Journal of Parkinson's Disease - Volume 4, issue 2

Authors: Jitkritsadakul, Onanong | Jagota, Priya | Bhidayasiri, Roongroj

Article Type: Research Article

Abstract: Introduction: Cultural sensitivities tend to limit assessments of sexual dysfunction (SD) in Parkinson's disease (PD). Objective: To assess the validity and reliability of the Thai translation (ASEX-Thai) of the Arizona Sexual Experiences Scale (ASEX). Method: The validity and reliability of ASEX-Thai were assessed with a random sample of 40 PD patients. Back translation and cross-cultural modifications assured content validity. Criterion validity used DSM-IV-TR criteria and receiver operating characteristics (ROC) analysis was calculated for cutoff points plus sensitivity and specificity. Internal consistency was assessed with Cronbach's alpha coefficient. Test-retest reliability was assessed by Pearson's correlation at baseline and at a 2-month …follow-up. Result: Criterion validity was conducted with a positive correlation between the clinical diagnosis of SD and DSM-IV-TR (r = 0.601; p < 0.001). The ROC analysis differentiated between SD and non-SD patients (p < 0.001). The cutoff point of ASEX-Thai at ≥16 points effectively screened for SD (sensitivity 96.2%, specificity 92.9%). Reliability was documented with the Cronbach's alpha of all items at baseline and at a 2-month follow-up with values of 0.948 and 0.962 respectively. The Pearson's correlation also showed highly significant test–retest reliability [Item 1 (r = 0.959, p < 0.001), Item 2 (r = 0.914, p < 0.001), Item 3 (r = 0.944, p < 0.001), Item 4 (r = 0.992, p < 0.001), Item 5 (r = 0.930, p < 0.001), and total ASEX-Thai score (r = 0.883, p < 0.001)]. Conclusion: ASEX-Thai is a valid and reliable instrument for the assessment of sexual dysfunction in Thai PD patients. Show more

Keywords: Arizona sexual experiences scale, ASEX-Thai, Parkinson's disease, sexual dysfunction

DOI: 10.3233/JPD-130271

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 205-210, 2014

Authors: Schrempf, Wiebke | Brandt, Moritz D. | Storch, Alexander | Reichmann, Heinz

Article Type: Review Article

Abstract: Sleep disorders in patients with Parkinson's disease (PD) are very common and have an immense negative impact on their quality of life. Insomnia, daytime sleepiness with sleep attacks, restless-legs syndrome (RLS) and REM-sleep behaviour disorder (RBD) are the most frequent sleep disorders in PD. Neurodegenerative processes within sleep regulatory brain circuitries, antiparkinsonian (e.g., levodopa and dopamine agonists) and concomitant medication (e.g., antidepressants) as well as comorbidities or other non-motor symptoms (such as depression) are discussed as causative factors. For the diagnosis of sleep disturbances we recommend regular screening using validated questionnaires such as the Pittsburgh Sleep Quality Index (PSQI) or …the Medical Outcomes Study Sleep Scale (MOS), for evaluating daytime sleepiness we would suggest to use the Epworth Sleepiness Scale (ESS), the inappropriate sleep composite score (ISCS) or the Stanford sleepiness scale (SSS). All of these questionnaires should be used in combination with a detailed medical history focusing on common sleep disorders and medication. If necessary, patients should be referred to sleep specialists or sleep laboratories for further investigations. Management of sleep disorders in PD patients usually starts with optimization of (dopaminergic) antiparkinsonian therapy followed by specific treatment of the sleep disturbances. Aside from these clinical issues of sleep disorders in PD, the concept of REM-sleep behaviour disorder (RBD) as an early sign for emerging neurodegenerative diseases is of pivotal interest for future research on biomarkers and neuroprotective treatment strategies of neurodegenerative diseases, and particularly PD. Show more

Keywords: Parkinson's disease, non-motor symptoms, sleep, REM sleep behaviour disorder (RBD), restless legs syndrome (RLS), insomnia

DOI: 10.3233/JPD-130301

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 211-221, 2014

Authors: Bhidayasiri, Roongroj | Jitkritsadakul, Onanong | Colosimo, Carlo

Article Type: Review Article

Abstract: Although nocturnal disturbances are increasingly recognized as an integral part of the continuum of daytime manifestations of Parkinson's disease (PD), there is still little evidence in the medical literature to support the occurrence of these complex phenomena in patients with atypical parkinsonian disorders (APDs). Based on the anatomical substrates in APDs, which are considered to be more extensive outside the basal ganglia than in PD, we might expect that patients with APDs encounter the whole range of nocturnal disturbances, including motor, sleep disorders, autonomic dysfunctions, and neuropsychiatric manifestations at a similar, or even greater, frequency than in PD. This article …is a review of the current literature on the problems at nighttime of patients with progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and dementia with Lewy bodies. MEDLINE, life science journals and online books were searched by querying appropriate key words. Reports were included if the studies were related to nocturnal manifestations in APDs. Forty articles fulfilled the selection criteria. Differences between these symptoms in APDs and PD are highlighted, given the evidence available about each manifestation. This analysis of nocturnal manifestations of APDs suggests the need for future studies to address these issues to improve the quality of life not only of patients with APDs but the caregivers who encounter the challenges of supporting these patients on a daily basis. Show more

Keywords: Atypical parkinsonian disorders, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, dementia with lewy body, nocturnal manifestations, REM behavioral disorder, nocturia, nocturnal akinesia, hallucinations

DOI: 10.3233/JPD-130280

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 223-236, 2014

Authors: Kim, Young Eun | Jeon, Beom S.

