Behav Brain Res. 2012 Mar 5. [Epub ahead of print]
Rahayel S, Frasnelli J, Joubert S.
de Recherche en Neuropsychologie et Cognition (CERNEC) Département de
Psychologie, Université de Montréal, CP 6128, Succursale Centre-Ville,
Montréal, Québec, H3C 3J7, Canada; Département de Psychologie,
Université du Québec à Montréal, CP 8888, Succursale Centre-Ville,
Montréal, Québec, H3C 3P8, Canada.
sense of smell is one of the earliest clinical features in both
Alzheimer's disease (AD) and Parkinson's disease (PD). A meta-analysis
was performed on articles obtained from the PubMed database in order to
determine what aspects of olfaction are affected in these two diseases.
By applying strict criteria, we included a total of 81 studies.
Included articles respected the following criteria: (1) patients had a
clinical diagnosis of AD or PD; (2) patients were compared to a healthy
control group; (3) patients and controls were age-matched; (4)
olfactory function was assessed by means of a psychophysical olfactory
test; (5) mean and standard deviation were reported. Results indicate
that AD and PD patients are more impaired on odor identification and
recognition tasks than on odor detection thresholds task. In addition,
PD patients are more impaired on detection thresholds than AD patients.
These results suggest that PD patients are more impaired on low-level
perceptual olfactory tasks whereas AD patients are more strongly
impaired on higher-order olfactory tasks involving specific cognitive
processes. The effect appears more pronounced for AD than PD, which
appears to be affected more homogeneously. In conclusion, olfactory
identification and recognition appear as the most interesting
candidates to be included in a battery to detect subclinical cases in
AD. In parallel, detection thresholds should be included in such a
battery for subclinical PD patients.
Djamshidian A, O'Sullivan SS, Lees A, Averbeck BB.
of Molecular Neuroscience and Reta Lila Weston Institute for
Neurological Studies, University College London (UCL), London, United
Parkinson's disease (PD) sometimes develop impulsive compulsive
behaviours (ICBs) due to their dopaminergic medication. We compared 26
impulsive and 27 non-impulsive patients with PD, both on and off
medication, on a task that examined emotion bias in decision making. No
group differences were detected, but patients on medication were less
biased by emotions than patients off medication and the strongest
effects were seen in patients with ICBs. PD patients with ICBs on
medication also showed more learning from negative feedback and less
from positive feedback, whereas off medication they showed the opposite
Department of Neurology, En Chu Kong Hospital, Sanxia District, New Taipei City, Taiwan.
retrospectively assessed the age- and sex-specific incidence and
relative risk of Parkinson disease (PD) in Taiwan's diabetic
RESEARCH DESIGN AND METHODS
Study cohort included 603,416
diabetic patients and 472,188 nondiabetic control subjects. Incidence
rate and relative risk of PD (ICD-9-CM 332.0) were evaluated.
incidence of PD was 3.59 and 2.15 per 10,000 person-years for the
diabetic and control group, respectively, representing a covariate
adjusted hazard ratio (HR) of 1.61 (95% CI 1.56-1.66), which was
substantially reduced to 1.37 (1.32-1.41) after adjusting for medical
visits. Diabetes was associated with a significantly elevated risk of
PD in all sex and age stratifications except in young women, with the
highest HR noted for young men aged 21-40 years (2.10 [1.01-4.42]),
followed by women aged 41-60 (2.05 [1.82-2.30]) and >60 years (1.65
Diabetes is associated with an increased risk
of PD onset in a Chinese population, and the relation is stronger in
women and younger patients.
The frequency of mild cognitive impairment (MCI) in Parkinson's disease
(PD) ranges from 19 to 40%, and this is probably due to methodological
differences between the studies. The aim of this study was to evaluate
the frequency and profile of MCI in a large sample of nondemented PD
subjects and neurologically healthy subjects (NHS). Methods: A total of
872 subjects (582 controls and 290 PD) were included. The association
between MCI and PD was tested, using logistic regression models; odds
ratios (OR) with 95% confidence intervals (CI) were calculated.
