Clinical Parkinsonism Related Disorders最新文献_第4页

The role of intraoperative monitoring in target selection in deep brain stimulation: A single centre study 术中监测在深部脑刺激靶选择中的作用：一项单中心研究。

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100299

Sandro Ibrulj , Dejan Georgiev , Žiga Samsa , Polona Mušič , Mitja Benedičič , Maja Trošt

Introduction

Intraoperative microelectrode recording (MER) and intraoperative test stimulation may provide vital information for optimal electrode placement and clinical outcome in movement disorders patients treated with deep brain stimulation (DBS). The aims of this retrospective study were to determine (i) how often the planned (imaging based) placements of electrodes were changed due to MER and intraoperative test stimulation in Parkinson’s disease (PD), dystonia and essential tremor (ET) patients; (ii) whether the frequency of repositioning changed over time; (iii) whether patients’ age or disease duration (in PD) influenced the frequency of repositioning.

Methods

Data on the planned and the final placement of 141 electrodes in 72 consecutive DBS treated patients (52 PD, 11 dystonia, 9 ET) was collected over the first 8 years of DBS implementation in a single center. An association between the rate of electrode repositioning and the patients’ age, disease duration and the time/year of implementation was explored.

Results

Analysis of all targets showed a change in final electrode placement in 39.7 % (56/141); 39.8 % (41/103) in PD, 40.9 % (9/22) in dystonia and 37.5 % (6/16) in ET. Annual analysis showed a decrease in rate of repositioning between the centre’s first and eighth year (p = 0.013) of implementation. No correlation was found between electrode repositioning rate and patient age (p = 0.42) nor disease duration (p = 0.09) in PD.

Conclusion

This retrospective analysis confirms the benefit of MER and intraoperative test stimulation during DBS surgery in determining the final electrode position during the early / initial period of implementing the procedure. Our findings show a learning curve in successful preoperative planning in our centre achieved through experience.

术中微电极记录（MER）和术中试验刺激可能为运动障碍患者接受深部脑刺激（DBS）治疗的最佳电极放置和临床结果提供重要信息。本回顾性研究的目的是确定(i)在帕金森病（PD）、肌张力障碍和特发性震颤（ET）患者中，由于MER和术中试验刺激，电极的计划（基于成像的）放置改变的频率；（ii）重新定位的频率是否随时间而改变；（iii）患者的年龄或病程（PD）是否影响重新定位的频率。方法：收集了72例连续DBS治疗患者（52例PD， 11例肌张力障碍，9例ET）在DBS实施的前8年中141个电极的计划和最终放置数据。探讨电极重新定位率与患者年龄、病程和实施时间/年之间的关系。结果：所有靶标分析显示，39.7%（56/141）患者最终电极放置位置发生改变；PD为39.8%(41/103)，肌张力障碍为40.9% (9/22)，ET为37.5%（6/16）。年度分析显示，在中心实施的第一年和第八年之间，重新定位率有所下降（p = 0.013）。PD患者电极复位率与患者年龄（p = 0.42）和病程（p = 0.09）无相关性。结论：本回顾性分析证实了在DBS手术早期/初始阶段，MER和术中试验刺激在确定最终电极位置方面的益处。我们的研究结果表明，通过经验，我们中心在成功的术前计划方面取得了学习曲线。

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引用次数: 0

Contribution of dopaminergic polymorphisms to levodopa treatment response and drug concentration in Chinese patients with Parkinson’s disease 多巴胺能多态性对中国帕金森病患者左旋多巴治疗反应和药物浓度的影响

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100333

Xiaoqin He , Kai Shi , Chengjun Mo , Yi Zhang , Qin Xiao , Xiaodong Yang

Background

Levodopa is the mainstay of treatments for Parkinson’s disease (PD), but large heterogeneity exists in patient response. Pharmacogenetic studies highlighted that genetic factors may play a relevant influence in this drug response variability.

Objective

To explore the relationship between dopaminergic polymorphisms, levodopa treatment response, and drug concentration in Chinese patients with PD.

Methods

Acute levodopa challenge test was conducted in 90 PD patients. Each patient underwent comprehensive neurological examination at baseline and after levodopa administration. Plasma levodopa concentrations were measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. Twelve genetic polymorphisms in genes encoding dopaminergic enzymes (TH, DDC, COMT, MAOB and DBH) were genotyped.

