Clinical Parkinsonism Related Disorders最新文献_第3页

“Does speech in patients with different Parkinson’s disease subtypes decline over time?” “不同帕金森病亚型患者的语言能力会随着时间的推移而下降吗？”

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100372

Vanessa Brzoskowski dos Santos , Fernanda Venzke Zardin , Rui Rothe-Neves , Maira Rozenfeld Olchik

Purpose

This study investigates whether speech changes over time in patients with different motor subtypes of Parkinson’s disease (PD).

Methods

This longitudinal study included 60 individuals with PD, classified into tremor-dominant (n = 42) and non-tremor-dominant (n = 18) subtypes according to the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Participants were assessed at three points: baseline, 12 months, and 24 months. Speech samples were collected from diadochokinesis (/pataka/) and 60-second monologue tasks. The analyzed acoustic variables included syllable number, duration, phonation time, articulation rate, average syllable duration (ASD), and pause ratio.

Results

There were no statistically significant differences between groups regarding age (p = 0.298), disease duration (p = 0.098), age at symptom onset (p = 0.879), HY (p = 0.895), and UPDRS (p = 0.224) at baseline. The tremor- and non-tremor-dominant subtypes did not show significant differences over time when analyzed separately in articulation time metrics. However, significant differences were observed between the subtypes in all variables of the diadochokinesia task, including the number of syllables (p < 0.001), phonation time (p < 0.001), articulation rate (p = 0.002), and ASD (p = 0.028). Regarding the trend analysis, for the monologue, the following were observed: dominant non-tremor [number of syllables (R² = 0.978), phonation time (R² = 0.860) and pause ratio (R² = 0.766)] and tremor [number of syllables (R² = 0.989) and phonation time (R² = 0.974)]. For the diadochokinesis: dominant non-tremor [number of syllables (R2 = 0.934) and phonation time (R² = 0.977)] and tremor [ASD (R² = 0.787)]

Conclusion

Over three years, the speech revealed that individuals with tremor and non-tremor subtypes exhibited stable patterns over time. Distinct speech differences emerged between the two groups, and articulation time metrics proved to be an effective tool for distinguishing between subtypes.This task emerged as a relevant approach from which biomarkers can be derived.

目的探讨帕金森病（PD）不同运动亚型患者的语言是否会随着时间的推移而改变。方法本研究纳入60例PD患者，根据运动障碍学会统一帕金森病评定量表分为震颤显性（n = 42）和非震颤显性（n = 18）亚型。参与者在三个点进行评估：基线、12个月和24个月。语音样本收集自对话（/pataka/）和60秒独白任务。分析的声学变量包括音节数、持续时间、发声时间、发音率、平均音节持续时间（ASD）和停顿率。结果两组患者基线年龄（p = 0.298）、病程（p = 0.098）、发病年龄（p = 0.879）、HY （p = 0.895）、UPDRS （p = 0.224）差异均无统计学意义。当分别分析发音时间指标时，震颤和非震颤显性亚型没有随时间的显着差异。然而，两种亚型之间在双重发音任务的所有变量中都观察到显著差异，包括音节数(p <；0.001)，发声时间(p <；0.001)，发音率（p = 0.002）和ASD （p = 0.028）。在趋势分析方面，对于独白，我们观察到优势无震颤[音节数（R2 = 0.978）、发声时间（R2 = 0.860）、停顿率（R2 = 0.766）]和震颤[音节数（R2 = 0.989）、发声时间（R2 = 0.974）]。在语音发育方面：主要是非震颤[音节数（R2 = 0.934）和发声时间（R2 = 0.977）]和震颤[ASD (R2 = 0.787)]。结论在3年多的时间里，震颤和非震颤亚型个体的语音表现出稳定的模式。两组之间出现了明显的语言差异，发音时间指标被证明是区分亚型的有效工具。这项任务作为一种相关的方法出现，从中可以获得生物标志物。

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引用次数: 0

Longitudinal Analysis of the Deep Brain Stimulation Impairment Scale for Subthalamic Nucleus Stimulation in Parkinson’s Disease 帕金森病丘脑底核深部脑刺激损伤量表的纵向分析

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100354

Paula Broetzmann , Carolin Semmler , Hannah Jergas , Gregor A. Brandt , Christina van der Linden , Charlotte Schedlich-Teufer , Franziska Maier , Elke Kalbe , Veerle Visser-Vandewalle , Michael T. Barbe , Juan Carlos Baldermann

Background

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for people with Parkinson’s disease (PwP). However, some patients treated with DBS may still experience quality of life limiting impairments after surgery, e.g., concerning posture and gait, cognition, speech, apathy or impulsivity, as well as technical challenges in managing the implanted device. The Deep Brain Stimulation Impairment Scale (DBS-IS) was developed to assess these impairments, yet their postoperative development is underexplored.

Methods

We retrospectively analysed changes in the DBS-IS Total Score and subscales assessed in patients at baseline, three, six and twelve months post-DBS implantation (n = 33 PwP) using linear mixed models for repeated measurements. Furthermore, we investigated device-related issues within the first year after surgery and their impact on quality of life in a larger sample (n = 99 PwP) using DBS-IS Facility Scores.