Results: Fifty-three percent of PD subjects and 45% NHS met the
criteria for MCI (p = 0.001). The PD subjects showed a higher frequency
of nonamnestic MCI (naMCI), compared to NHS (23.8 vs. 14.4%, p ≤
0.0001). In comparison to NHS, PD was associated with a univariate OR
of 1.9 (95% CI = 1.3-2.8) for naMCI, and this association was
marginally significant after multiple comparisons (multivariate OR =
1.5, 95% CI = 0.96-2.3, p = 0.077). Conclusion: The association between
PD and the impairment of nonmemory domains is probably due to
frontal-subcortical involvement, which characterizes the disease.
substantial fraction of Parkinson's disease patients deteriorate during
hospitalisation, but the precise proportion and the reasons why have
not been studied systematically and the focus has been on surgical
wards and on Accident & Emergency departments. We assessed the
prevalence and risk factors of deterioration of Parkinson's disease
symptoms during hospitalization, including all wards.
invited Parkinson's disease patients from three neurology departments
in The Netherlands to answer a standardised questionnaire on general,
disease and hospital related issues. Patients who had been hospitalized
in the previous year were included and analysed. Possible risk factors
for Parkinson's disease deterioration were identified. Proportions were
analysed using the Chi-Square test and a logistic regression analysis
Eighteen percent of 684
Parkinson's disease patients had been hospitalized at least once in the
last year. Twenty-one percent experienced deterioration of motor
symptoms, 33% did have one or more complications and 26% had received
incorrect anti-Parkinson's medication. There were no statistically
significant differences for these variables between admissions on
neurologic or non-neurologic wards and between having surgery or not.
Incorrect medication during hospitalization was significantly
associated with higher risk (OR 5.8, CI 2.5-13.7) of deterioration, as
were having infections (OR 6.7 CI 1.8-24.7). A higher levodopa
equivalent dose per day was a significant risk factor for
deterioration. When adjusting for different variables, wrong medication
distribution was the most important risk factor for deterioration.
medication and infections are the important risk factors for
deterioration of Parkinson's disease patients both for admissions with
and without surgery and both for admissions on neurologic and
non-neurologic wards. Measures should be taken to improve care and
incorporated in guidelines.
Poon LH, Lee AJ, Chiao TB, Kang GA, Heath S, Glass GA.
Purpose - The expanding role of a clinical pharmacist at a Veterans Affairs (VA)
out-patient clinic for patients with Parkinson's disease (PD) and
movement disorders is described.
Summary - San Francisco VA Medical
Center added a clinical pharmacist to the multi-disciplinary team
serving patients at an outpatient clinic operated by its Parkinson's
Disease Research, Education and Clinical Center (PADRECC). During the
first six months after joining the clinic team, the pharmacist met with
131 patients and made a total of 69 drug therapy recommendations that
were implemented by neurologists, clinical nurse specialists, and other
PADRECC providers. The results of a retrospective chart review
suggested that in about 21% of the cases evaluated, the pharmacist's
recommendations contributed to an improved medical outcome or the
resolution of a medical problem. Anonymous surveys indicated that
clinic providers (n = 33) and patients (n = 20) were satisfied with the
pharmacist's services. Using a five-point Likert scale (scores ranged
from 1 for "strongly disagree" to 5 for "strongly agree") that they had
more time to devote to other clinic responsibilities with the
pharmacist present in the clinic (mean score, 4.79); patients indicated
that they had an improved understanding of their medications after
speaking with the pharmacist (mean score, 4.88).
Conclusion - A clinical
pharmacist's regular involvement in an outpatient PD and movement
disorders clinic has been well received by patients and clinic
providers. The study results suggest that the pharmacist has made
important contributions in areas such as therapeutic problem solving
and medication education while freeing up providers for other
evidence and case-control studies suggest that dihydropyridine calcium
channel blockers (DiCCBs) may protect against Parkinson's disease. The
authors conducted a historical cohort study in Denmark to investigate
the association between DiCCB use and risk of Parkinson's disease
(1998-2006). Individual-level data on filled drug prescriptions,
diagnostic information, and covariates were linked between nationwide
registries. Among DiCCB users, 173 incident cases of Parkinson's
disease were detected during 461,984 person-years of follow-up,
compared with 5,538 cases during 17,343,641 person-years of follow-up
among nonusers. After adjustment for age, sex, year, propensity score,
and use of other antihypertensive drugs and statins, DiCCB use was
associated with a reduced risk of Parkinson's disease (rate ratio (RR)
= 0.71, 95% confidence interval (CI): 0.60, 0.82). This association was
not present in patients who had previously used DiCCBs (RR = 1.04, 95%
CI: 0.87, 1.24). DiCCB users aged ≥65 years were at lower risk of
Parkinson's disease than DiCCB users aged <65 years (RR = 0.59, 95%
CI: 0.40, 0.85). Among patients with Parkinson's disease, DiCCB use was
associated with reduced risk of death (adjusted RR = 0.66, 95% CI:
0.47, 0.91) but not dementia (adjusted RR = 0.97, 95% CI: 0.60, 1.56).