Results

Patients with the TH-rs6356 TT genotype showed higher ΔMDS-UPDRS-III scores compared to those with the CC + CT genotype after adjustment for the levodopa dose in the acute challenge test (P = 0.048). Furthermore, peak plasma levodopa concentration and Δplasma levodopa concentration were significantly higher in the TH-rs6356 TT group compared to the CC + CT group after adjustment (P = 0.007). Patients with the TH-rs6356 TT genotype exhibited a longer time to peak response compared to those with the CC + CT genotype (P = 0.042). However, this difference became non-significant after adjusting for levodopa dose (P = 0.066). The impact of other dopamine-related gene polymorphisms on levodopa efficacy appeared to be minimal in our study.

Conclusions

Our preliminary results from a relatively small patients’ sample, may suggest that the rs6356 polymorphism in the TH gene could act as a possible modifier of levodopa response in PD.

背景左旋多巴是治疗帕金森病（PD）的主要药物，但患者的反应存在很大的异质性。药物遗传学研究强调，遗传因素可能在这种药物反应变异性中发挥相关影响。目的探讨中国PD患者多巴胺能多态性、左旋多巴治疗反应和药物浓度之间的关系。方法对90例帕金森病患者进行急性左旋多巴激发试验。每位患者在基线和左旋多巴给药后进行了全面的神经学检查。采用液相色谱串联质谱法（LC-MS/MS）测定血浆左旋多巴浓度。对编码多巴胺能酶基因TH、DDC、COMT、MAOB和DBH的12个遗传多态性进行了基因分型。结果调整左旋多巴剂量后，TH-rs6356 TT基因型患者的ΔMDS-UPDRS-III得分高于CC + CT基因型患者（P = 0.048）。校正后TH-rs6356 TT组血浆左旋多巴峰值浓度和Δplasma左旋多巴浓度均显著高于CC + CT组（P = 0.007）。TH-rs6356 TT基因型患者与CC + CT基因型患者相比，达到峰值反应的时间更长（P = 0.042）。调整左旋多巴剂量后，差异无统计学意义（P = 0.066）。在我们的研究中，其他多巴胺相关基因多态性对左旋多巴疗效的影响似乎很小。结论从相对较小的患者样本中获得的初步结果可能表明TH基因的rs6356多态性可能是PD患者左旋多巴反应的一个可能的修饰因子。

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引用次数: 0

Minimal important changes of HFS-30 and HFS-7 questionnaires for patients with hemifacial spasm 半面肌痉挛患者HFS-30和HFS-7问卷的微小重要变化

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2024.100295

Weerawat Saengphatrachai, Nutchara Inthapong, Yuvadee Pitakpatapee, Natthapon Rattanathamsakul, Prachaya Srivanitchapoom

Introduction

Hemifacial spasm (HFS) significantly reduces health-related quality of life (HRQoL). Currently, the HFS-30 and HFS-7 questionnaires are used to evaluate the HRQoL in HFS patients; however, their minimal important changes (MICs) have not yet to be established. This study aimed to determine the MICs for HFS-30 and HFS-7 and patients’ characteristics associated with them.

Methods

Data were prospectively collected from HFS patients aged ≥18 years at a botulinum toxin clinic in a single tertiary university hospital between April 2022 and April 2023. We assessed HFS-30 and HFS-7 scores, Samsung Medical Center (SMC) grades, Patient Health Questionnaire-9 (PHQ-9) scores, and patient-reported HRQoL global rating of change scores at baseline, followed by assessments every two days for two weeks and at the one-month follow-up. MICs were determined based on the first follow-up visit when patients reported minimal improvement.

Results

The 112 enrolled patients had a median age of 62.8 years (IQR: 56.6–69.3) and a median disease duration of 10 years (IQR: 4–17). The MICs of the HFS-30 and HFS-7 questionnaires were −4.55 points (95 % CI: −5.49 to −3.62) and −0.96 points (95 % CI: −1.28 to −0.64), respectively. Patients with moderate-to-severe depression reported significantly greater MICs than those with milder depression (p < 0.001). Patients aged less than 60 had significantly greater MICs than older patients (p = 0.045).

Conclusions

The MICs of the HFS-30 and HFS-7 questionnaires were −4.55 and −0.96, respectively. The MIC is substantially greater in HFS patients with moderate-to-severe depression and younger age.

