these, 38 individuals were diagnosed with small fiber neuropathy. After adjusting for confounding variables, higher scores on the 13-item Small Fiber Neuropathy Symptom Inventory Questionnaire were significantly correlated with heightened symptoms of depression (B = 0.498, 95% CI = 0.080-0.917, p = 0.020), anxiety (B = 0.504, 95% CI = 0.099-0.908, p = 0.015), autonomic dysfunction (B = 1.118, 95% CI = 0.828-1.409, p < 0.001), and sleep disturbances (B = 0.694, 95% CI = 0.309-1.080, p = 0.001).ConclusionsPD patients with neuropathy, particularly those with small fiber neuropathy, demonstrate more pronounced non-motor symptoms. The severity of small fiber neuropathy is correlated with the extent of depression, anxiety, autonomic dysfunction, and sleep disturbances. These findings underscore the necessity for routine screening and early detection of peripheral neuropathy in PD patients.