Results

After surgery we observed significant improvement in the DBS-IS Total Score (β = −1.93; p = 0.005), particularly in the subscales of postural instability, gait difficulty and cognitive impairment. 43 % of patients reported device-related problems within one year after surgery. Patients with device-related problems showed significantly less improvement in quality of life (z = −2.40; p = 0.017). Exploratory post-hoc tests suggested a higher propensity for device-related complications among older individuals (z = −2.19; p = 0.029).

Conclusion

The majority of impairments evaluated by the DBS-IS, such as postural instability, gait difficulty and cognitive impairments, appear amenable to STN-DBS intervention. Special attention is warranted for potential device issues, especially in older patients, to optimize patients’ quality of life outcomes.

丘脑底核深部脑刺激（DBS）是帕金森病（PwP）患者的一种成熟治疗方法。然而，一些接受DBS治疗的患者术后仍可能出现生活质量受限的障碍，例如，姿势和步态、认知、言语、冷漠或冲动，以及管理植入装置的技术挑战。开发了脑深部刺激损伤量表（DBS-IS）来评估这些损伤，但其术后发展尚未得到充分探讨。方法回顾性分析dbs植入后基线、3个月、6个月和12个月（n = 33 PwP）患者DBS-IS总分和亚量表的变化，采用线性混合模型进行重复测量。此外，我们使用DBS-IS设施评分调查了手术后一年内设备相关问题及其对更大样本（n = 99 PwP）生活质量的影响。结果术后DBS-IS总分明显改善(β = - 1.93；P = 0.005)，尤其是在姿势不稳定、步态困难和认知障碍的亚量表中。43%的患者在手术后一年内报告了与器械相关的问题。存在器械相关问题的患者在生活质量方面的改善程度明显较低(z =−2.40；p = 0.017)。探索性事后检验表明，老年人器械相关并发症的倾向性更高(z = - 2.19；p = 0.029)。结论STN-DBS对体位不稳定、步态困难、认知功能障碍等损伤的评估均可接受STN-DBS干预。需要特别注意潜在的器械问题，特别是在老年患者中，以优化患者的生活质量。

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引用次数: 0

Gait and balance dysfunction are associated with cognitive performance only in men with Parkinson’s disease 步态和平衡功能障碍仅与帕金森病患者的认知能力有关

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100363

Amy W. Amara , Kimberly H. Wood , Aya M. Miften , Lina Kleinschmidt , Corey S. White , Allen Joop , Raima A. Memon , Jennifer Pilkington , Jutaluk Kongsuk , Corina Catiul , Adeel A. Memon , Marcas M. Bamman , Christopher P. Hurt

Introduction

Parkinson’s disease (PD) can cause locomotor dysfunction and cognitive impairment and these symptoms are often associated. This study assesses relationships between comprehensive cognitive performance and locomotor function domains: gait, balance, and mobility, in men and women with PD.

Methods

Sixty PD participants, Hoehn and Yahr 1–3, age ≥ 45, and Montreal Cognitive Assessment score ≥ 18, underwent locomotor function assessments and a comprehensive neurocognitive battery. Primary outcomes included Timed Up and Go (TUG), maximum walking speed (MWS), Mini Balance Evaluation Systems Test (Mini-BESTest), and cognitive composite score (CCS). Spearman correlations determined associations between cognition and locomotor function for the total sample and separately for men and women.

Results

CCS correlated with all primary locomotor outcomes for the overall group and men only. Specifically, positive relationships were observed between the CCS and Mini-BEST Test (balance) for the overall group (p = 0.009) and men (p = 0.001), as well as MWS (gait) for the overall group (p = 0.006) and men (p < 0.001). CCS and TUG (mobility) were negatively correlated for the overall group (p = 0.005) and men (p < 0.001). There were no significant correlations between CCS and locomotor outcomes in women. Exploratory analyses suggest that performance in executive function, visuospatial skills, and processing speed drive these relationships.

Conclusion

In PD, balance, gait, and mobility correlated with global cognition. Correlations between motor function and cognitive performance were evident only in men. This study enhances understanding of the complex interplay between cognition and motor function in PD, especially among men.

帕金森病（PD）可引起运动功能障碍和认知障碍，这些症状通常与之相关。本研究评估了男性和女性PD患者的综合认知表现与运动功能域（步态、平衡和活动能力）之间的关系。方法60例PD患者，年龄≥45岁，蒙特利尔认知评估评分≥18分，Hoehn和Yahr 1-3，进行运动功能评估和综合神经认知测试。主要结果包括计时起跑（TUG）、最大步行速度（MWS）、迷你平衡评估系统测试（Mini- best）和认知综合评分（CCS）。斯皮尔曼相关性决定了整个样本的认知和运动功能之间的联系，并分别对男性和女性进行了研究。结果sccs与所有主要运动结果相关，仅与男性相关。具体而言，总体组（p = 0.009）和男性（p = 0.001）的CCS和Mini-BEST测试（平衡）之间存在正相关，总体组（p = 0.006）和男性(p <；0.001)。整体组的CCS与TUG（移动性）呈负相关（p = 0.005），男性组的CCS与TUG（移动性）呈负相关(p <；0.001)。在女性中，CCS和运动结果之间没有显著的相关性。探索性分析表明，执行功能、视觉空间技能和处理速度的表现推动了这些关系。结论PD患者的平衡、步态和活动能力与整体认知相关。运动功能和认知表现之间的相关性仅在男性中明显。这项研究增强了对帕金森病患者，尤其是男性患者认知和运动功能之间复杂相互作用的理解。