面肌痉挛（HFS）显著降低健康相关生活质量（HRQoL）。目前主要采用HFS-30和HFS-7问卷评估HFS患者的HRQoL；但是，它们的最小重要变化（mic）尚未确定。本研究旨在确定HFS-30和HFS-7的mic及与之相关的患者特征。方法前瞻性收集2022年4月至2023年4月在某三级大学医院肉毒杆菌毒素门诊就诊的年龄≥18岁的HFS患者的数据。我们在基线时评估HFS-30和HFS-7评分、三星医疗中心（SMC）评分、患者健康问卷-9 （PHQ-9）评分和患者报告的HRQoL总体评分变化评分，随后在两周和一个月的随访中每两天评估一次。MICs是根据患者报告改善最小的第一次随访来确定的。结果纳入的112例患者中位年龄为62.8岁（IQR: 56.6-69.3），中位病程为10年（IQR: 4-17）。HFS-30和HFS-7问卷的MICs分别为- 4.55分（95% CI: - 5.49 ~ - 3.62）和- 0.96分（95% CI: - 1.28 ~ - 0.64）。中度至重度抑郁症患者报告的MICs显著高于轻度抑郁症患者(p <；0.001)。60岁以下患者的mic显著高于老年患者（p = 0.045）。结论HFS-30问卷和HFS-7问卷的MICs分别为- 4.55和- 0.96。中度至重度抑郁症和年龄较小的HFS患者的MIC明显更高。

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引用次数: 0

Correlation analyses between MIBG myocardial scintigraphy and monoamine levels in dementia with Lewy bodies show potential link with the serotonergic system

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100346

Annelies Heylen , Yannick Vermeiren , Sebastiaan Engelborghs , Frank Van Acker , Peter Paul De Deyn , Debby Van Dam

Setting

Dementia with Lewy bodies (DLB) remains poorly understood and frequently misdiagnosed, complicated by co-pathology with other dementia forms. DLB patients often present with autonomic dysfunction and peripheral Lewy body pathology alongside central lesions. Monoaminergic neurotransmitter systems seem an early target for DLB pathology, especially the noradrenergic system. Noradrenaline analogue ¹²³I-metaiodobenzylguanidine (MIBG) is considered an indicative biomarker for peripheral noradrenergic sympathetic denervation.

Objectives

Our aim was to measure paired monoaminergic levels and MIBG scintigraphy values in DLB patients, exploring a possible link between noradrenergic neurotransmission and peripheral denervation.

Design

44 patients with a possible DLB diagnosis entered the study. Peripheral uptake of ¹²³I-MIBG was determined by the heart-to-mediastinum (H/M) ratio, as a measure for noradrenergic sympathetic denervation. In cerebrospinal fluid (CSF), serum and plasma samples, monoamines ((nor)adrenaline ((N)A), 5-hydroxytryptamin (5-HT, serotonin), dopamine (DA)) and respective metabolites (3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC)), were measured by means of reversed-phase ultrahigh-performance liquid chromatography with electrochemical detection.

Results

We found significant correlations between the H/M ratio and serum 5-HIAA, plasma 5-HT, plasma 5-HIAA/5-HT and plasma HVA/5-HIAA, but no further correlations with the noradrenergic system. CSF-serum MHPG, CSF-serum DOPAC, CSF-serum HVA, CSF-plasma MHPG, CSF plasma NA, CSF-plasma DOPAC, CSF-plasma MHPG/NA and CSF-plasma DOPAC/DA were significantly correlated.

Conclusions

These results show an association between the H/M ratio and serotonergic system, but not between peripheral noradrenergic denervation and circulating noradrenergic levels.

路易体痴呆（DLB）仍然知之甚少，经常被误诊，并与其他形式的痴呆合并病理。DLB患者常表现为自主神经功能障碍和外周路易体病理伴中枢病变。单胺能神经递质系统似乎是DLB病理的早期目标，特别是去甲肾上腺素能系统。去甲肾上腺素类似物123I-metaiodobenzylguanidine （MIBG）被认为是外周去甲肾上腺素能交感神经去神经的指示性生物标志物。我们的目的是测量DLB患者的单胺能水平和MIBG成像值，探索去甲肾上腺素能神经传递和周围神经断连之间的可能联系。44例可能诊断为DLB的患者进入研究。外周123I-MIBG的摄取通过心脏与纵隔（H/M）比率来测定，作为去肾上腺素能交感神经断神经的测量。采用电化学反相超高效液相色谱法测定脑脊液（CSF）、血清和血浆样品中的单胺（肾上腺素（N)A）、5-羟色胺（5-HT、5-羟色胺）、多巴胺（DA））及其代谢物（3-甲氧基-4-羟基苯基乙二醇（MHPG）、5-羟基吲哚乙酸（5-HIAA）、高香兰酸（HVA）和3,4-二羟基苯基乙酸（DOPAC））。结果H/M比值与血清5-HIAA、血浆5-HT、血浆5-HIAA/5-HT、血浆HVA/5-HIAA呈显著相关，与去甲肾上腺素能系统无显著相关性。CSF-血清MHPG、CSF-血清DOPAC、CSF-血清HVA、CSF-血浆MHPG、CSF-血浆NA、CSF-血浆DOPAC、CSF-血浆MHPG/NA和CSF-血浆DOPAC/DA呈显著相关。结论H/M比值与血清素能系统有关，而与外周去甲肾上腺素能神经支配和循环去甲肾上腺素能水平无关。

