Journal of Parkinson's Disease - Volume 12, issue 8

Authors: Paschen, Steffen | Hansen, Clint | Welzel, Julius | Albrecht, Judith | Atrsaei, Arash | Aminian, Kamiar | Zeuner, Kirsten E. | Romijnders, Robbin | Warmerdam, Elke | Urban, Paul Peter | Berg, Daniela | Maetzler, Walter

Article Type: Research Article

Abstract: Background: Orthostatic hypotension (OH) in Parkinson’s disease (PD) is frequent and associated with impairments in quality of life and reduced activities of daily living. Abdominal binders (AB) and compression stockings (CS) have been shown to be effective non-pharmacological treatment options. Objective: Here, we investigate the effect of AB versus CS on physical activity using a digital mobility outcome (sit to stand [STS] frequency) collected in the usual environment as a primary endpoint. Methods: We enrolled 16 PD patients with at least moderate symptomatic OH. In a randomized, single-blinded, controlled, crossover design, participants were assessed without OH …treatment over 1 week (baseline), then were given AB or CS for 1 week and subsequently switched to the other treatment arm. The primary outcome was the number of real-life STS movements per hour as assessed with a lower back sensor. Secondary outcomes included real-life STS duration, mean/systolic/diastolic blood pressure drop (BPD), orthostatic hypotension questionnaire (OHQ), PD quality of life (PDQ-39), autonomic symptoms (SCOPA-AUT), non-motor symptoms (NMSS), MDS-UPDRS, and activities of daily living (ADL/iADL). Results: Real-life STS frequency on CS was 4.4±4.1 per hour compared with 3.6±2.2 on AB and 3.6±1.8 without treatment (p  = 1.0). Concerning the secondary outcomes, NMSS showed significant improvement with CS and AB. OHQ and SCOPA-AUT improved significantly with AB but not CS, and mean BPD drop worsened with CS but not AB. Mean STS duration, PDQ-39, MDS-UPDRS, ADL, and iADL did not significantly change. Conclusion: Both AB and CS therapies do not lead to a significant change of physical activity in PD patients with at least moderate symptomatic OH. Secondary results speak for an effect of both therapies concerning non-motor symptoms, with superiority of AB therapy over CS therapy. Show more

Keywords: Abdominal binder, compression stockings, orthostatic hypotension, Parkinson’s disease, sit-to-stand, blood pressure drop

DOI: 10.3233/JPD-223406

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2531-2541, 2022

Authors: Folkerts, Ann-Kristin | Haarmann, Lena | Nielsen, Jörn | Saliger, Jochen | Eschweiler, Mareike | Karbe, Hans | Allert, Niels | Vida, Viktoria | Trenkwalder, Claudia | Kruse, Annika | Oelsner, Henriette | Ebersbach, Georg | Kalbe, Elke

Article Type: Research Article

Abstract: Background: Fear of progression (FoP) is a reactive, conscious concern about chronic disease progression and its consequences which may limit quality of life substantially. Only one study has examined FoP in Parkinson’s disease (PD), showing the second highest FoP scores among chronic diseases. Objective: To examine FoP prevalence and to exploratorily analyze determinants of FoP in PD. Methods: Within a multicenter cross-sectional study, 120 PD inpatients (age: 64.45±9.20; 60.8% male; UPDRS-III: 28.86±16.12) were examined with the FoP questionnaire (FoP-Q; max. 20 points). Stepwise multiple linear regression analysis examined sociodemographic, clinical, and (neuro-) psychological determinants of FoP. …Results: With a mean FoP-Q score of 8.08±2.17, 63.0% of the patients were classified with moderate FoP and 17.6% with dysfunctional (i.e., severe) FoP. The highest scores were shown for the subscale ‘loss of autonomy’. Increased levels of anxiety, less self-efficacy, female gender, current employment, and lower health literacy were identified as significant determinants associated with FoP. Conclusion: With more than 80% of patients showing moderate to dysfunctional FoP, it must be regarded as a frequent symptom in PD, which needs to be further understood and addressed in clinical practice. Clinical parameters like PD duration and severity were no determinants for FoP, indicating that FoP awareness must be considered by professionals at all disease stages. Show more

Keywords: Parkinson’s disease, fear of progression, disease progression, anxiety, self-efficacy, health literacy, cross-sectional study