Article Type: Review Article

Abstract: REM sleep behavior disorder (RBD) appears to have a predilection for some neurodegenerative disorders, especially synucleinopathies such as Parkinson's disease (PD), dementia with Lewy bodies and multiple system atrophy. The frequency of RBD in PD has been reported to variably range from 20 to 72%. RBD may precede or follow onset of parkinsonism. Idiopathic RBD may foreshadow neurodegenerative diseases, and RBD in patients with PD has several associated clinical factors although their causal or temporal relationships are not known. RBD may be associated with the development of hallucinations and dementia in PD. It has been reported that the male gender, …old age, a non-tremor motor subtype, a more severe parkinsonism, fall, longer disease duration, autonomic dysfunction, and higher levodopa doses are factors associated with RBD in PD. This review will address the clinical implications of RBD as a preclinical marker of neurodegenerative diseases and PD phenotypes associated with RBD. Show more

Keywords: REM sleep behavior disorder, Parkinson's disease

DOI: 10.3233/JPD-130293

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 237-244, 2014

Authors: Hurt, Catherine S. | Alkufri, Fadi | Brown, Richard G. | Burn, David J. | Hindle, John V. | Landau, Sabine | Wilson, Kenneth C. | Samuel, Michael | on behalf of the PROMS-PD study group (see acknowledgements)

Article Type: Research Article

Abstract: Background: Dopaminergic drugs are the primary risk factor for Impulse Control Behaviours (ICB) in Parkinson's disease (PD), others being early-onset disease and gender. Objective: This report further explores ICB symptom relationships with motor and mood phenotypes, the complex relationship with dopaminergic medications, and hypothesizes a model with potential clinical implications. Methods: Data from 500 PD patients were analyzed. Hypersexuality, gambling and shopping behaviour were assessed using selected questions from the Minnesota Impulsive Disorders Interview questionnaire. Local questions assessed hobbyism. Motor characteristics considered were akinetic-rigid/gait disturbance (PIGD) and ‘non-PIGD’ phenotypes, motor severity, motor progression, and presence/absence of motor fluctuations. Other variables …included anxiety, depression, current levodopa and agonist use, age, gender and cognition. Results: Overall, ICB symptom frequency was 17.8%. There was no relationship between PIGD/non-PIGD motor phenotypes and ICB symptoms. Those with ICB symptoms had higher total combined levodopa/agonist equivalent intake, but not current agonist-only equivalent intake. ICB symptoms were reported by 23.1% of those taking combined levodopa and agonist compared to 19.2% on agonist monotherapy and 11.6% levodopa monotherapy. Compared with non-ICB patients, patients with ICB symptoms were more likely to show an anxious mood phenotype, reported more motor fluctuations, and were younger. Conclusions: Both PIGD and non-PIGD phenotypes are equally affected. Dose-related risk applies to total anti-parkinsonian medication and not just current agonist-only. Anxious mood phenotypes may carry increased risk. A role of anxiety, either as a marker of risk, indirect causal factor, or maintaining factor is incorporated into a preliminary model. We discuss implications for clinical management. Show more

Keywords: Parkinson, impulse control, motor, fluctuations, anxiety

DOI: 10.3233/JPD-130314

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 245-254, 2014

Authors: Okuma, Yasuyuki

Article Type: Review Article

Abstract: Freezing of gait (FOG) and falls are common and disabling phenomena in Parkinson's disease (PD) and related disorders as they may lead to loss of independence. Both are usually observed in the advanced stage of the disease, although they can also be seen in the early stage. FOG and falls have similar risk factors, such as axial motor disability and cognitive impairment, and FOG is one of the most common causes of falls. The objective of this review is to address recent ideas about the underlying pathophysiology of FOG and falls, and discuss the similarities, differences, and relationships between FOG …and falls. Recent advances in studies that elucidate physical and cognitive risk factors to predict future falls are also reviewed. In addition to the history of prior falls and disease severity, the presence of FOG and cognitive dysfunction are associated with falls in PD. Show more

Keywords: Parkinson's disease, freezing of gait, falls, pathophysiology

DOI: 10.3233/JPD-130282

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 255-260, 2014

Authors: Kim, Young Eun | Jeon, Beom S.

