Journal of Parkinson's Disease - Volume 14, issue 5

Authors: Cen, Shanshan | Zhang, Hui | Li, Yuan | Gu, Zhuqin | Yuan, Yuan | Ruan, Zheng | Cai, Yanning | Chhetri, Jagadish K. | Liu, Shuying | Mao, Wei | Chan, Piu

Article Type: Research Article

Abstract: Background: Gait disturbance is a vital characteristic of motor manifestation in α – synucleinopathies, especially Parkinson’s disease. Subtle gait alterations are present in isolated rapid eye movement sleep behavior disorder (iRBD) patients before phenoconversion; it is yet unclear, if gait analysis may predict phenoconversion. Objective: To investigate subtle gait alterations and explore whether gait analysis using wearable sensors is associated with phenoconversion of iRBD to α -synucleinopathies. Methods: Thirty-one polysomnography-confirmed iRBD patients and 33 healthy controls (HCs) were enrolled at baseline. All participants walked for a minute while wearing 6 inertial sensors on bilateral wrists, ankles, …and the trunk (sternal and lumbar region). Three conditions were tested: (i) normal walking, (ii) fast walking, and (iii) dual-task walking. Results: Decreased arm range of motion and increased gait variation (stride length, stride time and stride velocity) discriminate converters from HCs at baseline. After an average of 5.40 years of follow-up, 10 patients converted to neurodegenerative diseases (converters). Cox regression analysis showed higher value of stride length asymmetry under normal walking condition to be associated with an early conversion of iRBD to α – synucleinopathies (adjusted HR 4.468, 95% CI 1.088– 18.349, p  = 0.038). Conclusions: Stride length asymmetry is associated with progression to α – synucleinopathies in patients with iRBD. Gait analysis with wearable sensors may be useful for screening, monitoring, and risk stratification for disease-modifying therapy trials in patients with iRBD. Show more

Keywords: Gait analysis, REM sleep behavior disorder, synucleinopathies

DOI: 10.3233/JPD-230397

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1027-1037, 2024

Authors: Figura, Monika | Mrozowicz, Agnieszka | Milanowski, Łukasz | Szlufik, Stanisław | Raćkowska, Emilia | Lypkan, Hanna | Friedman, Andrzej | Koziorowski, Dariusz | Giebułtowicz, Joanna

Article Type: Research Article

Abstract: Background: Levodopa is the gold standard of treatment in Parkinson’s disease (PD). Its clinical effect changes as the disease progresses. Wearing off is a frequent first manifestation of motor fluctuations. Some patients with advanced PD report faster wearing off after physical exercise. Objective: The aim was to assess if pharmacokinetics of levodopa is influenced by physical exercise in patients with different disease advancement. Methods: 22 patients with PD (12 untreated with levodopa and 10 with motor fluctuations) and 7 healthy controls (HC) were included. Plasma samples were collected at 9 fixed timepoints following administration of levodopa/benserazide …200/50 mg for two days: rest day and standardized physical exercise day. Clinical assessment with Unified Parkinson Disease Rating Scale part III (UPDRS III) was performed in fixed timepoints. Liquid chromatography-tandem mass spectrometry was used to measure levodopa concentrations. Results: No differences between the HC, levodopa naïve and advanced PD groups were observed regarding selected pharmacokinetic parameters. In advanced PD and HC no differences in pharmacokinetic parameters of levodopa with and without effort were observed. In levodopa naïve PD group higher mean residence time after rest than after exercise (168.9±48.3 min vs. 145.5±50.8 min; p  = 0.026) was observed. In advanced PD group higher UPDRS III score (14.45±5.5 versus 20.9±6.1 points, p  = 0.04) was observed after exercise. Conclusions: The deterioration of motor status of advanced PD patients after physical effort is not reflected by changes in pharmacokinetics but rather mediated by central mechanisms. Show more

Keywords: Levodopa, Parkinson’s disease, pharmacokinetics, exercise

DOI: 10.3233/JPD-230384

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1039-1049, 2024

Authors: Deng, Xiao | Saffari, Seyed Ehsan | Xiao, Bin | Ng, Samuel Yong Ern | Chia, Nicole | Choi, Xinyi | Heng, Dede Liana | Ng, Ebonne | Xu, Zheyu | Tay, Kay-Yaw | Au, Wing-Lok | Tan, Eng-King | Tan, Louis C.S.

Article Type: Research Article

Abstract: Background: The detailed trajectory of data-driven subtypes in Parkinson’s disease (PD) within Asian cohorts remains undisclosed. Objective: To evaluate the motor, non-motor symptom (NMS) progression among the data-driven PD clusters. Methods: In this 5-year longitudinal study, NMS scale (NMSS), Hospital Anxiety Depression Scale (HADS), and Epworth sleepiness scale (ESS) were carried out annually to monitor NMS progression. H& Y staging scale, MDS-UPDRS part III motor score, and postural instability gait difficulty (PIGD) score were assessed annually to evaluate disease severity and motor progression. Five cognitive standardized scores were used to assess detailed cognitive progression. Linear mixed …model was performed to assess the annual progression rates of the longitudinal outcomes. Results: Two hundred and six early PD patients, consisting of 43 patients in cluster A, 98 patients in cluster B and 65 subjects in cluster C. Cluster A (severe subtype) had significantly faster progression slope in NMSS Domain 3 (mood/apathy) score (p  = 0.01), NMSS Domain 4 (perceptual problems) score (p  = 0.02), NMSS Domain 7 (urinary) score (p  = 0.03), and ESS Total Score (p  = 0.04) than the other two clusters. Cluster A also progressed significantly in PIGD score (p  = 0.04). For cognitive outcomes, cluster A deteriorated significantly in visuospatial domain (p  = 0.002), while cluster C (mild subtype) deteriorated significantly in executive domain (p  = 0.04). Conclusions: The severe cluster had significantly faster progression, particularly in mood and perceptual NMS domains, visuospatial cognitive performances, and postural instability gait scores. Our findings will be helpful for clinicians to stratify and pre-emptively manage PD patients by developing intervention strategies to counter the progression of these domains. Show more

Keywords: Parkinson’s disease, data-driven subtypes, longitudinal study

DOI: 10.3233/JPD-230209

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1051-1059, 2024

Authors: Spruijt, Linda E. | Mosch, Arne | Hoffmann, Carel F.E. | van Nieuwkoop, Cees | Tijsterman, Jasper D. | Zutt, Rodi | van der Gaag, Niels A. | Contarino, M. Fiorella

Article Type: Case Report

Abstract: Deep brain stimulation (DBS) is an advanced treatment in Parkinson’s disease. We describe a 71-year-old patient in whom the DBS got infected with Mycobacterium bovis shortly after intravesical BCG instillations as an adjuvant treatment of bladder cancer. The DBS internal pulse generator and extension wires had to be replaced, and the patient was treated successfully with rifampicin, isoniazid, and ethambutol during three months. This case suggests that physicians need to be aware of the risk of this kind of infection and add a specific Mycobacterial test to the regular cultures.

Keywords: Parkinson’s disease, deep brain stimulation, Bacillus Calmette Guerin, mycobacterium bovis, infection

DOI: 10.3233/JPD-230426

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1061-1069, 2024

Authors: Jellinger, Kurt A.

Article Type: Letter

DOI: 10.3233/JPD-240174

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1071-1072, 2024

Authors: Borghammer, Per | Okkels, Niels | Weintraub, Daniel

Article Type: Letter

DOI: 10.3233/JPD-249008

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1073-1074, 2024

Article Type: Correction

DOI: 10.3233/JPD-249005

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1075-1075, 2024