Parkinson's Disease最新文献

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.

Background: Parkinson's disease (PD), a progressive neurodegenerative disorder marked by motor and nonmotor symptoms, with resting-state fMRI (rsfMRI) proving pivotal in identifying neural circuit abnormalities and functional connectivity patterns, paving the way for a more personalized, precision medicine approach to PD diagnosis and treatment. Methods: Given its significance, this study conducted a bibliometric analysis to systematically map the intellectual landscape of rsfMRI applications in PD research. Relevant publications were sourced from the Web of Science Core Collection database from January 1, 2009, to July 18, 2024, and restricted to English-language articles and review articles. Utilizing VOSviewer and CiteSpace software, the analysis covered publication distributions across countries, institutions, and authors, along with co-citation patterns among co-authors and journals, keyword co-occurrence, and burst detection. Results: A total of 658 publications from January 1, 2009, to July 18, 2024, were identified, showing a gradual increase in annual publication and citation volume in earlier years. Notably, a decline emerged in 2023, highlighting the need for research paradigm shift to drive further progress. Among 45 countries and 865 institutions, China, led in publication and citation counts at both the institutional and author levels, with neuroscience-related journals playing a key role in advancing this field. Keyword analysis identified emerging research frontiers, including disease heterogeneity, early detection, symptom-specific mechanism exploration, and treatment evaluation. Conclusions: Results from this bibliometric analysis systematically elucidates the historical development, research progress over the years, and current research hotspots in rsfMRI studies of PD, thereby offering valuable guidance for future research endeavors in this field.

Background: While Parkinson's disease (PD) is primarily recognized for its motor symptoms, several non-motor symptoms may also be present. Among these, pain is one of the most common and debilitating, arising from complex neurophysiological mechanisms that often interact with motor symptoms and comorbidities, leading to a diverse range of clinical presentations. Although a variety of pharmacological and nonpharmacological therapies are used to manage pain in PD, the factors influencing treatment practices remain underexplored, particularly within the Australian healthcare context. This study, therefore, aimed to explore, from the patients' perspective, factors that influence pain management practices among people with PD living in Australia. Methods: A qualitative descriptive research methodology using a maximum variation sampling strategy was used to recruit people with PD, living in Australia. Data were collected using individual, semistructured interviews and thematically analyzed. Results: 18 participants shared their perspectives on the factors that influenced their pain management practices. Thematic analysis of interview data resulted in four themes: (1) recommendations from trusted sources; (2) explorative experimentation and solution seeking; (3) intervention and service provider characteristics; and (4) personal beliefs and abilities; and several subthemes. These findings highlight the complex nature of therapeutic decision-making from the perspective of people with PD, underscoring the interaction between external and internal influences. Conclusion: There is complexity and nuance in how people with PD make decisions about managing their pain. External and internal factors seem to influence therapeutic decision-making, while also highlighting notable gaps in the provision of PD pain care services. Understanding these complexities will be critical in developing accessible, effective, and patient-centered approaches to pain management within this population.

Background: There are many pharmacological treatment options beyond levodopa for Parkinson's disease (PD), with a variety of drug classes and formulations available. To achieve patient-centered care, clinicians must consider patients' backgrounds and preferences when selecting medications. Objectives: To investigate medication preferences regarding efficacy, safety, dosage/formulation, and cost in Japanese PD patients. Methods: Adults (18-90 years) from the Japan Parkinson's Disease Association receiving PD medication were eligible. An online survey was conducted, involving a discrete choice experiment, which set five medication characteristics including improvement of bothersome symptoms, risk of dyskinesia, risk of side effects other than dyskinesia, dosage/formulation, and monthly out-of-pocket cost. A questionnaire about the value of efficacy and safety of PD medications was also included. Results: In the full analysis set (N = 207), the mean age was 65.2 years, 53.1% were female, and 62.8% had wearing-off. The most impotrant characteristics of PD medications for patients were the risk of dyskinesia, improvement of bothersome symptoms, and risk of side effects other than dyskinesia. Latent class analysis identified three groups with different preferences who have varied backgrounds, such as disease severity. The three most important symptoms patients wanted to improve were moving difficulty/slow movement (79.7%), body stiffness (43.5%), and pain (42.0%). The three most important side effects patients wanted to avoid were dyskinesia (54.6%), hallucinations/visual hallucinations (19.3%), and constipation (11.6%). Conclusion: PD patients placed the highest importance on the risk of dyskinesia for PD medications and also efficacy. To achieve patient-centered care, clinicians should consider patients' backgrounds and preferences when selecting medications.

Background: It is unclear whether the two device-aided therapies (DATs: deep brain stimulation [DBS] and levodopa-carbidopa intestinal gel [LCIG]) affect personality in patients with Parkinson's disease (PD). Objective: This retrospective study aims to explore if patients with PD and their close relatives experience any changes in the patient's personality following the start of DAT. Methods: In total, 32 patients with DAT (17 DBS and 15 levodopa pump-based therapy) and their close relatives (n = 32) were asked to retrospectively assess potential personality changes in the patients using the Big Five Inventory (BFI) following DAT. They also answered questions regarding perceived quality of life and perceived impact on motor symptoms. Results: There was a diverse perceived change in the patients' five personality traits when divided into the type of therapy. DBS patients reported decreased extraversion (70.6%, n = 12), while their close relatives reported an increase in the trait neuroticism (82.4%, n = 14). A significant difference was found in perceived changes in agreeableness, with 8 DBS patients reporting an increase and 4 close relatives reporting a decrease (p=0.008). Most of the pump patients (LCIG) reported a decreased conscientiousness (66.7% n = 10), a perception confirmed by 73.3% (n = 11) of their close relatives, who in addition reported an increase in neuroticism (73.3%, n = 11). Conclusions: This study suggests perceived personality changes following DAT (DBS or LCIG), which vary by therapy and respondent role. Larger studies are needed, but the findings signal the importance of considering both patients' and their relatives' perspectives when assessing personality changes.

