(Monday, 30 June 2008) - Contributed by Sang-Myung Cheona, Min-Soo Hab, Min Jeong Parka and Jae Woo Kima
Abstract
The aim of this study was to explore the prevalence of nonmotor symptoms in Parkinson's disease (PD) and the patients’ and family members’ awareness of these symptoms. We evaluated 74 parkinsonian patients and 54 family members.
Seventy-three patients had more than one symptom (12.4±5.5 out of 30 symptoms on average). Nocturia was the most common in men and feeling sad in women. The average number of symptoms which patients knew to be related to PD was 5.2±6.8 and to family members 7.7±6.5. Twenty-eight patients and five family members were unaware of the
relationship between any of these symptoms and PD. For PD to be properly managed, nonmotor symptoms should be comprehensively assessed and patients and families informed that these are associated with PD.
Parkinsonism & Related Disorders
Volume 14, Issue 4, May 2008, Pages 286-290.
Tuesday, December 2, 2008
Functional balance performance in patients with Parkinson's disease after long-term treatment...
(Monday, 30 June 2008) - Contributed by M.H. Nilssona, b, , , G.-B. Jarnlob and S. Rehncrona
Abstract
The aim was to investigate if functional balance performance in patients with Parkinson's disease (PD) was affected by long-term (3 years) treatment with bilateral subthalamic nucleus (STN) high-frequency stimulation. Thirty-five patients were consecutively included, and 28 patients completed the study (mean age 62 years, SD 6.5). The Berg Balance Scale (BBS) was assessed preoperatively and 1 and 3 years postoperatively (with and without anti-PD medication and with the STN stimulation turned OFF or ON). Although the balance performance of patients with PD decreased over time, the functional balance performance was still positively affected by STN stimulation alone 3 years after surgery.
Parkinsonism & Related Disorders
Volume 14, Issue 4, May 2008, Pages 291-297
Abstract
The aim was to investigate if functional balance performance in patients with Parkinson's disease (PD) was affected by long-term (3 years) treatment with bilateral subthalamic nucleus (STN) high-frequency stimulation. Thirty-five patients were consecutively included, and 28 patients completed the study (mean age 62 years, SD 6.5). The Berg Balance Scale (BBS) was assessed preoperatively and 1 and 3 years postoperatively (with and without anti-PD medication and with the STN stimulation turned OFF or ON). Although the balance performance of patients with PD decreased over time, the functional balance performance was still positively affected by STN stimulation alone 3 years after surgery.
Parkinsonism & Related Disorders
Volume 14, Issue 4, May 2008, Pages 291-297
A questionnaire-based (UM-PDHQ) study of hallucinations in Parkinson's disease
(Friday, 20 June 2008) - Contributed by Spiridon Papapetropoulos et al.
Hallucinations occur in 20-40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing
home placement, increased mortality). Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice.
So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ) that allows comprehensive assessment of hallucinations in clinical or research settings.
Methods: The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period.
The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons. Results and Discussion: Seventy consecutive PD patients were included in the analyses.
Thirty-one (44.3%) were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE) between hallucinators and non-hallucinators.
Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2) whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles.
Conclusions: Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort.
Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations.
Author: Spiridon Papapetropoulos, Heather Katzen, Anette Schrag, Carlos Singer, Blake K Scanlon, Daniel Nation,
AlexandraGuevara and Bonnie Levin
Credits/Source: BMC Neurology 2008, 8:21
Hallucinations occur in 20-40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing
home placement, increased mortality). Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice.
So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ) that allows comprehensive assessment of hallucinations in clinical or research settings.
Methods: The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period.
The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons. Results and Discussion: Seventy consecutive PD patients were included in the analyses.
Thirty-one (44.3%) were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE) between hallucinators and non-hallucinators.
Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2) whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles.
Conclusions: Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort.
Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations.