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引用次数: 0

Integrating tele-palliative care for atypical Parkinsonian disorders: Lessons learned from a pilot program 整合非典型帕金森病的远程姑息治疗：从试点项目中吸取的经验教训

IF 1.9 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100352

Mitra Afshari , Kyurim Kang , Ankur A. Butala , Jana Guenther , Rab Razzak , Maya Katz , Nicholas B. Galifianakis , Alexander Pantelyat

Introduction

As evidence supporting palliative care (PC) via tele-medicine for neurologic patients increases, it is important to determine the best integration methods across various healthcare settings and patient populations to optimize outcomes. Given the rising demand for PC in chronic neurodegenerative diseases like Atypical Parkinsonian Disorders (APDs), it is imperative to explore different models of PC delivery for feasibility and effectiveness.

Methods

Participants with APDs and their care partners at the University of California, San Francisco (UCSF) and Johns Hopkins University (JHU) received 2 virtual telemedicine PC sessions (at baseline and 6 months). Adherence and feasibility-related outcomes were assessed using a satisfaction survey developed by the investigators, using a five-point Likert scale, administered at baseline and 6 months. Additionally, participants’ quality of life (QoL), mood, functional abilities, and care partner burden were assessed at baseline and 6-month follow-up virtual visits.

Results

There was a 100 % attendance rate among participants and their care partners at both sites. Satisfaction levels regarding visit convenience were > 78 % for both visits at UCSF and reached 100 % at JHU. No significant differences were observed between baseline and 6-month assessments at both sites in QoL, mood, or caregiver burden. However, there was a significant decrease in functional abilities during the second visit (6 months) at JHU.

Conclusion

These results support the integration and expansion of telemedicine PC services to address the evolving needs of individuals with APDs and their care partners, offering a viable solution to enhance access to PC in diverse healthcare settings.

随着支持神经系统患者通过远程医疗进行姑息治疗（PC）的证据越来越多，确定跨各种医疗环境和患者群体的最佳整合方法以优化结果非常重要。鉴于非典型帕金森病（APDs）等慢性神经退行性疾病对PC的需求日益增加，探索不同的PC给药模式的可行性和有效性势在必行。方法加州大学旧金山分校（UCSF）和约翰霍普金斯大学（JHU）的apd患者及其护理伙伴接受2次虚拟远程医疗PC会议（基线和6个月）。依从性和可行性相关结果使用由研究者开发的满意度调查进行评估，使用五点李克特量表，在基线和6个月进行。此外，在基线和6个月的虚拟随访中评估参与者的生活质量（QoL）、情绪、功能能力和护理伙伴负担。结果在两个地点，参与者及其护理伙伴的出勤率均为100%。对就诊便利的满意度分别为>；在加州大学旧金山分校的两次访问都是78%在约翰霍普金斯大学是100%在两个地点的基线和6个月评估中，在生活质量、情绪或照顾者负担方面没有观察到显著差异。然而，在JHU的第二次访问（6个月）期间，功能能力明显下降。结论这些结果支持远程医疗PC服务的整合和扩展，以满足apd患者及其护理伙伴不断变化的需求，为增强不同医疗环境中PC的访问提供了可行的解决方案。

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引用次数: 0

Clinical measures associated with aspiration risk in multiple system atrophy: a cross-sectional study 与多系统萎缩患者误吸风险相关的临床措施：一项横断面研究

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100401

Jun Tanimura , Toshiyuki Yamamoto , Yuji Takahashi

Introduction

Identifying clinical measures associated with aspiration risk is crucial for guiding clinical decisions in patients with multiple system atrophy (MSA). We investigated whether basic clinical measures—including the Barthel index (BI), Unified MSA Rating Scale (UMSARS), and dopamine transporter single-photon emission computed tomography imaging (DaT imaging)—are associated with aspiration risk in patients with MSA.

Methods

This cross-sectional, single-center study analyzed patients with MSA who underwent videofluoroscopic swallowing examinations (VF) and DaT imaging within 12 months of each other. Clinical measures were assessed within 3 months of VF. Patients were categorized into aspiration and non-aspiration groups based on VF findings. Multivariable modified Poisson regression and receiver operating characteristic (ROC) analyses were performed to explore the associations between clinical measures and aspiration, and their discriminative ability.

