Journal of Parkinson's disease最新文献

BackgroundSleep disturbances are prevalent and debilitating non-motor symptoms in patients with Parkinson's disease (PD).ObjectiveThis study aimed to explore sleep architecture and the prevalence of polysomnographic (PSG) sleep findings in PD, examining the associations between sleep parameters and other clinical characteristics.MethodsThe study included 97 PD patients (age: 67.1 ± 7.9) and 42 non-PD controls (age: 64.7 ± 9.7). Participants underwent clinical assessment and video-PSG. Sleep parameters, apnea-hypopnea index (AHI), periodic limb movements index (PLMI), and REM sleep without atonia (RSWA) were obtained. General linear models were used to explore interactions between disease duration and sleep variables in predicting PD symptoms.ResultsNearly 94% of PD patients showed at least one video-PSG-assessed sleep finding, including AHI-defined obstructive sleep apnea (OSA), periodic limb movements, and RSWA. Sleep alterations correlated with disease severity, with reduced sleep duration and efficiency, higher sleep latency, and higher AHI being associated with worse PD severity. Sleep efficiency was more strongly associated with motor symptoms and disease severity at longer disease duration, while AHI exhibited a stronger relationship with motor symptoms at shorter disease duration. Finally, PD patients showed significant alterations in sleep macrostructure compared to controls, including reduced sleep duration (d = 0.75) and efficiency (d = 1.15) and decreased percentage of stage 3 non-REM sleep (d = 0.37).ConclusionsThe study showed a high prevalence of video-PSG-defined sleep findings in PD, with interactions between disease duration, sleep efficiency, and AHI. The present results support personalized management of sleep disturbances in PD to potentially improve symptoms and reduce the burden of illness.

The subtyping of Parkinson's Disease (PD) into brain-first and body-first PD has a powerful neuropathological, neuroimaging and clinical basis, supported by most relevant subsequent studies that have examined its validity. Here, we put forward the idea that the previous classification into early and late onset PD may be related to this categorization. The mean age of motor onset in brain-first PD may be up to 10 years earlier than body-first PD. Early onset PD has features related to brain-first PD, including relative clinical and nigrostriatal neurodegeneration asymmetry and a relatively restricted motor phenotype. In fact, PD as described by James Parkinson, could represent both early onset and brain-first PD, accounting for the famous phrase "senses and intellect uninjured". We suggest here that, at the population level, age of onset could be used as a proxy for brain-first vs body-first PD, notwithstanding the lack of a direct one-to-one correlation and of a clear dichotomy in early vs. late onset PD, which rather represents a continuum. This would enable large scale population studies into the underlying genetic and epidemiological basis of these presumed separate nosological entities. Along these lines, there are some indications of a divergent exposure and genetic basis in early vs. delayed onset PD, and body-first vs. body-first PD respectively. Thus, studies of the etiopathological basis of PD could examine data sets with clinical data limited to age of onset, keeping in mind that within the overall concept of sporadic PD there may be two qualitatively different disease processes.

Sleep problems are among the most frequently reported non-motor symptoms of Parkinson's disease (PD), with a broad range of disorders: insomnia, REM sleep behavior disorder, restless legs syndrome, excessive daytime sleepiness, and sleep-related breathing disorders. These disturbances evolve in complexity across PD severity stages, significantly impact the patients' quality of life and may exacerbate motor and other non-motor symptoms. Neurodegenerative processes, impaired function of neurotransmitters, medication side effects, circadian rhythm dysfunction are among the most proposed mechanisms that may explain the frequent occurrence of sleep disorders in PD. However, there are still many unanswered questions related to the pathophysiological mechanisms of sleep disorders in PD that may offer the clue to better therapeutical options. Although the prevalence of sleep disturbances is very high, the treatment options are still limited. The current review focuses on main sleep disturbances encountered in PD, pathophysiological insights, current therapeutical options and future perspectives for a better and more personalized management of these disorders in PD.

