Movement Disorders Clinical Practice最新文献

Background: Mild behavioral impairment (MBI) is a syndrome characterized by the later-life onset of neuropsychiatric symptoms (NPS) and serves as a potential marker for dementia. In Parkinson's disease (PD), MBI has been associated with worse cognition, cortical atrophy, and altered connectivity. Unlike existing instruments that assess NPS in PD, the MBI Checklist (MBI-C) leverages sustained behavioral changes to identify patients at risk of cognitive impairment and neurodegeneration. The 34-item MBI-C has yet to be validated in PD.

Objective: This study assesses the MBI-C's psychometric properties in a multicenter Canadian PD sample and proposes a revised version optimized for PD.

Methods: A total of 406 PD patients from the Canadian Open Parkinson Network were assessed with the MBI-C to investigate its construct validity. Additional evaluations, including the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Neuropsychiatric Inventory (NPI), and Montreal Cognitive Assessment (MoCA), were implemented to examine the concurrent and criterion validities of the checklist.

Results: The original MBI-C exhibited considerable floor effects (24.9%). Exploratory factor analysis revealed a 5-factor 24-item MBI-C as consistent for PD (Cronbach's α = 0.856). All intrafactor correlations were statistically significant (P < 0.05), and convergent validity was found to be higher than divergent validity. Moreover, the MBI-C demonstrated moderate concurrent validity with the NPI (intraclass correlation coefficient [ICC]: 0.633, P < 0.001). The cutoff score associated with cognitive impairment on the revised instrument was 6|7.

Conclusions: Compared to the original version, the revised MBI-C exhibited enhanced psychometric properties for measuring MBI in PD. It also demonstrated acceptable specificity when related to cognitive impairment. Future psychometric research should focus on capturing the subtlest manifestations of MBI in PD, examining patient-caregiver concordance, and addressing predictive validity for cognitive decline.

Background: Skin punch biopsy has been investigated as a minimally invasive tool to aid in the diagnosis of idiopathic Parkinson's disease (IPD) via detection of cutaneous phosphorylated α-synuclein. The use and impact of this tool in clinical practice has not been well-characterized.

Objective: To understand the utilization of skin punch biopsies for diagnosis and management of α-synucleinopathy within a large medical system.

Methods: Three hundred charts of patients who underwent skin punch biopsy were reviewed. Of these, 149 (49.7%) met criteria for analysis (concern for α-synucleinopathy, age over 40). Demographic data, outpatient neurology and primary care notes, and imaging results were reviewed alongside biopsy results.

Results: Of 149 biopsies, 70% (N = 105) were positive in at least one skin sample. There was no statistically significant relationship between any pre-biopsy symptom and a positive result. Most patients identified as white (N = 124, 83%) and non-Hispanic (N = 131, 88%). The sex distribution was roughly equal (52% male, 48% female). While most tests were ordered for IPD or an unspecified primary parkinsonism, other clinical concerns included dementia with Lewy bodies (N = 41, 28%) and multiple system atrophy (N = 6, 4%). Only 4% of biopsies (N = 6) were ordered by movement disorders specialists. Results changed or strengthened diagnosis in 52% of cases and changed management in 60% of cases.

Conclusions: Skin punch biopsies are being used broadly with impactful results. However, there appears to be potential disparity in access to this test. Further research is required to inform clinical guidelines and promote equity in the use of this novel biomarker.