Results

Among 105 patients with MSA (58 females; median age: 63 years [range: 43–87 years]), 28 (26.7 %) showed aspiration on VF. The aspiration group showed significantly lower BI and higher UMSARS scores than the non-aspiration group. In multivariable regression analyses, BI was consistently and significantly associated with aspiration across all models. ROC analysis demonstrated moderate discriminative ability both BI (AUC 0.77, 95 %CI 0.66–0.87) and UMSARS (AUC 0.73, 95 %CI 0.63–0.83) for aspiration, with overlapping confidence intervals. The association was particularly notable for the parkinsonian MSA subtype.

Conclusion

The BI shows potential as a clinical marker of aspiration risk in MSA, particularly in the parkinsonian subtype, which may help guide the timing of swallowing assessments even in the absence of overt dysphagia symptoms.

识别与误吸风险相关的临床措施对于指导多系统萎缩（MSA）患者的临床决策至关重要。我们调查了基本的临床指标——包括Barthel指数（BI）、统一MSA评定量表（UMSARS）和多巴胺转运蛋白单光子发射计算机断层成像（DaT成像）——是否与MSA患者的误吸风险相关。方法本研究是一项横断面、单中心研究，分析了在12个月内分别接受了影像透视吞咽检查（VF）和DaT成像的MSA患者。临床措施在VF后3个月内进行评估。根据VF结果将患者分为抽吸组和非抽吸组。采用多变量修正泊松回归和受试者工作特征（ROC）分析来探讨临床措施与误吸之间的关系及其判别能力。结果105例MSA患者（女性58例，中位年龄63岁[43 ~ 87岁]）中，28例（26.7%）出现VF误吸。吸入组BI明显低于非吸入组，UMSARS评分明显高于非吸入组。在多变量回归分析中，BI与所有模型的期望一致且显著相关。ROC分析显示BI （AUC 0.77, 95% CI 0.66-0.87）和UMSARS （AUC 0.73, 95% CI 0.63-0.83）对误吸的判别能力中等，置信区间重叠。这种关联在帕金森MSA亚型中尤为显著。结论BI可作为MSA患者，特别是帕金森亚型患者误吸风险的临床指标，即使在没有明显吞咽困难症状的情况下，也可用于指导吞咽评估的时机。

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引用次数: 0

Advance care planning in Hispanic populations with Parkinson’s Disease: Investigating disparities in end-of life care 西班牙裔帕金森氏病患者的预先护理计划：调查临终护理的差异

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100388

Taylor Peabody , Monica Abou-Ezzi , Lucila Hernandez , Henry Moore , Silvia Vargas-Parra , Alberto Cruz , Danielle S. Shpiner

Introduction

Advance care planning (ACP) is a tool for optimizing end-of-life care and is an important aspect of healthcare for people with Parkinson’s disease (PD). However, there may be disparities in access to ACP based on race and/or ethnicity.

Methods

We conducted a cross-sectional survey of people with PD and care partners from a diverse academic Movement Disorders clinic regarding familiarity with ACP and sociodemographic factors. We compared prior experiences with ACP, with a primary outcome examining prior completion of healthcare power of attorney (HPOA) and advance directives (AD) among Hispanics and non-Hispanics in the cohort. Univariate analysis was utilized to compare cohort demographics. A multinomial logistic regression was performed to control for possible confounders.

Results

250 participants completed the survey, including 116 (46.4 %) who self-identified as Hispanic and 127 (50.8 %) non-Hispanic. Only 20 % of Hispanic participants had previously completed HPOA documentation versus 66.9 % non-Hispanics (p < 0.001). The rates of completion for AD were 6.1 % and 31.7 %, respectively (p < 0.001). Hispanic respondents were less likely to have heard about these documents and more likely to wait until later in the disease course to discuss ACP, despite a majority viewing these discussions as important. These trends remained when controlling for several demographic variables; however, age and preferred language of survey emerged as potential confounders for some answer choices.

Conclusions

Hispanic people with PD may be less likely to utilize ACP than their non-Hispanic counterparts. Awareness of these resources or cultural factors may play a role and should be explored further in future studies.

提前护理计划（ACP）是一种优化临终关怀的工具，是帕金森病（PD）患者医疗保健的重要方面。然而，根据种族和/或族裔，在获得非加太待遇方面可能存在差异。方法：我们对来自不同学术运动障碍诊所的PD患者和护理伙伴进行了一项关于ACP熟悉程度和社会人口因素的横断面调查。我们比较了该队列中西班牙裔和非西班牙裔患者之前接受ACP治疗的经历，主要结局是检查他们之前是否完成了医疗授权书（HPOA）和预先指示（AD）。采用单变量分析比较队列人口统计学特征。进行多项逻辑回归以控制可能的混杂因素。结果250名参与者完成了调查，其中116人（46.4%）自认为是西班牙裔，127人（50.8%）非西班牙裔。只有20%的西班牙裔参与者之前完成了HPOA文件，而非西班牙裔参与者的这一比例为66.9% (p <；0.001)。AD的完成率分别为6.1%和31.7% (p <；0.001)。西班牙裔受访者不太可能听说过这些文件，更有可能等到疾病过程的后期才讨论ACP，尽管大多数人认为这些讨论很重要。在控制了几个人口变量后，这些趋势仍然存在；然而，年龄和首选的调查语言成为一些答案选择的潜在混杂因素。结论西班牙裔PD患者使用ACP的可能性低于非西班牙裔患者。对这些资源或文化因素的认识可能起作用，应在未来的研究中进一步探讨。

