Parkinson's Disease最新文献

Background: Although patients with Parkinson's disease eventually experience motor complications and gait problems including falls, introducing the necessity for gait assistance, or freezing of gait, there may be a medication dose at which patients do not experience both in the early stage of the disease.

Objectives: To identify the medication dose at which Parkinson's disease patients, diagnosed and treated at our hospital, did not experience motor complications and gait problems.

Methods: We retrospectively reviewed the clinical course, including motor complications and gait problems, of 119 newly diagnosed patients with Parkinson's disease for 24 months after the introduction of medical treatment. According to the presence of motor complications and/or gait problems, we categorized the patients into Groups 1-3. We estimated the median latency of motor complications or gait problems by Kaplan-Meier survival analysis. We calculated the levodopa equivalent dose.

Results: Group 1 contained 25 patients with neither motor complications nor gait problems; Group 2 contained 40 patients who experienced motor complications first with a median latency of 11 months; and Group 3 contained 54 patients who experienced gait problems first with a median latency of 9 months. There were significant differences in the levodopa equivalent dose at 24 months among the groups: 250 mg in Group 1, 300 mg in Group 2, and 225 mg in Group 3.

Conclusions: Patients with Parkinson's disease receiving a levodopa equivalent dose between 225 and 300 mg did not experience motor complications and gait problems for 24 months after the introduction of medical treatment.

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder with significant social costs, mainly owing to hospitalization, which is frequently associated with high levodopa equivalent daily dose (LEDD) and polypharmacy rather than neurological symptoms alone. Integrative treatment combining Western and Korean medicine may help control these factors and reduce the need for hospitalization. We investigated the potential impact of integrative treatment on LEDD and polypharmacy in patients with PD > 5 years postdiagnosis.

Methods: Fifteen patients with PD (KCD code G20), diagnosed > 5 years earlier, who received integrative treatment at Gwangju Korean Medicine Hospital, Wonkwang University, from April 1, 2022, to July 30, 2024, were enrolled. A retrospective chart review was conducted to collect demographic and clinical data, including LEDD, medication count, and treatment details. Summary statistics were presented as median (IQR) and mean ± SD.

Results: In the integrative treatment cohort, the prevalence of both LEDD and polypharmacy was lower than that in studies involving conventional treatment alone. The mean LEDD was 321.71 (median, 200.0) mg, while only two patients exceeded the LEDD threshold of 300 mg, which was associated with motor complications. Polypharmacy was observed in 13.3% of patients and hyperpolypharmacy in 6.7%, representing lower proportions compared with previous reports on conventional treatments. Representative cases highlighted symptom improvement and a reduced need for medication with integrative approaches, particularly acupuncture and herbal medicine.

Conclusion: These findings suggest that integrative treatment may contribute to lowering LEDD and medication counts in patients with PD, which could potentially reduce hospitalization rates and the associated social costs. Further prospective studies comparing the integrative and nonintegrative treatment groups are needed to clarify these findings and evaluate the role of integrative treatment in the long-term management of PD.

Introduction: Early-onset Parkinson's disease (EOPD) shares similar clinical features to the late-onset form, but the risk of injury remains unclear. This study aimed to evaluate the risk of traumatic injury, including fracture, in patients with EOPD.

Methods: This matched cohort study used a Japanese administrative claims database to compare the risk of traumatic injury and fracture between EOPD patients and the general population. EOPD was defined by diagnosis between ages 21 and 49 together with the initiation of anti-PD medication. Crude incidence rates and adjusted hazard ratios (aHRs) were estimated using Poisson and Cox regression models. Subgroup analyses were performed by age and sex.

Results: In 368 EOPD patients and 1586 matched individuals from the general population, the traumatic injury rate was slightly higher in EOPD patients (9.5 vs. 7.9 events per 100 person-years), but the difference was not substantial (aHR, 1.2; 95% confidence interval [CI], 0.9-1.5). Fracture risk in the groups was similar, at 1.4 events per 100 person-years (aHR, 0.9; 95% CI, 0.5-1.6). Subgroup analyses showed an increased traumatic injury risk in EOPD patients aged 40-49 years (aHR, 1.4; 95% CI, 1.0-1.8) and in females (aHR, 1.3; 95% CI, 1.0-1.8). No clear differences were observed in other comparisons.

Conclusion: No major difference in traumatic injury or fracture risk was found between EOPD patients and the general population. However, preventive interventions may be warranted for patients aged 40-49 years and for females due to their elevated injury risk.