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引用次数: 0

Digital speech assessments and machine learning for differentiation of neurodegenerative diseases 用于神经退行性疾病鉴别的数字语音评估和机器学习

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100389

Kyurim Kang , Adonay S. Nunes , Ilkay Yildiz Potter , Ram Kinker Mishra , Andrew Geronimo , Jamie L. Adams , Catherine Isroff , Jesse E. Wang , Ashkan Vaziri , Anne-Marie Wills , Alexander Pantelyat

Introduction

Speech impairment is a prevalent symptom of neurological disorders, including Parkinson’s disease (PD), Progressive Supranuclear Palsy (PSP), Huntington’s disease (HD), and Amyotrophic Lateral Sclerosis (ALS), with mechanisms and severity varying across and within conditions. Scalable digital health tools and machine learning (ML) are essential for diagnosing and tracking neurodegenerative disease.

Methods

A total of 92 individuals were included in this study (21 PSP, 21 PD, 18 HD, 15 ALS, and 16 healthy elderly controls (CTR)). The Rainbow Passage was collected on a digital device and analyzed to extract 12 speech features representing speech production. A set of Elastic Net ML models was trained on these speech features to differentiate between diagnostic classes. A specialized Support Vector Machine ML model was then developed to differentiate PSP from PD.

Results

Elastic Net models achieved a balanced accuracy of 77% over 5 diagnostic classes (group-specific sensitivities of 76% for PSP, 67% for PD, 83% for HD, 73% for ALS, and 88% for CTR) and 83% over 4 diagnostic classes (group-specific sensitivities of 83% for PSP-PD, 83% for HD, 73% for ALS, and 94% for CTR). The PSP vs. PD classification model demonstrated a balanced accuracy of 85%, with sensitivity of 88% for PSP and 82% for PD. Key speech features differentiated clinical conditions, with Total Voiced Time being the strongest positive feature for combined PSP-PD. In HD, ALS, and CTR, Ratio Extra Words, Pauses per Second, and Intelligibility were the most strongly differentiating features, respectively. Articulatory Rate emerged as the most distinguishing feature between PD and PSP.

Conclusion

Our findings highlight the potential of digital health technology and ML in identifying and monitoring speech features in neurodegenerative diseases.

语言障碍是神经系统疾病的普遍症状，包括帕金森病（PD）、进行性核上性麻痹（PSP）、亨廷顿病（HD）和肌萎缩侧索硬化症（ALS），其机制和严重程度因病而异。可扩展的数字健康工具和机器学习（ML）对于诊断和跟踪神经退行性疾病至关重要。方法共纳入92例，其中PSP 21例，PD 21例，HD 18例，ALS 15例，健康老年对照（CTR） 16例。在数字设备上采集彩虹通道并进行分析，提取出12个代表语音产生的语音特征。在这些语音特征上训练了一组Elastic Net ML模型来区分诊断类别。然后开发了一个专门的支持向量机ML模型来区分PSP和PD。结果selastic Net模型在5种诊断类别中达到了77%的平衡准确性（PSP组特异性敏感性为76%，PD组为67%，HD组为83%，ALS组为73%，CTR组为88%），在4种诊断类别中达到了83%的平衡准确性（PSP-PD组特异性敏感性为83%，HD组敏感性为83%，ALS组敏感性为73%，CTR组敏感性为94%）。PSP与PD分类模型的平衡准确率为85%，其中PSP的敏感性为88%，PD的敏感性为82%。关键的言语特征区分了临床条件，总发声时间是合并PSP-PD的最强阳性特征。在HD， ALS和CTR中，额外单词比率，每秒停顿和可理解性分别是最明显的区分特征。发音速度是PD和PSP最显著的特征。结论数字健康技术和机器学习在识别和监测神经退行性疾病的语音特征方面具有很大的潜力。