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引用次数: 0

A single Center study of the Symbol Digit Modalities test as a screening tool for cognitive impairment in Parkinson’s disease 符号数字模态测试作为帕金森病认知障碍筛查工具的单中心研究

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100395

Daniyell Thomason , Morganne Manuel , Shannin Moody , Jesus Lovera , Brain Copeland , Deidre Devier

Background

Parkinson’s Disease (PD) can include physical signs and possibly cognitive impairment, resulting from the convergence of pathological processes involving dopaminergic dysfunction, accumulation of alpha-synuclein, cholinergic deficits, and disruption of other neurotransmitter systems. We used screening tests to evaluate the characteristics of cognitive performance in patients with PD and to assess their validity compared to the Montreal Cognitive Assessment (MoCA).

Methods

This is a natural history study of participants with PD and controls screened for possible cognitive impairment using the MoCA, Symbol Digit Modalities Test (SDMT), and King-Devick (KD). The groups were compared on performance and then factors associated with cognitive performance (age, diagnosis, and level of education) were analyzed to determine which best predicted test scores.

Results

SDMT scores were lower in the PD group (Mean = 36.7 ± 12.4) compared to controls (Mean = 47.2 ± 11.0, p < 0.001), but the MoCA (PD = 23.8 ± 3.5; Control = 25.5 ± 3.6, p = 0.02) and KD (PD = 70.1 ± 23.4 s; Control = 61.6 ± 17.5, p = 0.048) did not differentiate between groups after controlling for multiple comparisons. Age and diagnosis predicted SDMT raw scores and, as expected, only diagnosis remained significant after calculating T-scores based on published test norms. Age, education, and diagnosis predicted MoCA scores.

Conclusions

The SDMT emerged as a promising screening tool to detect cognitive impairment in PD. The test’s age and education corrected norms controlled for those variables and left diagnosis as the only predictor of performance. The MoCA scores were predicted by age, education, and diagnosis suggesting the education correction of the MoCA did not fully account for the influence of demographic variables.

帕金森氏病（PD）可包括身体体征和可能的认知障碍，由涉及多巴胺能功能障碍、α -突触核蛋白积累、胆碱能缺陷和其他神经递质系统破坏的病理过程的趋同引起。我们使用筛选试验来评估帕金森病患者的认知表现特征，并将其与蒙特利尔认知评估（MoCA）相比较，评估其有效性。方法：这是一项PD患者和对照组的自然史研究，通过MoCA、符号数字模态测试（SDMT）和King-Devick （KD）筛查可能的认知障碍。比较各组的表现，然后分析与认知表现相关的因素（年龄、诊断和教育水平），以确定哪一个最能预测考试成绩。结果PD组ssdmt评分（Mean = 36.7±12.4）低于对照组（Mean = 47.2±11.0,p < 0.001），但MoCA （PD = 23.8±3.5;Control = 25.5±3.6,p = 0.02）和KD （PD = 70.1±23.4 s; Control = 61.6±17.5,p = 0.048）经多重对照后，组间无显著差异。年龄和诊断预测了SDMT的原始分数，正如预期的那样，在根据公布的测试规范计算t分数后，只有诊断仍然显著。年龄、教育程度和诊断预测MoCA评分。结论SDMT是一种很有前景的PD认知功能障碍筛查工具。测试的年龄和受教育程度校正标准控制了这些变量，并将诊断作为表现的唯一预测因素。MoCA分数是由年龄、教育程度和诊断来预测的，这表明MoCA的教育校正并没有完全考虑人口变量的影响。

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引用次数: 0

Speech subtypes are associated with worsened tremor and axial symptoms in Parkinson’s disease patients 言语亚型与帕金森病患者恶化的震颤和轴向症状相关

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100373

Vanessa Brzoskowski dos Santos , Rafaela Ravazio , Daniel Teixeira-dos-Santos , Artur Francisco Schumacher Schuh , Christian Mattjie , Joana M. Pasquali , Mauricia Denise de Borba , Rodrigo C Barros , Maira Rozenfeld Olchik

Background

Parkinson’s disease (PD) is a heterogeneous disorder, suggesting the presence of distinct subtypes. Speech data, though easy to collect, remains underutilized in subtyping PD.