Background: Parkinson's disease (PD) is an age-related neurodegenerative condition with a range of motor and nonmotor symptoms. Nonmotor symptoms such as constipation and orthostatic hypotension can occur at any stage, while dysphagia is common in later stages of the disease. Previous work by our group showed that people with PD who lose weight within a year of diagnosis had a poorer prognosis. In this study, we explored whether fluid intake was also reduced in people with newly diagnosed PD.

Materials and methods: We invited people with newly diagnosed PD (within 6 months of a diagnosis or longer if not requiring treatment) to join the study. Controls were household members of the participants with PD. Participants all underwent the same assessments, including a 24-h dietary recall, a video-recorded swallowing assessment, and grading of stool sample consistency using the Bristol Stool Chart.

Results: We recruited 30 participants, 19 with PD and 11 household controls. People living with PD reported significantly lower fluid intake from drinks (control median = 1799 mL, PD median = 1124 mL, p=0.005 for difference in medians). People with PD drank fluid slightly slower than the controls, 6.0 mL/second vs 7.5 mL/second, but this did not reach statistical significance. Participants with PD had significantly harder stools than controls, with a mean Bristol Stool Chart number of 3.2 vs 4.6 for controls (p=0.01).

Conclusion: PD is associated with significantly reduced intake of fluids from beverages around the time of diagnosis, which may contribute to constipation and orthostatic hypotension.

Parkinson's disease (PD) is the second most common neurological disease. This study explores the determinant factors influencing medication adherence and disease stage among PD patients. This study was conducted on 161 PD patients at the Neurology Clinic. The eight-item Morisky Medication Adherence Scale (MMAS-8) and the International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) were used. Medication adherence and disease stage were analyzed using the chi-square test to measure the association of qualitative variables, and the Kruskal-Wallis test to test the association of quantitative data. Ordinal logistic regression was used to relate study variables with study outcomes. Medication adherence has a significant association with PD duration, number of times of taking PD drugs daily, comorbidity, total number of medications used, side effects, and history of medication discontinuation. The mean score of MDS-UPDRS subscales significantly differs. Medication adherence levels are suboptimal among PD patients, with significant correlations between medication adherence and disease stage, motor symptoms, and motor side effect. These insights underscore the critical need for targeted interventions to improve medication adherence and mitigate disease burden in PD patients.

Background: Previous studies revealed that optical coherence tomography (OCT) and visual evoked potential (VEP) were impaired in patients with Parkinson's disease (PD), but the results were inconsistent; in this meta-analysis, we tried to answer this issue by including studies that performed these two tests on the same sample size. Methods: PubMed, Scopus, Cochrane, and Google Scholar were comprehensively reviewed to retrieve the published studies investigating changes in OCT and VEP responses in PD patients. We analyzed the pooled weighted difference in means between PD patients and healthy controls using the random-effects model. Results: Ten studies were included (12 sets of data), enrolling 337 PD patients and 273 healthy controls. The P100 latency in PD patients was significantly higher compared to healthy controls (difference in means = 6.16, 95% CI: 1.16-11.15, p=0.02, n = 11). Significant thinning of the retinal nerve fiber layer (difference in means = -4.38, 95% CI: -6.29 to -2.47, p ≤ 0.001, n = 11) was observed in the PD eyes compared to the healthy subjects. However, no statistically significant difference was found in the means of P100 amplitude (p=0.06) and the average central foveal thickness (p=0.08) between PD patients and the control group. There was a significant negative correlation between RNFL weighted mean difference and P100 latency (r = -0.65, p ≤ 0.001) in all subjects. Conclusions: Our results confirmed that Parkinson's patients showed significant thinning of RNFL thickness and prolonged P100 latency time.

Background: In levodopa-treated individuals with Parkinson's disease (PD) and end-of-dose motor fluctuations, the BIPARK-I randomized controlled trial (RCT) demonstrated that opicapone is noninferior to entacapone in reducing OFF-time. Furthermore, the BIPARK-II RCT demonstrated that opicapone is well tolerated and significantly reduces OFF-time compared with placebo. This study developed a cost-effectiveness model (CEM) of opicapone compared with entacapone from the perspective of the English National Health Service (NHS) and personal social services (PSS). Methods: The CEM used a Markov model with three health states, including "<25% OFF-time," "≥25% OFF-time," and "dead," as individuals spending less than 25% of their awake time experiencing OFF-time have previously been shown to have a significantly improved health-related quality of life and to accumulate fewer healthcare costs. The CEM had a 25-year time horizon, expressed costs as 2021/22 Great British Pounds (GBPs), and health outcomes as quality-adjusted life years (QALYs). Both costs and health outcomes were discounted at 3.5% annually, and a cost-effectiveness threshold of £20,000 per QALY was used. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty. Results: The deterministic base case indicates that an individual treated with opicapone accrues fewer costs and more QALYs compared with each entacapone comparator and, therefore, is considered cost-effective. The PSA indicates that the probability that opicapone is cost-effective ranges from 87.2% to 98.0%, depending on the choice of entacapone comparator. Conclusions: Opicapone is cost-effective when compared with entacapone for levodopa-treated PD patients experiencing end-of-dose motor fluctuations. Trial Registration: ClinicalTrials.gov identifier: NCT01568073.

