Journal of Parkinson's Disease - Volume 5, issue 4

Authors: Price, Catherine C. | Levy, Shellie-Anne | Tanner, Jared | Garvan, Cyndi | Ward, Jade | Akbar, Farheen | Bowers, Dawn | Rice, Mark | Okun, Michael

Article Type: Research Article

Abstract: Background: Post-operative cognitive dysfunction (POCD) demarks cognitive decline after major surgery but has been studied to date in “healthy” adults. Although individuals with neurodegenerative disorders such as Parkinson’s disease (PD) commonly undergo elective surgery, these individuals have yet to be prospectively followed despite hypotheses of increased POCD risk. Objective: To conduct a pilot study examining cognitive change pre-post elective orthopedic surgery for PD relative to surgery and non-surgery peers. Methods: A prospective one-year longitudinal design. No-dementia idiopathic PD individuals were actively recruited along with non-PD “healthy” controls (HC) undergoing knee replacement surgery. Non-surgical PD and HC …controls were also recruited. Attention/processing speed, inhibitory function, memory recall, animal (semantic) fluency, and motor speed were assessed at baseline (pre-surgery), 3 weeks, 3 months, and 1 year post- orthopedic surgery. Reliable change methods examined individual changes for PD individuals relative to control surgery and control non-surgery peers. Results: Over two years we screened 152 older adult surgery or non-surgery candidates with 19 of these individuals having a diagnosis of PD. Final participants included 8 PD (5 surgery, 3 non-surgery), 47 Control Surgery, and 21 Control Non-Surgery. Eighty percent (4 of the 5) PD surgery declined greater than 1.645 standard deviations from their baseline performance on measures assessing processing speed and inhibitory function. This was not observed for the non-surgery PD individuals. Conclusion: This prospective pilot study demonstrated rationale and feasibility for examining cognitive decline in at-risk neurodegenerative populations. We discuss recruitment and design challenges for examining post-operative cognitive decline in neurodegenerative samples. Show more

Keywords: Orthopedics, arthroplasty, neurodegenerative, memory, executive function

DOI: 10.3233/JPD-150632

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 893-905, 2015

Authors: Pirker, Susanne | Perju-Dumbrava, Laura | Kovacs, Gabor G. | Traub-Weidinger, Tatiana | Pirker, Walter

Article Type: Research Article

Abstract: Background: Corticobasal degeneration (CBD) is characterized by neuronal and glial deposition of 4-repeat tau in the frontal and parietal cerebral cortex, white matter and striatum. There is neuronal loss in affected cortical regions and in the substantia nigra (SN). Recent single photon emission tomography (SPECT) studies have reported normal striatal dopamine transporter (DAT) binding in individual patients with CBD. Objective: To study the pattern and course of DAT binding loss in CBD. Methods: We retrospectively analyzed DAT SPECT studies in two patients presenting with a corticobasal syndrome in whom a diagnosis of CBD was later confirmed …pathologically. Results: Baseline scans at 1.5 years after symptom onset revealed only mild abnormalities (reduced uptake in one putamen). Follow up scans at 4.5 years (Case 1) and 5 years (Case 2) after symptom onset showed a marked decline of striatal DAT binding. In both cases, there was a 37% binding reduction from the age-expected striatal binding value. Asymmetry of striatal DAT binding had increased from mild in the first SPECT studies to moderate at the time of their final imaging. Conclusion: CBD patients can have delayed neuronal loss in the SN. Follow up DAT imaging may be of value in patients with possible CBD and a normal baseline scan. Show more

Keywords: Atypical parkinsonism, corticobasal syndrome, corticobasal degeneration, dopamine transporter, single photon emission computerized tomography

DOI: 10.3233/JPD-150625

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 907-912, 2015

Authors: Moccia, Marcello | Mollenhauer, Brit | Erro, Roberto | Picillo, Marina | Palladino, Raffaele | Barone, Paolo