Methods

Cross-sectional study with PD patients recruited from the Movement Disorders Outpatient Clinic of the Neurology Service at the University Hospital in Porto Alegre, Brazil. We included participants diagnosed with idiopathic PD and excluded participants with other disorders that could affect speech. Clinical and sociodemographic data were collected alongside MDS-UPDRS Parts II and III motor assessments. Tremor and gait-posture scores were derived from specific MDS-UPDRS items, with additional data on Deep Brain Stimulation (DBS) status and Levodopa Equivalent Daily Dose (LEDD). The tasks diadochokinesis (DDK) and monologue were recorded and acoustically analyzed using software. We compared our identified clusters using clinical data through an analysis of covariance adjusted for age, sex, and disease duration.

Results

Ninety individuals with PD were included, with 61.2 (± 9.4) years old, 13.6 (± 6.6) disease duration, and 47.6 (± 10) age at onset. We identified three speech groups with strong separation between them, comprising 49 (mild), 13 (moderate), and 29 (severe) patients. Tremor and postural-gait stability scores differed significantly across the three clusters, with cluster 3 exhibiting higher tremor (13.42 ± 10.66 vs. 7.09 ± 6.62, p = 0.020) and greater postural-gait instability (10.25 ± 6.69 vs. 5.46 ± 4.91, p = 0.009) than cluster 1. These differences weren’t explainable by distinct age, sex, or disease duration.

Conclusion

Our speech-based clustering algorithm effectively differentiated Parkinson’s disease subtypes in this sample, identifying distinct groups based on tremor and axial symptoms.

背景：帕金森病（PD）是一种异质性疾病，表明存在不同的亚型。语音数据虽然易于收集，但在PD亚型中仍未得到充分利用。方法对来自巴西阿雷格里港大学医院神经内科运动障碍门诊的PD患者进行横断面研究。我们纳入了诊断为特发性PD的参与者，排除了可能影响言语的其他疾病的参与者。临床和社会人口学数据与MDS-UPDRS第二部分和第三部分的运动评估一起收集。震颤和步态姿势评分来源于特定的MDS-UPDRS项目，以及深部脑刺激（DBS）状态和左旋多巴当量日剂量（LEDD）的额外数据。录音并利用软件进行声音分析。通过对年龄、性别和疾病持续时间进行协方差分析，我们比较了临床数据。结果纳入PD患者90例，年龄61.2（±9.4）岁，病程13.6（±6.6）岁，发病年龄47.6（±10）岁。我们确定了三个语音组之间有很强的分离，包括49例（轻度），13例（中度）和29例（重度）患者。地震和postural-gait稳定得分显著不同三个集群,集群3表现出更高的地震(13.42 ±10.66 vs 7.09  ± 6.62,p = 0.020)和大postural-gait不稳定(10.25 ± 6.69 vs 5.46 ± 4.91,p = 0.009)比集群1。这些差异不能用不同的年龄、性别或疾病持续时间来解释。结论基于语音的聚类算法有效地区分了该样本中帕金森病的亚型，根据震颤和轴向症状识别出不同的组。

{"title":"Speech subtypes are associated with worsened tremor and axial symptoms in Parkinson’s disease patients","authors":"Vanessa Brzoskowski dos Santos , Rafaela Ravazio , Daniel Teixeira-dos-Santos , Artur Francisco Schumacher Schuh , Christian Mattjie , Joana M. Pasquali , Mauricia Denise de Borba , Rodrigo C Barros , Maira Rozenfeld Olchik","doi":"10.1016/j.prdoa.2025.100373","DOIUrl":"10.1016/j.prdoa.2025.100373","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD) is a heterogeneous disorder, suggesting the presence of distinct subtypes. Speech data, though easy to collect, remains underutilized in subtyping PD.</div></div><div><h3>Methods</h3><div>Cross-sectional study with PD patients recruited from the Movement Disorders Outpatient Clinic of the Neurology Service at the University Hospital in Porto Alegre, Brazil. We included participants diagnosed with idiopathic PD and excluded participants with other disorders that could affect speech. Clinical and sociodemographic data were collected alongside MDS-UPDRS Parts II and III motor assessments. Tremor and gait-posture scores were derived from specific MDS-UPDRS items, with additional data on Deep Brain Stimulation (DBS) status and Levodopa Equivalent Daily Dose (LEDD). The tasks diadochokinesis (DDK) and monologue were recorded and acoustically analyzed using software. We compared our identified clusters using clinical data through an analysis of covariance adjusted for age, sex, and disease duration.</div></div><div><h3>Results</h3><div>Ninety individuals with PD were included, with 61.2 (± 9.4) years old, 13.6 (± 6.6) disease duration, and 47.6 (± 10) age at onset. We identified three speech groups with strong separation between them, comprising 49 (mild), 13 (moderate), and 29 (severe) patients. Tremor and postural-gait stability scores differed significantly across the three clusters, with cluster 3 exhibiting higher tremor (13.42 ± 10.66 vs. 7.09 ± 6.62, p = 0.020) and greater postural-gait instability (10.25 ± 6.69 vs. 5.46 ± 4.91, p = 0.009) than cluster 1. These differences weren’t explainable by distinct age, sex, or disease duration.</div></div><div><h3>Conclusion</h3><div>Our speech-based clustering algorithm effectively differentiated Parkinson’s disease subtypes in this sample, identifying distinct groups based on tremor and axial symptoms.</div></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":"13 ","pages":"Article 100373"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721806","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