{"title":"Digital speech assessments and machine learning for differentiation of neurodegenerative diseases","authors":"Kyurim Kang , Adonay S. Nunes , Ilkay Yildiz Potter , Ram Kinker Mishra , Andrew Geronimo , Jamie L. Adams , Catherine Isroff , Jesse E. Wang , Ashkan Vaziri , Anne-Marie Wills , Alexander Pantelyat","doi":"10.1016/j.prdoa.2025.100389","DOIUrl":"10.1016/j.prdoa.2025.100389","url":null,"abstract":"<div><h3>Introduction</h3><div>Speech impairment is a prevalent symptom of neurological disorders, including Parkinson’s disease (PD), Progressive Supranuclear Palsy (PSP), Huntington’s disease (HD), and Amyotrophic Lateral Sclerosis (ALS), with mechanisms and severity varying across and within conditions. Scalable digital health tools and machine learning (ML) are essential for diagnosing and tracking neurodegenerative disease.</div></div><div><h3>Methods</h3><div>A total of 92 individuals were included in this study (21 PSP, 21 PD, 18 HD, 15 ALS, and 16 healthy elderly controls (CTR)). The Rainbow Passage was collected on a digital device and analyzed to extract 12 speech features representing speech production. A set of Elastic Net ML models was trained on these speech features to differentiate between diagnostic classes. A specialized Support Vector Machine ML model was then developed to differentiate PSP from PD.</div></div><div><h3>Results</h3><div>Elastic Net models achieved a balanced accuracy of 77% over 5 diagnostic classes (group-specific sensitivities of 76% for PSP, 67% for PD, 83% for HD, 73% for ALS, and 88% for CTR) and 83% over 4 diagnostic classes (group-specific sensitivities of 83% for PSP-PD, 83% for HD, 73% for ALS, and 94% for CTR). The PSP vs. PD classification model demonstrated a balanced accuracy of 85%, with sensitivity of 88% for PSP and 82% for PD. Key speech features differentiated clinical conditions, with <em>Total Voiced Time</em> being the strongest positive feature for combined PSP-PD. In HD, ALS, and CTR, <em>Ratio Extra Words, Pauses per Second</em>, and <em>Intelligibility</em> were the most strongly differentiating features, respectively. <em>Articulatory Rate</em> emerged as the most distinguishing feature between PD and PSP.</div></div><div><h3>Conclusion</h3><div>Our findings highlight the potential of digital health technology and ML in identifying and monitoring speech features in neurodegenerative diseases.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"13 ","pages":"Article 100389"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Usability, safety and tolerability of CUE1 vibrotactile device as promising therapeutic approach in orthostatic tremor CUE1振动触觉装置治疗直立性震颤的可行性、安全性和耐受性

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100379

Viktoria Azoidou , Alexandra Zirra , Thomas Boyle , David Gallagher , Alastair John Noyce , Cristina Simonet

Introduction

Primary Orthostatic Tremor (POT) is a rare hyperkinetic movement disorder characterized by unsteadiness while standing, often exacerbated by anxiety and fatigue. It significantly impairs quality of life, and current treatment options are limited, with invasive procedures carrying notable risks.

Methods

This unblinded interventional study assessed the usability, safety, and tolerability of the CUE1, a non-invasive vibrotactile stimulation device worn on the sternum. Secondary exploratory outcomes included objective measures of balance and mobility: maximal stance time, tandem walk, heel raise hold, tandem stance, and Timed Up and Go (TUG) with and without dual tasking (DT). Assessments were performed at baseline, immediately after a 20-minute acclimatization session, and after 9 weeks of daily use (8 h/day). Patient-reported outcomes on fatigue, anxiety, and perceived change were also collected.

Results

Ten participants with POT (70 % female, aged 58–88 years) completed the study. Compliance and tolerability were excellent (100 %), with only mild, transient skin irritation reported in two cases. Immediate post-intervention improvements were observed in TUG [-1.22 s (95 % CI: −2.03, −0.26), p = 0.020], tandem stance [+1.41 s (0.00, 6.13), p = 0.025], tandem walk [+0.50 steps (0.00, 2.50), p = 0.042], and heel raise hold [+1.62 s (1.00, 3.32), p = 0.020]. After 9 weeks, improvements were observed in TUG [-2.13 s (−4.00, −0.26), p = 0.028], TUG-DT [-7.51 s (−14.88, −0.14), p = 0.047], tandem stance [+9.06 s (1.04, 17.08), p = 0.028], fatigue [-7.00 (−13.63, −0.37), p = 0.035], and patient-reported impression of change [+1.10 (0.14, 2.06), p = 0.027].

Conclusion

CUE1 vibrotactile stimulation is safe, well-tolerated, and shows promise in improving balance, mobility, and fatigue in POT. Larger, controlled trials are warranted.

原发性直立性震颤（POT）是一种罕见的多动性运动障碍，其特征是站立时不稳定，常因焦虑和疲劳而加重。它严重影响生活质量，目前的治疗选择有限，侵入性手术有明显的风险。方法本非盲性介入研究评估了CUE1的可用性、安全性和耐受性，这是一种佩戴在胸骨上的无创振动触觉刺激装置。次要的探索性结果包括平衡和活动的客观测量：最大站立时间，串联行走，脚跟抬高保持，串联站立，以及有和没有双重任务（DT）的定时起身和行走（TUG）。评估分别在基线、20分钟适应期后和9周每日使用（8小时/天）后进行。还收集了患者报告的疲劳、焦虑和感知变化的结果。结果10名POT患者（70%为女性，年龄58-88岁）完成了研究。依从性和耐受性非常好（100%），只有两个病例报告了轻微的，短暂的皮肤刺激。干预后立即观察到TUG [-1.22 s (95% CI:−2.03,−0.26),p = 0.020]，双人站立[+1.41 s (0.00, 6.13), p = 0.025]，双人步行[+0.50步（0.00,2.50），p = 0.042]和脚跟抬高[+1.62 s (1.00, 3.32), p = 0.020]的改善。9周后，观察到TUG [-2.13 s (- 4.00, - 0.26), p = 0.028]、TUG- dt [-7.51 s (- 14.88, - 0.14), p = 0.047]、双人站立[+9.06 s (1.04, 17.08), p = 0.028]、疲劳[-7.00 (- 13.63,- 0.37),p = 0.035]和患者报告的印象变化[+1.10 (0.14,2.06),p = 0.027]的改善。结论cue1振动触觉刺激是安全的、耐受性良好的，有望改善POT患者的平衡、活动能力和疲劳。