A definitive diagnostic test for Parkinson's disease (PD) remains elusive, so identification of potential biomarkers can facilitate diagnosis and early intervention. Two dogs were trained to distinguish between dry skin swabs obtained from people with Parkinson's (PwP) and control participants. After 38-53 weeks of training on 205 samples, the dogs were tested in a double-blind trial using 60 control and 40 target (drug-naïve PwP) samples. They each showed high sensitivity (70% and 80%) and specificity (90% and 98%). This supports previous findings that dogs can be trained to reliably detect the odor of PD.

BackgroundEarly onset Parkinson's disease (EOPD), defined as Parkinson's disease (PD) diagnosed before age 50, often presents unique challenges compared to late-onset PD, particularly with regard to non-motor symptoms. Psychosis in EOPD is associated with increased functional impairment and may lead to a higher mortality risk.ObjectiveOur study is aimed to determine the prevalence of psychosis in EOPD patients and its impact on all-cause mortality, along with examining the effects of antipsychotic medications and Selective Serotonin Reuptake Inhibitors (SSRIs) on mortality in EOPD patients.MethodsOur retrospective cohort included EOPD patients diagnosed between 1990 and 2022 at Mayo Clinic, Rochester, Minnesota. Psychosis was defined using the National Institute of Neurological Disorders and Stroke/the National Institute of Mental Health (NINDS/NIMH) Work Group criteria. Cox proportional hazards models were used to analyze the association of psychosis and medications with mortality.ResultsOf 829 patients with EOPD, 158 (19.1%) developed psychosis at a median of 12.1 years after PD motor symptom onset. Psychosis was significantly associated with increased mortality in unadjusted (HR = 4.31, 95% CI: 2.59-7.18, p < 0.001) and adjusted (HR = 3.55, 95% CI: 2.10-6.01, p < 0.001) models. No significant difference in mortality risk was observed between patients treated with antipsychotics or SSRIs versus those who were not.ConclusionsPsychosis is a possible complication in EOPD and is associated with a significant increase in all-cause mortality. The use of antipsychotics and SSRIs did not significantly alter the mortality risk in these patients. Further research is needed to understand the mechanisms driving this association and to develop tailored interventions.

BackgroundDetecting motor symptoms in Parkinson's disease (PD) at home, especially in the prodromal, is crucial for disease-modifying therapies.ObjectiveTo evaluate the effectiveness of machine learning models using smartphone-based assessments in predicting motor symptoms in untreated de novo PD.MethodsUsing a clinical trial in early de novo patients with PD, the PDAssist smartphone application and machine learning models were investigated for eight motor tasks: resting tremor, postural tremor, finger tapping, facial expressions, rigidity, speech, walking, and pronation/supination to predict motor symptoms of PD as comparing with UPDRS Part III scores.ResultsOur prediction model demonstrated acceptable performance in detecting PD mild symptoms, with accuracy ranging from 0.87 to 0.93 for resting tremor, postural tremor, finger tapping, facial expressions and postural stability, while the rigidity model achieved 0.81 accuracy with a Kappa of 0.74, and the speech model showed 0.79 accuracy and 0.61 Kappa, emphasizing its potential for detecting subtle motor deficits and remote monitoring. External validation confirmed the model's robustness, with significantly higher predicted scores (all tasks) for PD patients (9.45 ± 3.08) compared to healthy controls (3.79 ± 1.99, t = -14.27, p < 0.001), validating its ability to differentiate between the two groups.ConclusionsSmartphone-based assessments effectively discriminate de novo PD patients from controls and monitor motor symptoms in prodromal and early PD patients. Future work will involve expanding patient cohorts and refining algorithms for better generalizability and reliability of self-collected data in home settings.

Planned discontinuation or acute unplanned cessation of oral dopaminergic medications might result in a severe relapse of Parkinson's symptoms or, sporadically, in life-limiting withdrawal syndromes. Unplanned cessation may occur due to dysphagia or decreased alertness, amongst other reasons. Planned acute discontinuation occurs during surgery or a medical necessity for a 'nil per os' policy (such as hospitalizations for gastrointestinal diseases). Non-oral alternatives are available, such as transdermal rotigotine, subcutaneous apomorphine, and levodopa delivered subcutaneously or via an enteral tube. Selecting the best treatment can be difficult and should be based upon clinical considerations, patient preference and be tailored to the care setting. These considerations will differ during the course of disease. For example, more invasive treatment options can be considered in hospitalized persons with early to moderate-stage disease, whereas symptomatic palliative treatments are more appropriate towards the end of life. Here, we discuss several practical considerations for three, partially overlapping, but conceptually distinct moments at which acute discontinuation or cessation events occur: during hospitalization (including surgery), late-stage disease and end of life. We stress the need for prevention and early advance care planning and present a stepwise pharmacological approach to address unplanned acute cessation or planned discontinuation.