Validation of the English version of the Parkinson Anxiety Scale in two Canadian Parkinson’s disease samples 帕金森焦虑量表英文版在两个加拿大帕金森病样本中的验证

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.prdoa.2025.100387

Joyce S.T. Lam , Kira N. Tosefsky , Xuyan Tang , Dylan Meng , Petra Uzelman , Fabricio Pio , Nicholas J. Ainsworth , Fidel Vila-Rodriguez , Andrew K. Howard , Silke Appel-Cresswell

Introduction

The 12-item Parkinson Anxiety Scale (PAS) assesses the severity of anxiety symptoms in people with Parkinson’s disease (PwP). However, psychometric evidence supporting the English self-rated PAS remains largely limited to validation studies by the developers. This study aimed to reinforce validation of this scale through a comprehensive psychometric evaluation in PwP in Canada.

Methods

Data were drawn from two Canadian samples of 130 and 53 PwP, respectively, at a tertiary center. Acceptability, reliability, validity, and factor structure were assessed. The Mini International Neuropsychiatric Interview was administered to confirm anxiety diagnoses. Optimal cut-off scores suggesting the presence of an anxiety disorder were determined using receiver operating characteristic (ROC) curve analysis.

Results

The PAS and its three subscales demonstrated good acceptability and internal consistency reliability (Cronbach’s α > 0.70). Good convergent validity with the State-Trait Anxiety Inventory and divergent validity with scales assessing other non-motor symptoms were obtained. Confirmatory factor analysis supported the three-factor structure (comparative fit index = 0.987; Tucker-Lewis index = 0.983; root mean square error of approximation = 0.083; standardized root mean square residual = 0.087). Optimal cut-off scores were 12.5 for the total PAS (area under the ROC curve = 0.81, sensitivity = 0.89, specificity = 0.58), 8.5 for the persistent anxiety subscale, and 2.5 for the episodic anxiety and avoidance behavior subscales. Approximately 22 % of participants in the larger sample had a diagnosed anxiety disorder.

Conclusion

The English self-rated PAS is a valid and reliable instrument for screening and assessing severity and dimensions of anxiety in PwP.

12项帕金森焦虑量表（PAS）评估帕金森病患者（PwP）焦虑症状的严重程度。然而，支持英语自评PAS的心理测量学证据在很大程度上仍然局限于开发者的验证研究。本研究旨在通过对加拿大PwP患者进行全面的心理测量评估来加强该量表的有效性。方法数据分别取自加拿大某三级医疗中心的130和53个PwP样本。评估可接受性、信度、效度及因子结构。迷你国际神经精神病学访谈被用来确认焦虑症的诊断。使用受试者工作特征（ROC）曲线分析确定提示存在焦虑障碍的最佳截止分数。结果PAS及其三个分量表具有良好的可接受性和内部一致性信度(Cronbach’s α >；0.70)。与状态-特质焦虑量表有较好的收敛效度，与其他非运动症状量表有较好的发散效度。验证性因子分析支持三因素结构(比较拟合指数= 0.987；Tucker-Lewis指数= 0.983；近似均方根误差= 0.083；标准化均方根残差= 0.087)。总PAS的最佳分值为12.5分（ROC曲线下面积= 0.81，敏感性= 0.89，特异性= 0.58），持续焦虑量表为8.5分，情景性焦虑和回避行为量表为2.5分。在更大的样本中，大约22%的参与者被诊断为焦虑症。结论英文自评PAS是一种有效、可靠的筛查和评估PwP患者焦虑程度和维度的工具。

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引用次数: 0