Background: Patients affected by idiopathic Parkinson's disease (IPD) are known to have difficulties in sensorial integration. The ratio of the postural sway in the standing position with closed eyes to open eyes (Romberg Quotient) is a simple way to investigate the role of the visual channel in postural control in this category of patients. Objective: We aim to share our observation about the incidence in patients with IPD of postural blindness, namely the reduction of the postural sway by closing the eyes. Methods: Patients had to stay quiet on a force plate for 30 s in four conditions: eyes open and closed both on a firm and a compliant surface. Results: 30% of the 22 patients analyzed reduced their postural sway by closing their eyes on both firm and compliant surfaces. Conclusion: The role of vision for postural control in patients with IPD should be further investigated.

Objective: Subthalamotomy using magnetic resonance-guided high-intensity focused ultrasound (MRg-FUS) is a noninvasive therapy that improves the cardinal symptoms of Parkinson's disease. However, clinical outcomes show high variability even when all inclusion criteria for this treatment are met. In this work, we aim to study the relationship between brain volumetry and clinical response in patients undergoing this treatment. Methods: Twenty patients who underwent MRg-FUS subthalamotomy were included and evaluated at baseline and 3 months post-treatment. Brain volumes were obtained from pretreatment MRI scans processed with the open-source package FreeSurfer. The treatment response was assessed using the movement disorder society unified Parkinson's disease rating scale (MDS-UPDRS). Principal component analysis (PCA) and clustering methods were used to identify groups of patients with similar clinical outcome. Results: PCA identified 2 clusters of patients, and a sensitivity and a specificity of 80% classified patients who will have a response to treatment with an improvement greater than 40% of the pretreatment UPDRS III scale. A positive association was found with the response to treatment with the variables: brain volume, cortical thickness and volume of total gray matter, and subcortical gray matter and white matter. On the other hand, a negative association was found with the response to treatment with the variables: ventricular volume. Conclusion: Our findings suggest that brain atrophy, reduced global cortical thickness, and increased ventricular volume are significantly associated with the predicting treatment response in Parkinson's disease patients undergoing MRg-FUS subthalamotomy.

Background: People with Parkinson's disease (PD) may use cannabis-based products for symptom management. In France, products containing tetrahydrocannabinol (THC) are prohibited, while cannabidiol (CBD)-products are readily available. However, data on cannabinoid use in French people with PD are lacking. Objectives: To identify correlates of the use of cannabis-based products and to document their patterns of use and perceived effects. Methods: A French nationwide online survey was conducted from May to July 2023. Regression analyses helped identify factors associated with current cannabis and CBD use (regardless of their form). Patterns of use and self-reported effects were also documented. Results: The study sample comprised 1136 participants, with a median age of 68 years. Six percent (5.9%) and 17.9% reported using cannabis and CBD, respectively. Both substances were associated with better knowledge of cannabinoids and a poor self-perceived household economic situation. The most common routes of cannabis administration were oral ingestion (44.8%) and smoking (41.4%); for CBD, they were oral ingestion (82.8%) and smoking (6.4%). Users reported that cannabis and CBD were very effective for sleep disorders, pain, and rigidity/cramps. The satisfaction level for both substances was also high. Conclusion: Cannabis and CBD use among people with PD was associated with better knowledge about cannabinoids and a poor self-perceived household economic situation. Furthermore, users reported high levels of satisfaction for both substances. An enhanced communication with healthcare providers and facilitated access to safe cannabis/CBD products are needed in France to enable people with PD to maximize the benefits of cannabinoids when clinically appropriate.

To evaluate the diagnostic accuracy of machine learning-assisted magnetic resonance imaging (MRI) in detecting cognitive impairment among Parkinson's disease (PD) patients through a systematic review and meta-analysis. We systematically searched for studies that applied machine learning algorithms to MRI data for diagnosing PD with mild cognitive impairment (PD-MCI). Data were extracted and synthesized to calculate pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative diagnostic likelihood ratio (NLR), and diagnostic odds ratios (DOR). A bivariate random-effects model and summary receiver operating characteristic (SROC) curves were employed for statistical analysis. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) instrument. The publication bias was investigated through Deeks' funnel plot. All statistical analyses were conducted using Stata 14.0. The pooled sensitivity and specificity for diagnosing PD-MCI using machine learning-assisted MRI were 0.82 (95% CI: 0.75-0.87) and 0.81 (95% CI: 0.73-0.87), respectively. The PLR was 4.28 (95% CI: 2.93-6.27), and the NLR was 0.23 (95% CI: 0.16-0.32), indicating a high diagnostic accuracy. The area under the curve (AUC) for the SROC was 0.85 (95% CI: 0.82-0.88). Quality assessment using the QUADAS-2 tool showed a predominantly low risk of bias among the studies, and the Deeks' funnel plot suggested no significant publication bias (p=0.30). In summary, the MRI combined with machine learning for diagnosing PD-MCI achieved high accuracy with the pooled sensitivity of 82% and specificity of 81%.