In conclusion, DiCCB exposure was associated with a reduced risk of
incident Parkinson's disease, particularly in older patients, and with
reduced mortality among patients with Parkinson's disease.
Eur J Neurol. 2012 Mar 5. doi: 10.1111/j.1468-1331.2012.03683.x. [Epub ahead of print]
Bauso DJ, Tartari JP, Stefani CV, Rojas JI, Giunta DH, Cristiano E.
de Neurología Hospital Italiano de Buenos Aires Investigación en
Medicina Interna, Servicio de Clínica Médica Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina.
and purpose: Epidemiologic studies of incidence and prevalence in
Parkinson's Disease (PD) show highly variable results. Despite the
large number of studies performed worldwide during the last decades,
little is known about its prevalence in South America and no incidence
studies have been performed. The goal of this study is to assess the
incidence and prevalence of PD in a health maintenance organization
from Buenos Aires City, the capital city of Argentina.
population were all members of the 'Plan de Salud, Hospital Italiano de
Buenos Aires', a large prepaid health medical organization in Buenos
Aires. From 1 January 2003 to 31 December 2008 patients diagnosed with
PD according to Brain Bank of London diagnostic criteria were
identified retrospectively. Incidence density was calculated with 95%
Results: Hundred and forty thousand people were
followed for a total of 754,082 person-years. A total of 239 incident
cases of PD were identified. Crude incidence density was 31.2/100,000
person-years. Prevalence was 394/100,000 in the population older than
40years. Male to female ratio was 1.31.
Conclusions: This is the
first study in South America that estimates the incidence of PD. Our
results are consistent with other studies from other regions using
Eur J Neurol. 2012 Feb 16. doi: 10.1111/j.1468-1331.2012.03663.x. [Epub ahead of print]
Herlofson K, Ongre SO, Enger LK, Tysnes OB, Larsen JP.
of Neurology, Sorlandet Hospital, Arendal Department of Neurology,
Haukeland University Hospital, Bergen Department of Neurology,
Stavanger University Hospital and the Norwegian Centre for Movement
Disorders, Stavanger University Hospital, Stavanger, Norway.
and purpose: Although fatigue is recognized as a common and
debilitating symptom in patients with Parkinson's disease (PD), little
is known on how and when this symptom emerges during disease
progression. The aim of the study was to explore the presence and
severity of fatigue in patients with PD at the time of diagnosis,
before dopaminergic treatment has been instituted. Methods: The
present study is part of the Norwegian ParkWest project, a large cohort
study of patients with incident PD in Norway. PD was diagnosed
according to the Gelb criteria. The study population comprised 199
patients with untreated, newly diagnosed PD and 172 control subjects,
matched for gender and age. Fatigue was measured by the Fatigue
Severity Scale (FSS). Results: Fifty-five percent of the patients with
PD had clinical significant fatigue (FSS > 4), compared with about
20% of the controls (RR = 2.9). The mean score in patients on the FSS
was 4.4 (SD 1.7) and in controls 3.1 (SD 1.3). In addition, there were
highly significant differences between patients and controls in each of
the nine FSS items. In a regression analysis, only the Montgomery and
Åsberg Depression Rating Scale and Unified Parkinson's Disease Rating
Scale-Activities of Daily Living scores were significantly associated
with fatigue. There was no correlation between fatigue and cognitive
impairment and hypersomnia. Conclusion: Fatigue is a common symptom in
PD, also in patients with early, untreated disease, and it has a
negative impact on these patients' activity of daily living. Also in
early PD, fatigue is an important consideration in the management of
patients with the disease.