Article Type: Review Article

Abstract: The human impulsivity-related trait has a complex background that is influenced by genetic and non-genetic factors. Impulsivity-related genetic factors have been evaluated in the field of psychiatry previously. Many previous reports have suggested that genetic variants associated with the hyperstimulation of the dopaminergic and serotonergic systems may have main roles in impulsivity. Although impulse control and related behaviors (ICRBs) in Parkinson's disease (PD) are now recognized as important nonmotor symptoms, ICRBs has seldom been evaluated for its genetic susceptibility in PD. This review will address genetic studies on ICRBs in the general population and PD. Although this trait has genetic …susceptibility in part, it should be remembered that human trait is not entirely determined by genes. Show more

Keywords: Genetics, polymorphism, impulse control disorders, Parkinson's disease

DOI: 10.3233/JPD-130292

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 261-272, 2014

Authors: Bhidayasiri, Roongroj | Petchrutchatachart, Sitthi | Pongthornseri, Ronachai | Anan, Chanawat | Dumnin, Songphon | Thanawattano, Chusak

Article Type: Research Article

Abstract: Background: Tremors are common clinical complaints among the elderly and non-specialist physicians frequently are challenged by the need to provide an accurate diagnosis of various tremor syndromes, particularly Parkinson's disease and essential tremor in their busy practices. Objective: We sought to develop an easy-to-use, mobile robust, accurate, and cost-effective instrument that can objectively quantify tremors. Method: The low-cost, 3-dimension, inertial sensors were developed for automated tremor assessment. The main sensor unit consists of a 3-axis accelerometer and a 3-axis gyroscope for the purpose of measuring the tilting angle relative to the gravity, linear acceleration, and angular velocity of the body …segments affected by tremors. The transmitter consists of five main modules, including a microcontroller, power management module, sensor module, external memory interface module, and Bluetooth™ communication interface module, which connects to the sensors by a thin wire. The signal processing utilized fast Fourier transform analysis to include RMS angular rate, RMS angle, RMS rate, RMS velocity, peak frequency, peak frequency magnitude, and dispersion of frequency as variables. Result: The prototype was tested with a tremor simulator at programmable angular rates of 2-, 4-, and 8-Hz confirming its accuracy. Twenty subjects (10 PD and 10 age-matched ET patients) participated as part of the experimental verification to perform three tremor tasks, including rest, postural, and kinetic tremor according to the teaching videotape of the motor section of the UPDRS. The mean peak frequency was significantly lower in PD than ET patients at rest on the x- (p < 0.01) and z-axis (p < 0.01). In PD patients, the RMS angular rate, RMS angle, RMS rate, RMS velocity, and peak magnitude were all significantly higher than those values in ET patient at rest while the data was not significantly difference during postural and kinetic actions. ET patients had significantly higher peak frequency during postural action in the y-axis than PD patients (p < 0.05). Conclusion: The study provides the technical development of an accurate, inexpensive, and simple method to measure the kinematics of tremor in humans. Further studies are warranted to confirm the validity of each parameter and the diagnostic accuracy in each tremor syndrome. Show more

Keywords: Tremor, Parkinson's disease, essential tremor, inertial sensors, accelerometer, gyroscope

DOI: 10.3233/JPD-130311

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 273-282, 2014

Authors: Melse, Maartje | Tan, Sonny K.H. | Temel, Yasin | van Kroonenburgh, Marinus J.P.G. | Leentjens, Albert F.G.

Article Type: Research Article

Abstract: Background: Serotonin (5-HT) has long been implied in the pathophysiology of Parkinson's disease (PD). In addition, the 5-HT2A receptor is associated with the regulation of motor function and mood. Objective: To assess regional 5-HT2A receptor expression in unmedicated patients with de novo PD. Methods: Eight de novo, drug naïve patients with PD and eight healthy control subjects underwent a single photon emission computed tomography (SPECT) scan with the highly selective 5-HT2A radioligand 123 I-5-I-R91150. Results: In de novo PD patients 5-HT2A receptor binding was significantly reduced in the anterior striatum and the premotor cortex in PD …patients compared to controls. In addition, occipital binding was elevated in PD patients. No changes in 5-HT2A receptor binding were found in the prefrontal and parietal cortex. Conclusion: In de novo PD patients, 5-HT2A receptor expression is changed in key areas of the basal ganglia-thalamocortical motor circuit and occipital cortex. This suggests altered 5-HT neurotransmission to contribute to development of PD motor and non-motor symptoms. Show more

Keywords: 5-HT$_{2A}$ receptor, serotonin, Parkinson's disease, neuroimaging

DOI: 10.3233/JPD-130300

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 283-287, 2014

Authors: Klingelhoefer, Lisa | Samuel, Michael | Chaudhuri, K. Ray | Ashkan, Keyoumars

Article Type: Review Article

Abstract: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established therapy for patients with Parkinson's disease (PD), especially those with advanced motor complications. The effect of STN DBS on non motor symptoms (NMS) of PD is less well studied. In this article, we review the pertinent literature on the impact of STN DBS on NMS when they co-exist with disabling motor symptoms in PD patients. We also present evidence that the number and the severity of most NMS decrease after STN DBS which can have a major impact on patients' quality of life.

Keywords: Deep brain stimulation, DBS, Parkinson's disease, PD, subthalamic nucleus, STN, internal globus pallidus, GPi, non motor symptoms

DOI: 10.3233/JPD-130273

Citation: Journal of Parkinson's Disease, vol. 4, no. 2, pp. 289-300, 2014