Parkinson's disease (PD) is a chronic neurodegenerative disorder which can impair patients' ability to complete complex motor skills, such as driving. There is currently a lack of research into the effectiveness of police officers discerning PD symptoms from those exhibited by alcohol intoxication during traffic stops. We conducted a survey on 58 PD patients and 52 age-matched controls to investigate experiences with police interactions during traffic stops. PD patients had statistically significant (p = 0.03204) higher perceptions of mistreatment and misclassification of intoxication. We propose the need for additional training and support on PD for law enforcement officers to ensure fair evaluation.

BackgroundProdromes of Parkinson's disease (PD) include both motor and non-motor symptoms. Although questionnaires have been established for non-motor symptoms, no quantitative self-assessment tool has been developed to assess subtle motor symptoms during the prodromal stage.ObjectiveTo develop a self-administered questionnaire to assess subtle motor symptoms during the prodromal stage.MethodsWe created the Screening Questionnaire for Subtle Parkinsonism (SQSP). The SQSP and questionnaires on non-motor symptoms were collected from health checkup examinees. Individuals with ≥ 2 non-motor symptoms, including autonomic dysfunction, hyposmia, and REM sleep behavior disorder, were classified as high-risk, while those without these symptoms were low-risk. We also conducted comprehensive evaluations, including neurological examinations and imaging tests, on 30 patients with PD, 71 high-risk, and 24 low-risk subjects.ResultsAmong 1183 health checkup examinees, high-risk subjects had higher SQSP scores than low-risk (9 [4-15] vs. 3 [1-6]). Patients with PD had the highest SQSP scores, followed by high-risk subjects and then low-risk. SQSP scores correlated with MDS-UPDRS II and III scores and specific binding ratios of DaT-SPECT. High-risk subjects with abnormal DaT-SPECT had higher SQSP scores than those with normal imaging (9 [7-19] vs. 5.5 [2-10]). Although 26 of the 71 high-risk and 23 of the 24 low-risk subjects scored zero on the MDS-UPDRS II, most high-risk and half low-risk subjects had SQSP scores above zero.ConclusionsThe SQSP was deemed effective for assessing subtle motor symptoms during the prodromal stage of PD and identifying prodromal PD cases within the general population.

BackgroundCare for persons with Parkinson's disease (PD) is to a great extent carried out by care partners. It is important to understand their needs to ease their burden and help with their important role.ObjectiveTo present (1) what is known about needs in caregiving for someone with PD from both qualitative and quantitative papers; and (2) to identify research gaps in the existing literature to guide future research.MethodsA systematic search was conducted, searching PubMed, CINAHL, PsychINFO, and MEDLINE for both qualitative and quantitative studies examining care partner needs in Parkinson's disease published from the start of the databases up to 13 November 2024. The best-fit framework synthesis method was employed for qualitative data extraction and analysis. The Critical Appraisal Skills Programme (CASP) and the Newcastle-Ottawa Scale (NOS) were used for quality assessment of studies.ResultsForty-eight qualitative studies, ten quantitative studies, and three mixed methods studies met the eligibility criteria. All studies were of observational, cross-sectional design. A total of nine themes (the need for information, the need to be heard, PD healthcare, emotional support, daily living, financial support, skills, care partner physical well-being, and respite care) were identified from qualitative data and all quantitative data could fit this framework. Quantitative data on the frequency of needs and when they arise over the course of PD were scarce. Only one quantitative study made use of a validated measurement instrument to measure care partner needs, the Family Needs Questionnaire.ConclusionsCare partner needs in PD are wide-ranging. A significant gap identified is the absence of quantitative data to determine the prevalence, timing, and factor contributing to the needs revealed by the qualitative research.