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.

Background: Most studies have analyzed the urodynamic characteristics of patients with Parkinson's disease (PD) and multiple system atrophy (MSA) using conventional urodynamic studies.

Objectives: This study investigated the urodynamic characteristics of both diseases using video urodynamic study (VUDS).

Methods: VUDS results from November 2004 to September 2020 were retrospectively analyzed at Seoul National University Hospital. The VUDS findings in patients with PD and those with MSA were compared. Movement disorder specialists diagnosed patients with PD and MSA.

Results: A total of 709 patients, comprising 364 PD (260 men, 104 women) and 345 MSA (215 men, 130 women) cases, were identified. Patients with MSA had a significantly younger age at onset, lower maximum flow rate (Qmax), larger postvoid residual volume, higher rate of poor bladder compliance, higher prevalence of urinary incontinence, and lower detrusor pressure at Qmax than those with PD. Among the fluoroscopic findings of VUDS, patients with MSA had a higher rate of incompetent bladder neck (18.8% vs. 4.7%, P < 0.001), bladder trabeculation (33.0% vs. 17.0%, P < 0.001), and vesicoureteral reflux (2.9% vs. 0.5%, P = 0.019) than those with PD. In VUDS performed in patients without urinary incontinence in conventional urodynamic study, an incompetent bladder neck was found in 14.6% of patients with MSA and 3.3% of patients with PD (P < 0.001).

Conclusions: Our results demonstrate that VUDS can provide additional information on bladder urethral dysfunction, particularly regarding the risk of upper urinary tract damage and bladder neck status in patients with PD and MSA.

Background: Isolated rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The basal forebrain (BF), a key cholinergic structure, is a site of known pathology in later stages of Lewy body disorders. Although bilateral BF atrophy has been linked to cognitive decline in iRBD, its potential role in predicting phenoconversion to PD and DLB remains unclear.

Objectives: The aims were to examine BF gray matter volume differences between iRBD patients and healthy controls, and evaluate their utility as predictors of phenoconversion to PD or DLB. Exploratory post hoc analyses were also conducted to explore the lateral-specific effects of BF atrophy in relation to disease conversion.

Methods: We assessed 41 participants with polysomnography-confirmed iRBD and 38 healthy controls using baseline T1-weighted magnetic resonance imaging (MRI) and longitudinal clinical assessments. Gray matter volumes of the left and right BF were compared between groups. Cox proportional hazards models examined baseline BF volumes as predictors of phenoconversion risk to PD and DLB.

Results: Although no significant group differences in BF volume were found, lower BF volume was associated with poorer global cognition in iRBD. Bilateral BF atrophy predicted increased risk of phenoconversion to either PD or DLB. An exploratory post hoc analysis revealed that left BF atrophy specifically predicted conversion to DLB, whereas right BF volume did not.

Conclusion: Bilateral BF atrophy may represent an early biomarker of phenoconversion in iRBD, with left-sided atrophy potentially indicating increased risk for DLB. These findings highlight the prognostic value of BF degeneration in prodromal synucleinopathies.

Background: As Parkinson's disease (PD) progresses, managing symptoms becomes increasingly difficult. Foslevodopa/foscarbidopa (LDp/CDp), a 24-hour/day continuous subcutaneous infusion of levodopa/carbidopa (LD/CD) prodrugs, improves motor complications. The feasibility and sustainability of LDp/CDp monotherapy warrants investigation.

Objective: The aim was to report the efficacy and safety of LDp/CDp monotherapy and combination therapy.

Methods: This post hoc analysis assessed patients with PD and ≥2.5 "Off" hours/day receiving LDp/CDp monotherapy or combination therapy in 3 trials: a 12-week randomized active-controlled trial (RCT) comparing LDp/CDp with oral immediate-release LD/CD (NCT04380142), a 52-week open-label trial of LDp/CDp (NCT03781167), and its 96-week open-label extension study (OLE; NCT04379050). Monotherapy was defined as receiving LDp/CDp without concomitant PD medications; combination therapy was defined as receiving LDp/CDp with other PD medications.

Results: In the RCT, 74 of 141 patients received LDp/CDp. The 52-week trial enrolled 244 patients; 129 entered the OLE. Of LDp/CDp-treated patients, 19 of 74 (25.7%) in the RCT, 49 of 244 (20.1%) in the 52-week trial, and 46 of 129 (35.7%) in the OLE received monotherapy. In the RCT, mean (standard deviation) change from baseline to week 12 in "Off" time was -4.5 (4.4) and -3.0 (3.5) hours for monotherapy and combination therapy, respectively; +4.1 (3.7) and +3.1 (3.6) hours for "On" time without troublesome dyskinesia; and +4.0 (3.6) and +4.0 (3.9) hours for "On" time without dyskinesia. Efficacy was similar in open-label trials. Improvements in the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part II, 39-item Parkinson's Disease Questionnaire, Parkinson's Disease Sleep Scale-2 scores, and overall safety were comparable between monotherapy and combination therapy groups.

Conclusions: LDp/CDp monotherapy treatment may be suitable for up to 96 weeks.