Author: Spiridon Papapetropoulos, Heather Katzen, Anette Schrag, Carlos Singer, Blake K Scanlon, Daniel Nation,
AlexandraGuevara and Bonnie Levin
Credits/Source: BMC Neurology 2008, 8:21
Fatigue in Parkinson's disease is not related to excessive sleepiness or quality of sleep
(Wednesday, 18 June 2008) - Contributed by Eva Havlikovaa et al.
Abstract
Objectives
Many patients with Parkinson's disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled for age, gender and disease duration.
Methods
The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8 ± 8.7, mean disease duration 7.2 ± 6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data.
Results
Sleepiness did not show significant association with fatigue in any of the fatigue domains; neither did quality of sleep. Depression was significantly associated with all domains of fatigue, the strongest being the relationship with general fatigue (2 .42), reduced motivation (2 .39), mental fatigue (2 .35) (p < .001), and physical fatigue (2 .31) (p < .01), while the relationship with reduced activity was less strong (2 .22) (p < .05). Worse functional status was significantly related to
reduced activity (2 .50), general fatigue (2 .35), physical fatigue (2 .35), and mental fatigue (2 .35) (p < .001).
Conclusion
Fatigue is not related to daytime sleepiness or night-time sleep dysfunction. Fatigue is more strongly influenced by the presence of depression and worse functional status.
Journal of the Neurological Sciences
Volume 270, Issues 1-2, 15 July 2008, Pages 107-113
Abstract
Objectives
Many patients with Parkinson's disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled for age, gender and disease duration.
Methods
The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8 ± 8.7, mean disease duration 7.2 ± 6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data.
Results
Sleepiness did not show significant association with fatigue in any of the fatigue domains; neither did quality of sleep. Depression was significantly associated with all domains of fatigue, the strongest being the relationship with general fatigue (2 .42), reduced motivation (2 .39), mental fatigue (2 .35) (p < .001), and physical fatigue (2 .31) (p < .01), while the relationship with reduced activity was less strong (2 .22) (p < .05). Worse functional status was significantly related to
reduced activity (2 .50), general fatigue (2 .35), physical fatigue (2 .35), and mental fatigue (2 .35) (p < .001).
Conclusion
Fatigue is not related to daytime sleepiness or night-time sleep dysfunction. Fatigue is more strongly influenced by the presence of depression and worse functional status.
Journal of the Neurological Sciences
Volume 270, Issues 1-2, 15 July 2008, Pages 107-113
Efficacy of long-term continuous subcutaneousapomorphine infusion in advanced Parkinson's disease
(Monday, 16 June 2008) - Contributed by Pedro J. García Ruiz MD et al.
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long- term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 ± 11.07; disease duration, 14.39 ± 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 ± 16.3 months. Mean daily dose of CSAI was 72.00 ± 21.38 mg run over 14.05 ± 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 ± 3.09 vs. 1.36 ± 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 ± 536.7 vs. 800.1 ± 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.
Continuous subcutaneous apomorphine infusion (CSAI) is, at present, an alternative option for advanced Parkinson's disease (PD) with motor fluctuations. We studied the evolution of patients with PD and severe motor fluctuations long- term treated with CSAI. We reviewed data from 82 patients with PD (mean age, 67 ± 11.07; disease duration, 14.39 ± 5.7 years) and severe motor fluctuations referred to 35 tertiary hospitals in Spain. These patients were long-term treated (for at least 3 months) with CSAI and tolerated the procedure without serious side effects. We compared the baseline data of these 82 patients (before CSAI) with those obtained from the last follow-up visit of each patient. The mean follow-up of CSAI was 19.93 ± 16.3 months. Mean daily dose of CSAI was 72.00 ± 21.38 mg run over 14.05 ± 1.81 hours. We found a statistically significant reduction in off-hours, according to self-scoring diaries (6.64 ± 3.09 vs. 1.36 ± 1.42 hours/day, P < 0.0001), total and motor UPDRS scores (P < 0.0001), dyskinesia severity (P < 0.0006), and equivalent dose of antiparkinsonian therapy (1,405 ± 536.7 vs. 800.1 ± 472.9 mg of levodopa equivalent units P < 0.0001). CSAI is an effective option for patients with PD and severe fluctuations, poorly controlled by conventional oral drug treatment.