DOI: 10.3233/JPD-223314

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2543-2553, 2022

Authors: Doppler, Christopher E.J. | Smit, Julia | Hommelsen, Maximilian | Seger, Aline | Okkels, Niels | Horsager, Jacob | Kinnerup, Martin | Hansen, Allan K. | Fedorova, Tatyana D. | Knudsen, Karoline | Otto, Marit | Nahimi, Adjmal | Fink, Gereon R. | Borghammer, Per | Sommerauer, Michael

Article Type: Research Article

Abstract: Background: Although sleep disturbances are highly prevalent in patients with Parkinson’s disease, sleep macroarchitecture metrics show only minor changes. Objective: To assess alterations of the cyclic alternating pattern (CAP) as a critical feature of sleep microarchitecture in patients with prodromal, recent, and established Parkinson’s disease. Methods: We evaluated overnight polysomnography for classic sleep macroarchitecture and CAP metrics in 68 patients at various disease stages and compared results to 22 age- and sex-matched controls. Results: Already at the prodromal stage, patients showed a significantly reduced CAP rate as a central characteristic of sleep microarchitecture. Temporal …characteristics of CAP showed a gradual change over disease stages and correlated with motor performance. In contrast, the sleep macroarchitecture metrics did not differ between groups. Conclusion: Data suggest that alterations of sleep microarchitecture are an early and more sensitive characteristic of Parkinson’s disease than changes in sleep macroarchitecture. Show more

Keywords: REM sleep behavior disorder, Parkinson’s disease, cyclic alternating pattern, microsleep, polysomnography

DOI: 10.3233/JPD-223442

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2555-2560, 2022

Authors: Pavelka, Lukas | Rauschenberger, Armin | Landoulsi, Zied | Pachchek, Sinthuja | Marques, Taina | Gomes, Clarissa P.C. | Glaab, Enrico | May, Patrick | Krüger, Rejko

Article Type: Research Article

Abstract: Background: The hypothesis of body-first vs. brain-first subtype of PD has been proposed with REM-Sleep behavior disorder (RBD) defining the former. The body-first PD presumes an involvement of the brainstem in the pathogenic process with higher burden of autonomic dysfunction. Objective: To identify distinctive clinical subtypes of idiopathic Parkinson’s disease (iPD) in line with the formerly proposed concept of body-first vs. brain-first subtypes in PD, we analyzed the presence of probable RBD (pRBD), sex, and the APOE ɛ 4 carrier status as potential sub-group stratifiers. Methods: A total of 400 iPD …patients were included in the cross-sectional analysis from the baseline dataset with a completed RBD Screening Questionnaire (RBDSQ) for classifying as pRBD by using the cut-off RBDSQ≥6. Multiple regression models were applied to explore (i) the effect of pRBD on clinical outcomes adjusted for disease duration and age, (ii) the effect of sex on pRBD, and (iii) the association of APOE ɛ 4 and pRBD. Results: iPD-pRBD was significantly associated with autonomic dysfunction (SCOPA-AUT), level of depressive symptoms (BDI-I), MDS-UPDRS I, hallucinations, and constipation, whereas significantly negatively associated with quality of life (PDQ-39) and sleep (PDSS). No significant association between sex and pRBD or APOE ɛ4 and pRBD in iPD was found nor did we determine a significant effect of APOE ɛ4 on the PD phenotype. Conclusion: We identified an RBD-specific PD endophenotype, characterized by predominant autonomic dysfunction, hallucinations, and depression, corroborating the concept of a distinctive body-first subtype of PD. We did not observe a significant association between APOE ɛ4 and pRBD suggesting both factors having an independent effect on cognitive decline in iPD. Show more

Keywords: Idiopathic Parkinson’s disease, probable REM-Sleep behavior disorder, RBDSQ, non-motor symptoms, APOE, stratification

DOI: 10.3233/JPD-223511

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2561-2573, 2022

Authors: Lennaerts-Kats, Herma | Ebenau, Anne | Kanters, Silvia | Bloem, Bastiaan R. | Vissers, Kris C.P. | Dijkstra, Bauke W. | Meinders, Marjan J. | Groot, Marieke M.