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引用次数: 0

Effects of a treadmill and oculomotor dual-task intervention vs. -nordic walking on balance in Parkinson’s disease patients − a pilot study 跑步机和动眼肌双任务干预与北欧步行对帕金森病患者平衡的影响——一项初步研究

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100392

Marc Niering , Corinna Wirth , Rainer Beurskens , Elisa Ueding , Tim Fischer , Johanna Seifert

Background

Oculomotor function has been established as a critical factor influencing balance, and both domains are frequently impaired in Parkinson’s disease (PD). Despite increasing recognition of younger PD cases, targeted therapeutic research remains limited.

Purpose

This pilot study evaluated the effects of a treadmill-based oculomotor dual-task intervention in individuals with PD, comparing its impact on balance and non-motor outcomes with that of Nordic walking (NW).

Method

Using a sequential within-subjects design, this study contrasts a four-week NW intervention with a subsequent four-week oculomotor intervention. Baseline, interim, and post-intervention assessments were conducted, with data collected using both qualitative and quantitative measures.

Results

The treadmill and oculomotor intervention led to greater improvements in unilateral and static balance parameters compared to NW, particularly under horizontal eye-movement conditions. While motor scores improved comparably in both interventions, non-motor domains such as emotional well-being and stigma improved only after the oculomotor protocol.

Conclusion

Treadmill-based oculomotor dual-task training appears to be a viable and time-efficient alternative to NW for improving specific aspects of balance and non-motor function in PD. Given its indoor feasibility and short duration, this approach may enhance accessibility in clinical and home-based rehabilitation settings.

运动功能是影响平衡的关键因素，在帕金森病（PD）中，这两个领域都经常受损。尽管越来越多的人认识到年轻的PD病例，但靶向治疗研究仍然有限。目的：本初步研究评估了基于跑步机的眼部运动双任务干预对PD患者的影响，比较了其对平衡和非运动结果的影响与北欧步行（NW）。方法采用连续受试者设计，本研究将为期四周的NW干预与随后为期四周的动眼肌干预进行对比。进行了基线、中期和干预后评估，采用定性和定量方法收集数据。结果与NW相比，跑步机和动眼肌干预对单侧和静态平衡参数的改善更大，尤其是在水平眼动条件下。虽然运动得分在两种干预措施中都得到了相当程度的改善，但非运动领域，如情绪幸福感和耻辱感，只有在动眼病治疗方案后才得到改善。结论基于跑步机的动眼肌双任务训练似乎是一种可行且高效的替代NW的方法，可以改善PD患者的平衡和非运动功能的特定方面。鉴于其室内可行性和持续时间短，这种方法可以提高临床和家庭康复环境的可及性。

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引用次数: 0

Impact of levodopa and deep brain stimulation on visual impairments in Parkinson’s disease 左旋多巴和深部脑刺激对帕金森病视力损害的影响

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100390

Sana Aslam , Markey Olson , Melissa Kovacs , Pireh Ansari , Amputch Karukote , Justine Chan , Shadi Barbu , Sydney Felsen , Holly A. Shill , Charles H. Adler

Background

Parkinson’s disease (PD) often causes visual changes that impair visuospatial processing, reading speed, and contrast acuity, impacting patients’ quality of life.

Objectives

This study aimed to investigate the effects of levodopa and deep brain stimulation (DBS) on visual symptoms associated with PD.

Methods

Patients were assessed either before DBS surgery (both off and on medication) or at their first DBS programming session (off medication, with and without stimulation). The King-Devick reading speed and color contrast visual tests were administered in each condition, evaluating high and low contrast across black, red, and yellow.

Results

Reading speed and color contrast acuity did not change following levodopa dosing or when deep brain stimulation was off or on. However, those patients that had testing before and after DBS showed a non-significant trend towards improvement in their rapid reading test scores from pre-DBS to post-DBS and black color contrast sensitivity using the 2.5% contrast.

Conclusions

Although levodopa and DBS did not significantly improve reading speed or contrast acuity after single dosing or turning DBS on and off, in this small study, these findings provide valuable insights into the stability of these visual symptoms under current treatments. There was evidence that DBS surgery may improve certain aspects of reading speed and contrast acuity and further study is needed. This work underscores the need for innovative approaches to enhance visual function in PD.