Treadmill walking in Parkinson's disease patients: Adaptation and generalization effect
(Monday, 16 June 2008) - Contributed by Olalla Bello BSc, Jose A.Sanchez PhD, Miguel Fernandez-del-Olmo PhD
We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinson's disease (PD) with different degrees of disease severity. Eight moderate PD patients (Hoehn and Yahr stage 2-2.5), eight advanced PD patients (Hoehn and Yahr 3), and eight matched control subjects participated in this study. Subjects first walked overground on a 10-m walkway at a self-selected speed (pretreadmill). They then performed a 20-min treadmill training session, followed by three trials of overground walking (Post1, Post2, Post3). Cadence, step length, speed, and coefficient of variation of stride time (CV) were recorded. During the treadmill session the advanced PD patients significantly decreased their cadence (t = 3.9, P 0.01) and increased their step length (t = 4.27, P 0.01) compared with pretreadmill walking. After the treadmill, all subjects walked overground significantly faster (F = 16.51 P 0.001) and with a larger step length (F = 13.03 P 0.01) than pretreadmill walking. The present study shows a specific adaptation to walk over the treadmill for the advanced PD patients. Moreover, this confirms the potential therapeutic use of the treadmill for PD gait rehabilitation since a single familiarization session lead to an increase in the step length and thus to the improvement of the main gait impairment in PD.
We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinson's disease (PD) with different degrees of disease severity. Eight moderate PD patients (Hoehn and Yahr stage 2-2.5), eight advanced PD patients (Hoehn and Yahr 3), and eight matched control subjects participated in this study. Subjects first walked overground on a 10-m walkway at a self-selected speed (pretreadmill). They then performed a 20-min treadmill training session, followed by three trials of overground walking (Post1, Post2, Post3). Cadence, step length, speed, and coefficient of variation of stride time (CV) were recorded. During the treadmill session the advanced PD patients significantly decreased their cadence (t = 3.9, P 0.01) and increased their step length (t = 4.27, P 0.01) compared with pretreadmill walking. After the treadmill, all subjects walked overground significantly faster (F = 16.51 P 0.001) and with a larger step length (F = 13.03 P 0.01) than pretreadmill walking. The present study shows a specific adaptation to walk over the treadmill for the advanced PD patients. Moreover, this confirms the potential therapeutic use of the treadmill for PD gait rehabilitation since a single familiarization session lead to an increase in the step length and thus to the improvement of the main gait impairment in PD.
A pilot study into the effect of vocal exercises and singing on dysarthric speech
(Friday, 13 June 2008) - Contributed by Jeanette Tamplin
Abstract
This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor
respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment – the Sentence Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-treatment and a reduction in the number and length of pauses was verified via waveform analysis. Preliminary findings suggest that a program of vocal exercises and singing may facilitate more normative speech production for people with acquired dysarthria and support the need for further research in this area.
NeuroRehab. V. 23 N.3 2008
Abstract
This pilot study aimed to investigate the effects of vocal exercises and singing on intelligibility and speech naturalness for subjects with acquired dysarthria following traumatic brain injury or stroke. A multiple case study design was used, involving pre, mid, and post-treatment assessments of intelligibility, rate, naturalness, and pause time for four subjects with dysarthria. Each subject participated in 24 individual music therapy sessions over eight weeks involving oral motor
respiratory exercises, rhythmic and melodic articulation exercises, rhythmic speech cuing, vocal intonation therapy, and therapeutic singing using familiar songs. Results were measured using a standardized dysarthric speech assessment – the Sentence Intelligibility Test, waveform analysis, and ratings of speech naturalness. Statistically significant improvements in functional speech intelligibility were achieved but improvements in rate of speech were not significant. Speech naturalness improved post-treatment and a reduction in the number and length of pauses was verified via waveform analysis. Preliminary findings suggest that a program of vocal exercises and singing may facilitate more normative speech production for people with acquired dysarthria and support the need for further research in this area.
NeuroRehab. V. 23 N.3 2008
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