Cognitive impairment in Parkinson's disease (PD) is common, but there is scarce evidence as to how this group of patients can be most effectively assessed and managed. Our quality improvement project evaluated the impact of integrating a PD specialist psychiatrist (PDSP) into an existing multidisciplinary team (MDT) to allow direct referral of patients with cognitive impairment rather than to a separate service. We collected data over 1 year to map the referral trajectories of patients through the new pathway and estimated cost savings by comparison with the previous pathway. Eighty-five patients were referred to our PDSP, 47 with cognitive impairment. Estimated cost savings attributed to the new pathway were more than £1000, with the greatest savings associated with patients diagnosed with mild cognitive impairment (MCI). Integration of a PDSP into our MDT led to a more streamlined service, rapid access to diagnosis and management and likely cost savings.

Managing Parkinson's disease (PD) symptoms can be challenging due to multiple factors, including complex symptoms, which are often reported late, and a lack of resources, resulting in worse outcomes. Self-management of PD symptoms is a priority for patients, their carers, healthcare staff and systems. However, there is no effective comprehensive self-management intervention for use in the United Kingdom to support people with PD to self-manage problematic symptoms. We have developed a facilitated self-management toolkit through literature reviews and co-design workshops. We conducted a single-group, pre-post feasibility study to evaluate the feasibility and acceptability of this toolkit, ahead of a randomised controlled trial (RCT). We assessed the feasibility of the study by measuring recruitment rate, retention rate, data completion, outcome measures and serious adverse events. In addition, we collected fidelity data to ensure the intervention was delivered as designed. For acceptability, we measured participants' engagement through attendance at sessions, as well as through a feedback survey completed by participants at follow-up. In a subgroup of participants, we conducted semistructured interviews to gain feedback on what participants thought was good and what could be improved with the intervention, as well as how acceptable the trial procedures were. All quantitative data were summarised descriptively, and qualitative data were analysed using codebook thematic analysis. We successfully recruited the target population within a predefined timeline, maintained intervention engagement and completed sufficient follow-up, with limited missing data and no intervention-related serious adverse events. The intervention was delivered with 93% fidelity, and 89% of participants were engaged. Participants found the supporter sessions most helpful, followed by information pages, and setting person-centred goals. Having all their PD information in one place was seen as valuable, as well as talking through their challenges and problem-solving how to overcome them. The toolkit is now being tested in a national RCT. Trial Registration: ISRCTN registry: ISRCTN92831552.

Background: Research into alternative treatments for Parkinson's disease (PD) is gaining increasing attention. Mucuna pruriens (M. pruriens), a plant traditionally used in Ayurvedic medicine, contains a significant amount of L-dopa (4%-6%), the primary active component of conventional levodopa (LD) therapy-the gold standard treatment for PD. M. pruriens is also recognized for its anti-inflammatory, antioxidant, antiapoptotic, and antiparkinsonian properties, which collectively suggest therapeutic benefits for individuals with PD. Objective: This systematic review aims to investigate the efficacy and safety of M. pruriens in managing symptoms of PD. Methods: A comprehensive search was conducted in PubMed, Embase, and Web of Science for clinical trials published up to February 2024. Studies comparing M. pruriens to LD were included. Quality assessment was performed, and findings were synthesized narratively. Results: Out of 466 articles identified, 5 clinical trials involving a total of 108 participants (mean age: 60 years) were included. Quality assessment rated one study as high quality, one as having some concerns, and three as low quality. Despite heterogeneity in M. pruriens interventions, the findings consistently showed improvements in PD symptoms and therapy-related complications. Treatment with M. pruriens was associated with a shorter time to reach the "on" disease stage, prolonged duration of this stage, and fewer adverse events, with no dyskinesia reported. Conclusion: M. pruriens shows promise in improving motor symptoms and reducing therapy complications in PD patients. However, current clinical evidence is limited, and further high-quality trials are needed to confirm its efficacy and safety.