Movement Disorders Clinical Practice最新文献

Background: Studies focusing on the treatment of neuropsychiatric symptoms (NPS) in Huntington's disease (HD) are scarce and show a wide variation in design, outcome measures and methodological quality. The effectiveness of pharmacological treatment of NPS in HD has not been systematically reviewed so far.

Objective: To provide an overview of the available literature on the effectiveness of pharmacological treatment of NPS in HD.

Methods: PubMed and the Cochrane library were systematically searched for studies assessing the effects of pharmacotherapy of NPS, both as a primary and as secondary outcome. A risk of bias assessment was performed for each article.

Results: Fifteen articles qualified for critical evaluation: 10 randomized controlled trials (RCTs) (five placebo-controlled and five cross-over) and five open label studies. One RCT reported improvement of the overall NPS with nabilone treatment; another RCT reported that fluoxetine slightly improved irritability. Lower-level evidence from open studies suggests that the atypical antipsychotics cariprazine, olanzapine and risperidone may improve overall NPS, and that cariprazine, venlafaxine XR and olanzapine may improve depression. In addition, olanzapine may improve obsessive thoughts, aggression, anxiety and irritability.

Conclusions: We conclude that although NPS in HD are common, hardly any clinical trials have addressed their treatment. As a result, convincing evidence that could guide clinical practice is lacking. More focused, and larger, multicenter trials focusing on NPS are urgently needed to generate the knowledge necessary to support the development of evidence-based clinical treatment guidelines.

Background: Axial postural abnormalities (APAs) are frequent and disabling axial symptoms of Parkinson's disease (PD). Image-based measurement is considered the gold standard but may not accurately detect the true severity of APAs because these symptoms can appear or get worse under dynamic conditions.

Objective: The aim was to evaluate quantitative changes in APAs degree during prolonged standing and walking in both single- and dual-task conditions (motor + cognitive).

Methods: We measured the degree of anterior and lateral trunk flexion (LTF) of 16 PD patients using AutoPosturePD during 4 tasks of 3 min each: (1) standing in place in a quiet condition, (2) standing in place while reading, (3) walking without performing other tasks, and (4) walking performing a cognitive task.

Results: During prolonged standing, we found a significant LTF worsening under both single- and dual-task conditions over time (P: 0.010 and 0.018); anterior trunk flexion (ATF) with thoracic and lumbar fulcrum showed a significant worsening only under dual-task conditions (P < 0.05). All trunk flexion angles were higher during dual task compared to single task, and the difference in dual task was already statistically significant after 1 min. During walking, only ATF with lumbar fulcrum showed a significant worsening (P < 0.05), observed in dual task already after 1 min.

Conclusions: Our pilot study suggests that one minute standing while reading may be sufficient to obtain a more reliable measure of the severity of LTF and ATF, with an expected change of ~ 7° for LTF and ATF with thoracic fulcrum and 11° for ATF with lumbar fulcrum.

Background: Clinical outcomes assessments (COAs) in spinocerebellar ataxia (SCA) need to be standardized, ataxia-specific, sensitive to change, clinically relevant, and meaningful to patients.

Objectives: To evaluate the longitudinal 1- and 2-year performances of different patient reported outcomes, including the Patient Reported Outcome Measure of Ataxia (PROM-Ataxia), and clinician reported outcomes, including FARS and SARA, in those with early manifest symptoms of SCA 1, 2, 3, and 6.

Methods: We studied 53 patients with early stage SCA1-3 and SCA6 from The Instrumented Data Exchange for Ataxia Study and 24 age-matched healthy controls. Participants were seen every 6 months for 2 years. Mixed models were used to estimate change over 12- and 24-months of follow-up. Changes on the FARS-FS and PGI-C were used as anchors to estimate meaningful changes.

Results: Among persons with SCA, mean age was 48.7 years and mean SARA score was 9.3. Few measures showed statistically significant changes at 12 months. At 24-months, the FARS-ADL, PROM-Ataxia total, PROM-Ataxia physical, and PROM-Ataxia ADL scores showed the strongest associations of change.

Conclusions: Patient reported or derived outcome measures, such as FARS-ADL and ADL sub domain of the PROM-Ataxia, can capture longitudinal change in patients' symptom experience over a 2-year period and its impact on daily activities, even in those with early disease. More work is needed to identify outcomes that reliably capture change earlier.