帕金森氏病（PD）经常导致视觉变化，损害视觉空间处理、阅读速度和对比灵敏度，影响患者的生活质量。目的探讨左旋多巴联合深部脑刺激（DBS）对PD相关视觉症状的影响。方法在DBS手术前（停药和服药）或第一次DBS编程时（停药，有刺激和没有刺激）对患者进行评估。在每种情况下进行King-Devick阅读速度和颜色对比视觉测试，评估黑色、红色和黄色的高对比度和低对比度。结果左旋多巴给药及脑深部电刺激关闭后，阅读速度和色彩对比灵敏度均无明显变化。然而，那些在DBS之前和之后进行测试的患者在DBS之前到DBS之后的快速阅读测试分数和使用2.5%对比度的黑色对比敏感度方面都没有明显的改善趋势。结论虽然左旋多巴和DBS在单次给药或打开和关闭DBS后并没有显著提高阅读速度或对比视力，但在这项小型研究中，这些发现为当前治疗下这些视觉症状的稳定性提供了有价值的见解。有证据表明DBS手术可以提高某些方面的阅读速度和对比敏锐度，需要进一步研究。这项工作强调需要创新的方法来增强PD的视觉功能。

{"title":"Impact of levodopa and deep brain stimulation on visual impairments in Parkinson’s disease","authors":"Sana Aslam , Markey Olson , Melissa Kovacs , Pireh Ansari , Amputch Karukote , Justine Chan , Shadi Barbu , Sydney Felsen , Holly A. Shill , Charles H. Adler","doi":"10.1016/j.prdoa.2025.100390","DOIUrl":"10.1016/j.prdoa.2025.100390","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD) often causes visual changes that impair visuospatial processing, reading speed, and contrast acuity, impacting patients’ quality of life.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the effects of levodopa and deep brain stimulation (DBS) on visual symptoms associated with PD.</div></div><div><h3>Methods</h3><div>Patients were assessed either before DBS surgery (both off and on medication) or at their first DBS programming session (off medication, with and without stimulation). The King-Devick reading speed and color contrast visual tests were administered in each condition, evaluating high and low contrast across black, red, and yellow.</div></div><div><h3>Results</h3><div>Reading speed and color contrast acuity did not change following levodopa dosing or when deep brain stimulation was off or on. However, those patients that had testing before and after DBS showed a non-significant trend towards improvement in their rapid reading test scores from pre-DBS to post-DBS and black color contrast sensitivity using the 2.5% contrast.</div></div><div><h3>Conclusions</h3><div>Although levodopa and DBS did not significantly improve reading speed or contrast acuity after single dosing or turning DBS on and off, in this small study, these findings provide valuable insights into the stability of these visual symptoms under current treatments. There was evidence that DBS surgery may improve certain aspects of reading speed and contrast acuity and further study is needed. This work underscores the need for innovative approaches to enhance visual function in PD.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"13 ","pages":"Article 100390"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The diagnostic value of transcranial sonography in Swedish parkinsonism patients: A retrospective cohort study with long-term follow-up 经颅超声诊断瑞典帕金森病患者的价值：一项长期随访的回顾性队列研究

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100411

M. Stiehm , C. Nilsson , Ö. Skogar , U. Walter

Introduction

Although transcranial sonography (TCS) assessing hyperechogenic substantia nigra (SN+) as biomarker for Parkinsońs disease (PD) has been introduced elsewhere, the clinical relevance and accuracy in a Swedish population is still unknown.

Methods

This retrospective single-center study included 74 patients with predominantly early-stage parkinsonism at first visit who had been examined by TCS from 2013 to 2017 to determine the SN+ biomarker status in relation to PD, atypical parkinsonian disorders (APS), essential tremor (ET) and vascular/secondary/ unspecified parkinsonism, with the aim of long-term follow-up to confirm the clinical diagnosis. The cut-off value for SN+ was regarded as the 90 % percentile of SN echogenicity in a local healthy cohort (here, 0.23 cm²).

Results

In 2024, the mean follow-up time was 95 months. Three patients (4 %) without transcranial bone were excluded. SN+ was found in 38/51 patients with finally diagnosed PD and 4/20 patients with other final clinical diagnoses (p < 0.001). Sensitivity was moderate (75 %) whereas specificity and the positive predictive value were higher (80 % and 90 %, respectively). SN area measurements (most abnormal side) were significantly different in PD-patients compared to non-PD patients (n = 63; 0.28 ± 0.09 [95 % CI: 0.25–0.30] cm² vs. 0.23 ± 0.10 [0.18–0.29] cm², p 0.035).

Conclusion

After a follow-up of up to 8 years, to maximize diagnostic certainty, our findings support the use of TCS as a valuable add-on tool in PD diagnostics in a Swedish patient population, already in the early stage of disease but not for screening.