Article Type: Research Article

Abstract: Background: Parkinson’s disease (PD) subjects are less likely to ever smoke and are more prone to quit smoking, as compared to controls. Therefore, smoking habits can be considered part of the non-motor phenotype, preceding the onset of motor PD by several years. Objective: To explore non-motor symptom (NMS) correlates of smoking habits in de novo PD. Methods: This cross-sectional study included 281 newly diagnosed, drug-naïve PD subjects, recruited in Naples (Italy) and in Kassel (Germany). All subjects completed the NMS Questionnaire (NMSQ), and were investigated for smoking status (never, current and former smokers) and intensity (pack-years). …Results: 140 PD subjects never smoked, 20 currently smoked, and 121 had quit smoking before PD diagnosis. NMSQ total score did not associate with smoking status, but with smoking intensity (p  = 0.028; coefficient = 0.088). A multinomial logistic regression stepwise model presenting never smoking as reference, selected as NMSQ correlates of current smoking: sex difficulties (p  = 0.002; OR = 5.254), daytime sleepiness (p  = 0.046; OR = 0.085), insomnia (p  = 0.025; OR = 0.135), and vivid dreams (p  = 0.040; OR = 3.110); and of former smoking: swallowing (p  = 0.013; OR = 0.311), nausea (p  = 0.027; OR = 7.157), unexplained pains (p  = 0.002; OR = 3.409), forgetfulness (p  = 0.005; OR = 2.592), sex interest (p  = 0.007; OR = 0.221), sex difficulties (p  = 0.038; OR = 4.215), and daytime sleepiness (p  = 0.05; OR = 0.372). An ordinal logistic regression stepwise model selected as NMSQ correlates of smoking intensity: nocturnal restlessness (p  = 0.027; coefficient = 0.974), and leg swelling (p  = 0.004; coefficient = 1.305). Conclusions: Certain NMSs are associated with different smoking status and intensity, suggesting a variety of adaptive mechanisms to cigarette smoking. Show more

Keywords: Parkinson, de novo, non-motor, smoking, nicotine, cigarette, motor

DOI: 10.3233/JPD-150639

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 913-924, 2015

Authors: Fearon, Conor | Butler, John S. | Newman, Louise | Lynch, Timothy | Reilly, Richard B.

Article Type: Research Article

Abstract: Background: Sensory and perceptual disturbances progress with disease duration in Parkinson’s disease (PD) and probably contribute to motor deficits such as bradykinesia and gait disturbances, including freezing of gait (FOG). Simple reaction time tests are ideal to explore sensory processing, as they require little cognitive processing. Multisensory integration is the ability of the brain to integrate sensory information from multiple modalities into a single coherent percept, which is crucial for complex motor tasks such as gait. Objectives: The aims of this study were to: 1. Assess differences in unisensory (auditory and visual) and multisensory processing speed in people …with PD and age-matched healthy controls. 2. Compare relative differences in unisensory processing in people with PD with disease duration and freezing of gait status taking into account the motor delays, which are invariably present in PD. 3. Compare relative differences in multisensory (audiovisual) processing between the PD cohort and age-matched controls. Methods: 39 people with PD (23 with FOG) and 17 age-matched healthy controls performed a reaction time task in response to unisensory (auditory-alone, visual-alone) and multisensory (audiovisual) stimuli. Results: The PD group were significantly slower than controls for all conditions compared with healthy controls but auditory reaction times were significantly faster than visual for the PD group only. These relative unisensory differences are correlated with disease duration and divide the PD group by FOG status, but these factors are co-dependent. Although multisensory facilitation occurs in PD, it is significantly less enhanced than in healthy controls. Conclusion: There are significant unisensory and multisensory processing abnormalities in PD. The relative differences in unisensory processing are specific to PD progression, providing a link between these sensory abnormalities and a motor feature of PD. Sensory disturbances have previously been postulated to be central to FOG but this is the first study to predict audiovisual processing abnormalities using FOG status. The multisensory processing abnormalities are independent of disease duration and FOG status and may be a potential biomarker for the disease. Show more

Keywords: Parkinson’s disease, sensory processing, multisensory, auditory, visual

DOI: 10.3233/JPD-150655

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 925-936, 2015

Authors: van der Eijk, Martijn | Bloem, Bastiaan R. | Nijhuis, Frouke A.P. | Koetsenruijter, Jan | Vrijhoef, Hubertus J.M. | Munneke, Marten | Wensing, Michel | Faber, Marjan J.

