Neurodegenerative disease management最新文献

Aims: The purpose of this review is to identify the characteristics of responders in interventions targeting motor function for individuals with Parkinson disease.

Materials & methods: The primary search included, 'Parkinson' + 'responder.' A second, broader, search further included 'response' + 'responsiveness' + 'responsive.' Records were sorted by intervention: neuromodulation, pharmaceutical, physical, and placebo.

Results: Thirteen studies were identified in the primary and 19 studies in the secondary search, culminating in 120 characteristics. For neuromodulation interventions, responders were younger at onset, more responsive to levodopa, and had more difficulties with activities of daily living. Responders to pharmaceuticals were younger at diagnosis. Physical intervention responders had worse balance, less balance confidence, and worse cognition. No relevant characteristics were identified for placebo interventions.

Conclusions: Although there are clear limitations and gaps in the literature, responder analyses represent an important step toward more personalized treatments for the motor symptoms of Parkinson disease.

Objectives: To explore healthcare professionals' experiences managing cough and secretion problems in Amyotrophic Lateral Sclerosis (ALS).

Methods: A qualitative study was completed with 23 individuals participating in four focus groups. Data was analyzed using reflexive thematic analysis and COM-B and theoretical domains framework (TDF) behavior change frameworks.

Results: This study found that roles, responsibilities, and expectations needed to be clearly defined and that building relationships was important to support care delivery. Barriers identified included limited access to specialist care, equipment, and opportunities to gain knowledge and skills. A structured clinical assessment was highlighted to enable good-quality care. Data mapped most commonly to the environmental context/resources, knowledge, skills (TDF), and physical capability (COM-B) behavior change domains.

Conclusion: Cough and secretion management in ALS is complex due to the multifaceted nature of the disease. This study emphasizes the need for future development of clinical interventions to support care.

Alzheimer's disease (AD) is the largest global health burden among age-related conditions; it involves inflammation, plaque buildup, and oxidative stress combined with tangles that lead to brain atrophy and a decline in cognitive function. Though intensive research efforts have been focused on identifying the etiology of AD, its causative factors, especially concerning therapeutic interventions that can make a significant impact in this regard, are relatively vague due to several impediments such as the blood-brain barrier (BBB). Prodrugs and nanomedicine deliver new promising alternatives for drug administration over the BBB with better therapeutic results. This paper documents several prodrugs created for AD along with in vitro techniques for analyzing prodrug kinetics and recently developed nanotechnology-based delivery systems. The innovations discussed herein aim to enhance the bioavailability, stability, and activity of drugs toward offering better treatment opportunities as well as new research avenues against AD.

Aim: This study investigates the prevalence and clinical features of advanced Parkinson's disease (APD) in Moroccan patients and evaluates their eligibility for Device-Aided Therapies (DATs), including Deep Brain Stimulation (DBS), Continuous Subcutaneous Apomorphine Infusion (CSAI), and Levodopa-Carbidopa Intestinal Gel infusion (LCIG).

Methods: We conducted a cross-sectional study across 15 facilities in five cities within the Casablanca-Settat region, Morocco. We collected demographics, clinical, and health-related quality of life data. Logistic regression identified factors predicting disease progression and DATs eligibility.

Results: This study included 370 patients with Parkinson's disease, of whom 44.6% (95%CI: 39.5%-49.8%) had APD. Each additional year of disease duration increased APD odds by 8% (ORa = 1.08, p = 0.047). Overall, 38.9% of patients qualified for at least one DAT, including 18.9% for DBS, 35.4% for CSAI, and 13.8% for LCIG; however, only one patient received DBS. Younger age at onset was associated with greater DATs eligibility, with each additional year reducing eligibility by 7% (ORa = 0.93, p < 0.001). Additionally, premotor REM sleep behavior disorder increased the odds of LCIG eligibility (ORa = 2.38, p = 0.009), while prior sports engagement nearly tripled the odds for CSAI (ORa = 2.87, p = 0.038).

Conclusion: Although many Moroccan patients qualify for DATs, their use is minimal. Addressing access barriers is crucial to improve outcomes.

Aims: This study aimed to evaluate the effects of riluzole on survival and changes in ALS Functional Rating Scale (ALSFRS) among Chinese patients with Amyotrophic Lateral Sclerosis (ALS).

Patients & methods: Propensity score matching was used to balance baseline variables between the riluzole group (n = 238) and control group (n = 454). Survival was analyzed using Kaplan - Meier curves and Cox regression, while multivariable linear regression assessed ALSFRS changes at 6 and 12 months. Subgroup analyses were conducted to identify potential responders.

Results: Riluzole did not significantly improve survival (p = 0.478) or ALSFRS changes at 6 months (p = 0.380) or 12 months (p = 0.175). Subgroup analyses revealed no survival benefit in any subgroup, and further stratification showed inconsistent adverse effects on ALSFRS scores.

Conclusions: Riluzole neither prolonged survival nor slowed functional decline in Chinese ALS patients, with no subgroup demonstrating a better response.

Aim: Neurogenic overactive bladder symptoms are very common in patients with multiple sclerosis (MS). In current approaches, neuromodulation methods are preferred. To investigate the effect of transcutaneous posterior tibial nerve stimulation (TPTNS) and repetitive transcranial magnetic stimulation (rTMS) on neurogenic overactive bladder symptoms in patients with MS.

Patients methods: Sixteen female MS patients with neurogenic overactive bladder were randomized into TPTNS and rTMS groups for a pilot study. Treatment was blinded to the investigator and statistician but not to patients and physiotherapists. Treatments were applied for a total of 10 sessions over two consecutive weeks. The primary outcome of the study was urodynamic testing, and secondary outcomes were Overactive Bladder Questionnaire-V8 (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale (I-QOL) and voiding diary applied before and after treatment.

Results: In TPTNS and rTMS groups, urodynamic parameters did not show any statistically significant change within and between groups (p > 0.05). Only nocturia frequency provided statistically significant improvement in the TPTNS group compared to the rTMS group (p = 0.01). OAB-V8, ISI and I-QOL parameters did not change significantly between groups (p > 0.05).

Conclusion: Although TPTNS and rTMS methods are not superior to each other, they can be used to reduce symptoms and improve quality of life.

Clinical trial registration: NCT05312138.