Int J Nurs Stud. 2012 Feb 17. [Epub ahead of print]
Drey N, McKeown E, Kelly D, Gould D.
to prescribed medication is low. It is a major problem as following
practitioners' recommendations is strongly associated with good patient
outcomes. Little research has been undertaken with people in the early
stages of Parkinson's disease although achieving symptom control
depends on regularly timing doses.
do people with Parkinson's disease adhere to prescribed medication, and
what are the antecedents of non-adherence to antiparkinsonian
Exploratory qualitative study using semi-structured interviews.
Specialist Parkinson's disease clinic in one National Health Service hospital in England.
consecutive patients not yet in the advanced stages of Parkinson's
disease living at home and responsible for managing their own
medication or managing medication with the help of their carer.
Semi-structured interviews with open questions.
respondent demonstrated at least one type and in most cases several
different types of non-adherent behaviour. Inadvertent minor
non-adherence occurred because patients forgot to take tablets or
muddled doses. Minor deliberate deviations occurred when patients took
occasional extra tablets or brought forward doses to achieve better
symptom control, often to cater for situations that were anticipated as
especially demanding. Deliberate major non-adherence was very common
and always related to over-use of medication. The experiences of
parkinsonism were particular to the individual. The specific
circumstances that prompted an episode of non-adherence varied between
patients. Nevertheless there was evidence of negotiation between
respondents and the Parkinson's disease nurse specialist; medication
regimes were altered in conjunction with the patient during formal
consultations and by telephone.
to prescribed medication for people with chronic conditions is complex
and for people with Parkinson's disease it was possible to identify
different types of non-adherence. The possible existence of a typology
of non-adherence for people with other chronic conditions merits
investigation. Further research is needed to establish whether the
findings of this small scale qualitative study can be replicated with a
larger, more representative sample and establish how people with
Parkinson's disease might be encouraged to adhere to medication regimes
to improve symptom control.
avenues of research including epidemiology, molecular genetics and cell
biology have identified links between Parkinson's disease and type 2
diabetes mellitus. Several recent discoveries have highlighted common
cellular pathways that potentially relate neurodegenerative processes
with abnormal mitochondrial function and abnormal glucose metabolism.
This includes converging evidence identifying that peroxisome
proliferator activated receptor gamma coactivator 1-α, a key regulator
of enzymes involved in mitochondrial respiration and insulin
resistance, is potentially pivotal in the pathogenesis of
neurodegeneration in Parkinson's disease. This evidence supports
further study of these pathways, most importantly to identify
neuroprotective agents for Parkinson's disease, and/or establish more
effective prevention or treatment for type 2 diabetes mellitus. In
parallel with these advances, there are already randomized trials
evaluating several established treatments for insulin resistance
(pioglitazone and exenatide) as possible disease modifying drugs in
Parkinson's disease, with only preliminary insights regarding their
mechanisms of action in neurodegeneration, which may be effective in
both disease processes through an action on mitochondrial function.
Furthermore, parallels are also emerging between these same pathways
and neurodegeneration associated with Alzheimer's disease and
Huntington's disease. Our aim is to highlight this converging evidence
and stimulate further hypothesis-testing studies specifically with
reference to the potential development of novel neuroprotective agents
in Parkinson's disease.
J Neural Transm. 2012 Feb 18. [Epub ahead of print]
impairment is common in Parkinson disease (PD), with long-term
longitudinal studies reporting that most PD patients develop dementia.
A high proportion of patients with PD and mild cognitive impairment
(MCI) progress to dementia within a short time. Impairments occur in a
range of cognitive domains, but single-domain impairment is more common
than multiple one, non-amnestic more common than amnestic impairment.
Although the term MCI applied to PD (PD-MCI) is not without controversy
due to the lack of uniform diagnostic consensus criteria, the
biological validity of PD-MCI is supported by many recent studies that
show heterogenous mechanisms in the clinical presentation,
neuropsychology, neuroimaging, biomarkers, and neuropathology,
suggesting abnormal metabolic network activities involving several
cortical and subcortical nervous systems. Prospective studies using
specific biomarkers, including amyloid imaging, and cerebro-spinal
fluid biomarkers are warranted for an exact diagnosis and prognostic
assessment of early cognitive deficits in PD patients.