虽然经颅超声（TCS）评估高回声黑质（SN+）作为Parkinsońs疾病（PD）的生物标志物已经在其他地方被引入，但在瑞典人群中的临床相关性和准确性仍然未知。方法本回顾性单中心研究纳入74例首次就诊以早期帕金森为主的患者，于2013 - 2017年接受TCS检查，确定PD、非典型帕金森病（APS）、特发性震颤（ET）和血管性/继发性/不明原因帕金森病相关的SN+生物标志物状态，目的是长期随访以确认临床诊断。在当地健康队列中，SN+的临界值被视为SN回声的90%百分位数（0.23 cm2）。结果2024年平均随访95个月。排除无经颅骨的3例（4%）患者。最终诊断为PD的患者中有38/51，其他最终临床诊断为PD的患者中有4/20出现SN+ (p < 0.001)。敏感性中等（75%），而特异性和阳性预测值较高（分别为80%和90%）。pd患者与非pd患者的SN面积测量（最异常侧）差异显著（n = 63; 0.28±0.09 [95% CI: 0.25-0.30] cm2 vs. 0.23±0.10 [0.18-0.29]cm2, p 0.035）。结论：在长达8年的随访后，为了最大限度地提高诊断的确定性，我们的研究结果支持将TCS作为一种有价值的附加工具，用于已经处于疾病早期但未用于筛查的瑞典患者人群的PD诊断。

{"title":"The diagnostic value of transcranial sonography in Swedish parkinsonism patients: A retrospective cohort study with long-term follow-up","authors":"M. Stiehm , C. Nilsson , Ö. Skogar , U. Walter","doi":"10.1016/j.prdoa.2025.100411","DOIUrl":"10.1016/j.prdoa.2025.100411","url":null,"abstract":"<div><h3>Introduction</h3><div>Although transcranial sonography (TCS) assessing hyperechogenic substantia nigra (SN+) as biomarker for Parkinsońs disease (PD) has been introduced elsewhere, the clinical relevance and accuracy in a Swedish population is still unknown.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 74 patients with predominantly early-stage parkinsonism at first visit who had been examined by TCS from 2013 to 2017 to determine the SN+ biomarker status in relation to PD, atypical parkinsonian disorders (APS), essential tremor (ET) and vascular/secondary/ unspecified parkinsonism, with the aim of long-term follow-up to confirm the clinical diagnosis. The cut-off value for SN+ was regarded as the 90 % percentile of SN echogenicity in a local healthy cohort (here, 0.23 cm<sup>2</sup>).</div></div><div><h3>Results</h3><div>In 2024, the mean follow-up time was 95 months. Three patients (4 %) without transcranial bone were excluded. SN+ was found in 38/51 patients with finally diagnosed PD and 4/20 patients with other final clinical diagnoses (p < 0.001). Sensitivity was moderate (75 %) whereas specificity and the positive predictive value were higher (80 % and 90 %, respectively). SN area measurements (most abnormal side) were significantly different in PD-patients compared to non-PD patients (n = 63; 0.28 ± 0.09 [95 % CI: 0.25–0.30] cm<sup>2</sup> vs. 0.23 ± 0.10 [0.18–0.29] cm<sup>2</sup>, p 0.035).</div></div><div><h3>Conclusion</h3><div>After a follow-up of up to 8 years, to maximize diagnostic certainty, our findings support the use of TCS as a valuable add-on tool in PD diagnostics in a Swedish patient population, already in the early stage of disease but not for screening.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"13 ","pages":"Article 100411"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A meta-analysis of the long-term efficacy of Amantadine for Levodopa-induced dyskinesia in Parkinson’s disease 金刚烷胺治疗左旋多巴诱导的帕金森病运动障碍的长期疗效荟萃分析

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100405

Kayla Williams , Maurice A. Curtis , Lisa Gombinsky , Priya Parmar

Introduction

This systematic review and meta-analysis investigated the long-term efficacy of Amantadine for Levodopa-induced dyskinesia (LID) in Parkinson’s disease patients. Our analysis focused on longer-term motor outcomes, including those which are under-reported in the literature.

Methods

We identified relevant articles by searching four online databases and reviewing citations. The primary outcomes included the Unified Parkinson’s Disease Rating Scale (UPDRS) or Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part IV and daily “ON” time; secondary outcomes included UPDRS/MDS-UPDRS III and IVa, Unified Dyskinesia Rating Scale (UDysRS) total score, and daily “OFF” time. For each outcome, we conducted meta-analyses for numerous time-points after beginning treatment: “up to 13 weeks”, “up to 16 weeks”, “12 to 16 weeks”, and “38 to 101 weeks”. Our outcome measure was the Standardized Mean Differences (SMDs) between the pooled Amantadine-Levodopa and Levodopa only (control) groups.

Results

We found associations between Amantadine and each motor outcome. The most considerable was an SMD of −0.73 points for Amantadine compared to control for the UPDRS/MDS-UPDRS IV at up to 16 weeks after beginning treatment (P < 0.0001). However, the magnitude of most associations decreased with time, indicating declining long-term efficacy. We also identified a risk of added “adverseness”; 11 studies had patient-reported adverse events, mainly overlaid with known symptoms.