Article Type: Research Article

Abstract: Background: ParkinsonNet, a nationwide organization with regionally oriented professional health networks in TheNetherlands, aims to improve the quality of Parkinson care. Facilitation of multidisciplinary collaboration is a key objective of ParkinsonNet. Objectives: This study examined whether the concept enhances multidisciplinary collaboration between healthcare professionals involved in Parkinson care. Methods: A regional network involving 101 healthcare professionals was newly established. Participants received two questionnaires. One aimed at documenting direct working relationships (‘connections’) between professionals and the other aimed at evaluating multidisciplinary team performance. Additionally, thirteen healthcare professionals were interviewed to identify barriers and facilitators for multidisciplinary collaboration. …‘Social network analysis’ focused on sub-networks around three community hospitals at baseline and one year after the implementation. Results: The number of ‘knowing each other ’ connections increased from 1431 to 2175 (52% , p  <  0.001) and ‘professional contact ‘ connections increased from 664 to 891 (34% , p <  0.001). Large differences between sub-networks were found, positive changes being associated with a central role of neurologists and nurse specialists committed to multidisciplinary care. The perceived team performance did not change. Participants experienced problems with information exchange and interdisciplinary communication. Generally, participants were unaware of other healthcare professionals involved in individual patients and what treatments they provide simultaneously. Conclusions: ParkinsonNet partially enhanced multidisciplinary collaboration between healthcare professionals involved in Parkinson care. Crucial facilitators of this were a central role of nurse specialists and the commitment to collaborate with and refer to expert therapists among neurologists. Additional measures are needed to further improve multidisciplinary care across different institutions and around individual patients. Show more

Keywords: Parkinson disease, multidisciplinary communication, collaboration, social networking, community network

DOI: 10.3233/JPD-150673

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 937-945, 2015

Authors: Malek, Naveed | Swallow, Diane M.A. | Grosset, Katherine A. | Lawton, Michael A. | Marrinan, Sarah L. | Lehn, Alexander C. | Bresner, Catherine | Bajaj, Nin | Barker, Roger A. | Ben-Shlomo, Yoav | Burn, David J. | Foltynie, Thomas | Hardy, John | Morris, Huw R. | Williams, Nigel M. | Wood, Nicholas | Grosset, Donald G. | on behalf of the PRoBaND clinical consortium

Article Type: Research Article

Abstract: Background: There is wide variation in the phenotypic expression of Parkinson’s disease (PD), which is driven by both genetic and epidemiological influences. Objectives: To define and explain variation in the clinical phenotype of PD, in relation to genotypic variation. Methods: Tracking Parkinson’s is a multicentre prospective longitudinal epidemiologic and biomarker study of PD. Patients attending specialist clinics in the United Kingdom with recent onset (<3.5 years) and young onset (diagnosed <50 years of age) PD were enrolled. Motor, non-motor and quality of life assessments were performed using validated scales. Cases are followed up 6 monthly up …to 4.5 years for recent onset PD, and up to 1 year for young onset PD. We present here baseline clinical data from this large and demographically representative cohort. Results: 2247 PD cases were recruited (1987 recent onset, 260 young onset). Recent onset cases had a mean (standard deviation, SD) age of 67.6 years (9.3) at study entry, 65.7% males, with disease duration 1.3 years (0.9), MDS-UPDRS 3 scores 22.9 (12.3), LEDD 295 mg/day (211) and PDQ-8 score 5.9 (4.8). Young onset cases were 53.5 years old (7.8) at study entry, 66.9% male, with disease duration 10.2 years (6.7), MDS-UPDRS 3 scores 27.4 (15.3), LEDD 926 mg/day (567) and PDQ-8 score 11.6 (6.1). Conclusions: We have established a large clinical PD cohort, consisting of young onset and recent onset cases, which is designed to evaluate variation in clinical expression, in relation to genetic influences, and which offers a platform for future imaging and biomarker research. Show more

Keywords: Parkinson’s disease, heterogeneity, genotype, phenotype

DOI: 10.3233/JPD-150662

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 947-959, 2015

Authors: Cohen, Matthew L. | Schwab, Nadine A. | Price, Catherine C. | Heilman, Kenneth M.