Background: Patients with Progressive Supranuclear Palsy (PSP) suffer from several neuropsychological impairments. These mainly affect the frontal lobe and subcortical brain structures. However, a scale for the assessment of cognitive and neuropsychiatric disability in PSP is still missing.

Objectives: To create and validate a new scale for cognitive and neuropsychiatric impairment in PSP.

Methods: The Short Cognitive and Neuropsychiatric (ShoCo) scale was developed containing five items (bradyphrenia, apathy, aphasia, dysexecution and disinhibition). Each item can be categorized into 0 = no deficit, 1 = mild deficit, 2 = moderate deficit and 3 = severe deficit. The total score includes 15 points, 0 meaning no deficit and 15 severe deficits. Cross-sectional and longitudinal data from 201 baseline and 71 follow up patients were analyzed.

Results: Baseline ShoCo scale results were 5.9 ± 2.9. No significant differences between patients with Richardson syndrome (PSP-RS) and variants (vPSP) could be detected in the PSP-ShoCo scale scores (PSP-RS 6.1 ± 3.0, n = 160, vPSP 5.1 ± 2.6, n = 41, P = 0.057). The scale showed good correlation with established scores (eg, Montreal cognitive assessment r = -0.535, P = 0.001). The ShoCo scale showed significant annualized change within the PSP-RS patients (baseline 6.2 ± 2.9, follow up 6.9 ± 3.1, annualized diff. 1.0 ± 3.1, n = 57, P = 0.022).

Conclusions: The ShoCo scale seems a promising and valid tool to measure specific neuropsychological disabilities of PSP patients in clinical routine and research.

Background: The neuropathologies of Alzheimer's disease (AD) and Lewy body disease (LBD) commonly co-occur. Parkinsonism is the hallmark feature in LBD but it can be difficult to predict the presence of these co-pathologies early in the course of clinical disease. Timely diagnosis has crucial implications, especially with the advent of disease-modifying therapies.

Objectives: We sought to define early motor features that predict the ultimate neuropathological diagnoses of normal, AD, AD with concurrent LB pathology, and pure LB.

Methods: We examined the associations between individuals' early motor features from their initial visit using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III and their neuropathological diagnoses using the U.S. National Alzheimer's Coordinating Center (NACC) Database.

Results: We included data from participants with neuropathologically normal brains (n = 49), AD (n = 502), AD w/LB (n = 167), and pure LB (n = 51). Total UPDRS Part III scores were increasingly higher with purer LB pathology. Decreased facial expression at baseline differentiated those with AD w/LB pathology from those with AD. Participants having pure LB pathology more often had deficits in speech, facial expression, posture, gait, bradykinesia, and upper extremity rigidity relative to those with AD w/LB.

Conclusion: Diminished facial expression significantly predicted the presence of LBs among those with concurrent AD pathology. Worse early speech, facial expression, posture, gait, bradykinesia, and upper extremity rigidity were suggestive of more pure LB pathology. These findings emphasize the utility of the neurological exam in the clinical assessment of persons with cognitive complaints as it can guide management.

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor symptoms, with a significant genetic component. Early-onset Parkinson's disease (EOPD), manifesting before age 45, is often linked to mutations in genes such as PARK2, PINK1, and PARK7, the latter coding for the protein DJ-1.

Objective: We present the first reported cases of EOPD carrying a previously undescribed homozygous PARK7 mutation, p.Thr110Pro.

Methods: Whole exom sequencing was performed on two inbred Moroccan siblings with early-onset Parkinson's disease (EOPD). Detailed clinical assessments, including neurological evaluations and cognitive testing, were conducted to understand the clinical presentation of the patients. Genetic analysis was also carried out to examine their genetic background. Therapeutic responses to treatments were monitored to assess the effectiveness of management strategies.

Results: The sequencing revealed that both siblings carried the homozygous PARK7 mutation, p.Thr110Pro. Both siblings presented with typical EOPD features, including motor and non-motor symptoms. The patients both presented with cognitive impairment, with the male sibling exhibiting more pronounced symptoms. He also developed compulsive behaviors, which underscore the varied clinical presentations and therapeutic responses associated with this genetic variant.

Conclusion: This case study expands the genetic and geographic diversity of PD presentations, highlighting cognitive and behavioral challenges and variable therapeutic outcomes. It underscores the necessity for genetic screening and individualized management strategies for patients with PD.