Article Type: Research Article

Abstract: Background: Parkinson’s disease (PD) is an increasingly prevalent and progressive degenerative disease. Palliative care for PD should be integrated into the routine care for people with PD. However, PD health care professionals typically lack knowledge of palliative care, highlighting the necessity of educational programs in this field. Objective: To determine the effectiveness of a multidisciplinary blended learning program for health care professionals specialized in PD in the Netherlands. Methods: We used a pre-posttest intervention design. The intervention consisted of an e-learning in combination with an online network meeting in which the participating health care professionals discussed …palliative care for PD with specialists from the field of palliative care. Outcome variables included self-rated level of knowledge (scale 1-10), familiarity with specialized palliative care services (5-point Likert scale) and the validated End-of-Life Professional Caregiver Survey (EPCS). Results: A total of 1029 participants from sixteen different disciplines, all active in the care for people with PD, with a mean age of 45 years and 13 years of working experience, followed the blended learning program. Self-rated level of knowledge improved from 4.75 to 5.72 (0.96; p  < 0.001; 95% CI change = [0.85 . . . 1.08]. Familiarity with palliative care services also increased by 1.06 (from 1.85 to 2.90; p =<0.001; 95% CI change = [1.00 . . . 1.12]). Conclusion: A blended learning program can improve self-rated knowledge about palliative care and its services. Such programs might be a first step towards optimal integration of palliative care expertise and services within PD-care. Show more

Keywords: Parkinson’s disease, palliative care, blended learning, e-learning, health care professionals, multidisciplinary, education

DOI: 10.3233/JPD-223539

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2575-2584, 2022

Authors: Domingos, Josefa | de Lima, Ana Ligia Silva | Steenbakkers-van der Pol, Tessa | Godinho, Catarina | Bloem, Bastiaan R. | de Vries, Nienke M.

Article Type: Research Article

Abstract: Background: People with Parkinson’s disease (PD) benefit from boxing exercise. Adding kicking variations to the boxing may provide additional benefit to improve balance. However, the benefits and adherence to such trainings is unknown. Objective: To explore the feasibility, safety, and benefits on balance of boxing training combined with kicking techniques in comparison to boxing without kicking in PD. Methods: Participants were randomized to group-based boxing training with kicking techniques (BK) or to group-based boxing alone training (BO). Both groups trained for one hour, once a week, for a period of 10 weeks. Participants were assessed at …baseline and ten weeks post-intervention for difference in balance, fear of falling, balance confidence, walking ability, and quality of life. Results: Twenty-nine people with PD (median age 64 years; median disease duration 5 years) participated. Both interventions were feasible and acceptable for all participants. No adverse events occurred. Most participants (BK 80%; BO 75%) were satisfied with the training. We found no significant between group difference on either the primary (Mini-BEST) or secondary outcomes. The within group comparison showed that balance improved in both groups after the intervention (BK 22.60 (2.7) to 25.33 (2.64) p  = 0.02; BO 23.09 (3.44) to 25.80 (2.39); p  = 0.01 on the Mini BEST test). Conclusion: Both types of boxing seem to be feasible and safe. Adding kicking techniques to boxing does not improve balance significantly more than boxing alone. Incorporation of kicking may be a valuable addition to the exercise therapy repertoire. Show more

Keywords: Parkinson’s disease, boxing, exercise, balance, kicking, physiotherapy

DOI: 10.3233/JPD-223447

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2585-2593, 2022

Authors: Badihian, Negin | Jackson, Lauren M. | Klassen, Bryan T. | Hassan, Anhar | Low, Phillip A. | Singer, Wolfgang | Coon, Elizabeth A.

Article Type: Short Communication

Abstract: The course of patients with multiple system atrophy (MSA) who undergo deep brain stimulation (DBS) is unclear. In a retrospective review of 1,496 patients with MSA evaluated at our institutions from 1998–2021, 12 patients underwent DBS; 9 had a diagnosis of Parkinson’s disease at the time of surgery. Nine patients reported initial improvement in at least one symptom and 7 experienced overall worsening following DBS. All patients had at least one red flag sign or symptom suggesting atypical parkinsonism prior to surgery. Considering overall poor outcomes of DBS in MSA, we recommend careful consideration of red flags in patient selection.

Keywords: Parkinson’s disease, multiple system atrophy, parkinsonism, ataxia, deep brain stimulation

DOI: 10.3233/JPD-223504

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2595-2600, 2022

Authors: Rocanières, Pierre | Lamure, Sylvain | Geny, Christian | Hillaire-Buys, Dominique | Faillie, Jean-Luc | Bres, Virginie

Article Type: Letter

DOI: 10.3233/JPD-223496

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2601-2603, 2022

Article Type: Other

DOI: 10.3233/JPD-229009

Citation: Journal of Parkinson's Disease, vol. 12, no. 8, pp. 2605-2607, 2022