Article Type: Research Article

Abstract: Background: Planned and initiated actions frequently need to be terminated in favor of another action. It is known that many individuals with Parkinson’s disease (PD) have more difficulty self-initiating movement (i.e., endogenously evoked movement) than moving in response to environmental stimuli (i.e., exogenously evoked movement). However, it is not known if individuals with PD display this same endogenous-exogenous asymmetry when needing to terminate, disengage, and reprogram movements. Objective: This study used a novel reaction time (RT) paradigm to test whether patients with mild PD have subclinical deficits of endogenous movement initiation and endogenous movement reprogramming. Methods: …Twelve non-demented individuals with PD on medication and 15 demographically similar healthy control (HC) participants completed an experimental paradigm that examined their RTs (key press) following self-selected valid action preparation (endogenous cues) versus valid exogenously presented cues. The paradigm also assessed participants’ ability to rapidly stop their endogenous or exogenous preparation following an invalid cue and execute an alternative action (key press). Results: Participants with PD produced similar RTs as controls following endogenous and exogenous valid cues, and following invalid exogenous cues. However, following invalid endogenous cues, PD participants were slower than HC participants to stop an endogenous preparation and execute an alternative action. Conclusions: Despite having mild disease and being on dopaminergic medication, these individuals with PD displayed deficits in motor disengagement and reprograming of self-selected actions. Future studies should examine how this phenomenon influences every day actions, as well as possible treatments for this deficit. Show more

DOI: 10.3233/JPD-150672

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 961-970, 2015

Authors: Pirogovsky-Turk, Eva | Filoteo, J. Vincent | Litvan, Irene | Harrington, Deborah L.

Article Type: Research Article

Abstract: Background: Changes in episodic memory are common early in Parkinson’s disease (PD) and may be a risk factor for future cognitive decline. Although medial temporal lobe (MTL) memory and frontostriatal (FS) executive systems are thought to play different roles in distinct components of episodic memory impairment in PD, no study has investigated whether different aspects of memory functioning are differentially associated with MTL and FS volumes in nondemented patients without mild cognitive impairment (PD-woMCI). Objectives: The present study investigated MRI markers of different facets of memory functioning in 48 PD-woMCI patients and 42 controls. Methods: Regional …volumes were measured in structures comprising the MTL and FS systems and then correlated with key indices of memory from the California Verbal Learning Test. Results: In PD-woMCI patients, memory was impaired only for verbal learning, which was not associated with executive, attention/working memory, or visuospatial functioning. Despite an absence of cortical atrophy, smaller right MTL volumes in patients were associated with poorer verbal learning, long delayed free recall, long delayed cued recall, and recognition memory hits and false positives. Smaller right pars triangularis (inferior frontal) volumes were also associated with poorer long delayed cued recall and recognition memory hits. These relationships were not found in controls. Conclusions: The findings indicate that MTL volumes are sensitive to subtle changes in almost all facets of memory in PD-woMCI, whereas FS volumes are sensitive only to memory performances in cued-testing formats. Show more

Keywords: Parkinson’s disease, magnetic resonance imaging, memory, neuropsychology, medial temporal lobe system, frontostriatal system, cognitive functions

DOI: 10.3233/JPD-150652

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 971-981, 2015

Authors: Nilsson, Maria H. | Iwarsson, Susanne | Thordardottir, Björg | Haak, Maria

Article Type: Research Article

Abstract: Background: Activity performance is marked by the degenerative nature of Parkinson’s disease (PD), but few qualitative studies have focused on how people with PD perceive participation in life situations. Objective: To identify and describe barriers and facilitators for participation from the perspective of people with PD. Methods: Qualitative data was obtained by the focus group method using a semi-structured interview guide. Participants were recruited by purposeful sampling until saturation was reached. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate, severe). Nine focus groups (three per PD severity level) included a total …of 29 participants. Results: Complex dynamics between the individual and the physical and social environment create barriers and facilitators for participation as described in the four categories which emerged out of the focus group discussions. The category Ambiguity of attitudes and the support of others describes how attitudes and support of other people act both as facilitators and barriers for participation. PD specific complexity of the body and physical environment interaction describes barriers for participation. Facilitators emerged in the two categories PD expertise in health care and social services and Information and education foster PD specific understanding . Conclusions: Our findings imply several potential means to facilitate participation for people with PD, taking the person as well as the environment into account in person-centred interventions. This involves aspects such as having access to PD specific expertise, increasing the knowledge and thereby the understanding of PD as well as providing support for maintained work-life. Show more

Keywords: Activities, education, environment, falls, family, knowledge, patient involvement, self-help devices, transportation, work

DOI: 10.3233/JPD-150631

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 983-992, 2015

Authors: Lamotte, Guillaume | Rafferty, Miriam R. | Prodoehl, Janey | Kohrt, Wendy M. | Comella, Cynthia L. | Simuni, Tanya | Corcos, Daniel M.

Article Type: Correction

DOI: 10.3233/JPD-159002

Citation: Journal of Parkinson's Disease, vol. 5, no. 4, pp. 993-993, 2015