Conclusion

Our findings suggest that Amantadine is an effective adjunct medication for improving LID and broader Parkinson’s disease symptoms. However, evidence of its declining long-term efficacy and “adverseness” have important implications for its use in Parkinson’s disease therapy.

本系统综述和荟萃分析探讨了金刚烷胺治疗帕金森病患者左旋多巴诱导的运动障碍（LID）的长期疗效。我们的分析侧重于长期运动结果，包括那些在文献中被低估的结果。方法通过检索4个网络数据库并查阅引文，筛选相关文献。主要结局包括统一帕金森病评定量表（UPDRS）或运动障碍学会统一帕金森病评定量表（MDS-UPDRS）第四部分和每日“ON”时间；次要结局包括UPDRS/MDS-UPDRS III和IVa、统一运动障碍评定量表（UDysRS）总分和每日“OFF”时间。对于每个结果，我们对开始治疗后的多个时间点进行了荟萃分析：“长达13周”、“长达16周”、“12至16周”和“38至101周”。我们的结果测量是金刚烷胺-左旋多巴混合组和左旋多巴（对照组）之间的标准化平均差异（SMDs）。结果我们发现金刚烷胺与运动预后之间存在关联。最显著的是，在开始治疗后16周，金刚烷胺与UPDRS/MDS-UPDRS IV组相比，SMD为- 0.73分（P < 0.0001）。然而，大多数相关性的程度随着时间的推移而下降，表明长期疗效下降。我们还发现了增加“逆反情绪”的风险；11项研究有患者报告的不良事件，主要与已知症状重叠。结论金刚烷胺是改善LID和更广泛帕金森病症状的有效辅助药物。然而，其长期疗效下降和“逆反性”的证据对其在帕金森病治疗中的应用具有重要意义。

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引用次数: 0

Obesity and the development of Parkinson’s disease within the Framingham Heart study cohort 弗雷明汉心脏研究队列中的肥胖和帕金森病的发展。

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2024.100291

Sarah O’Shea , Yuilin Liu , Chunyu Liu , Samuel A. Frank , Ludy C. Shih , Rhoda Au

Objective

To determine the role of obesity in the development of Parkinson’s disease (PD).

Background

Obesity has been reported to be both a risk factor for PD, as well as potentially protective. The Framingham Heart Study (FHS) is a multigenerational longitudinal cohort study that was started in 1948, which is well-known for its cardiovascular health studies. In this study, we utilized the extensive cardiovascular and neurological data to determine if obesity contributes to the risk of the development of PD.

Methods

Participants in the FHS Original and Offspring cohorts were included in this study. Controls were selected based on sex and age at baseline examination, 1:10. Cox proportional hazard regression models were used, adjusting for age and sex. PD case status was determined utilizing prior medical and neurological examination data, Framingham Heart Study examinations, and self-report data by a panel of movement disorders neurologists using the UK Brain Bank Criteria (UKBB) and other supporting clinical details after being flagged for review by FHS neurologists. We used p < 0.05 for significance.

Results

Accounting for missing covariate data, this study included 117 participants with PD, with 1170 controls. We found that higher BMI was associated with lower PD risk, with participants with BMI 25 kg/m2 to 30 kg/m2 having HR of 0.66 (CI 0.44–0.98; p = 0.04) and BMI >= 30 kg/m2 having HR 0.47 (CI 0.27–0.84; p = 0.01). When the overweight and obese BMI groups were combined, we noted a more robust association, with combined HR of 0.67 (0.41–0.86; p = 0.01).

Conclusions

Obesity during mid-life potentially reduces the risk of developing PD; however, additional studies are needed to further explore this association.

目的：探讨肥胖在帕金森病（PD）发展中的作用。背景：据报道，肥胖既是帕金森病的危险因素，也是潜在的保护因素。弗雷明汉心脏研究（FHS）是一项多代纵向队列研究，始于1948年，以其心血管健康研究而闻名。在这项研究中，我们利用广泛的心血管和神经学数据来确定肥胖是否会增加PD的发病风险。方法：本研究纳入了FHS原始和后代队列的参与者。对照根据基线检查时的性别和年龄选择，1:10。采用Cox比例风险回归模型，对年龄和性别进行调整。PD病例的状态是根据先前的医学和神经学检查数据、弗雷明汉心脏研究检查和运动障碍神经科医生使用英国脑库标准（UKBB）和其他支持性临床细节的自我报告数据确定的，这些数据由FHS神经科医生进行标记审查。考虑到协变量数据的缺失，本研究包括117名PD患者和1170名对照。我们发现较高的BMI与较低的PD风险相关，BMI为25 kg/m2至30 kg/m2的参与者的风险比为0.66 (CI 0.44-0.98；p = 0.04), BMI >= 30 kg/m2的危险度为0.47 (CI 0.27-0.84；p = 0.01)。当超重和肥胖BMI组合并时，我们注意到一个更强的关联，合并HR为0.67 (0.41-0.86；p = 0.01)。结论：中年肥胖可降低患帕金森病的风险；然而，需要进一步的研究来进一步探讨这种联系。

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引用次数: 0