Cereda E, Barichella M, Cassani E, Caccialanza R, Pezzoli G.
literature suggests that diabetes is a risk factor for Parkinson
disease (PD). We investigated the clinical features of patients with
idiopathic PD (IPD) in whom the onset of diabetes came first.
designed a case-control study. From the cohort of all new patients with
IPD free of vascular disease (n = 783) admitted and evaluated at our
institute over a 3-year period (2007-2010), we included all the
patients with a diagnosis of diabetes prior to PD onset (n = 89) and a
control group (n = 89) matched (1:1) for gender, body mass index (±1
kg/m(2)), and duration of PD (±1 year). The Unified Parkinson's Disease
Rating Scale (UPDRS) motor score was the primary endpoint.
study entry, patients with diabetes were similar to controls in terms
of most demographic, lifestyle, and general medical features with
exception of statins (18% vs 3.4%; p = 0.003). However, diabetes was
associated with higher UPDRS motor (22.3 ± 9.0 vs 19.3 ± 7.9; p =
0.019) and activities of daily living (9.7 ± 5.1 vs 8.3 ± 4.3; p =
0.049) scores, more severe Hoehn & Yahr staging (p = 0.009), and
higher treatment doses of levodopa (mg/day, 448 ± 265 vs 300 ± 213; p
< 0.0001; mg/kg/day, 5.8 ± 4.0 vs 3.8 ± 2.9; p < 0.0001).
of diabetes before the onset of PD appears to be a risk factor for more
severe PD symptoms. These findings support the hypothesis that diabetes
has a role in the etiopathogenesis of PD. Neurologists should be aware
of the potential impact of diabetes on overall PD management.
examinations are commonly performed in the analysis of tremor and
Parkinson's disease (PD). We analyzed the accuracy of subjective and
objective assessment of handwriting samples for distinguishing 27 PD
cases, 22 with tremulous PD, and five with akinetic-rigid PD, from 39
movement-disorder patients with normal presynaptic dopamine imaging
(subjects without evidence of dopamine deficiency or SWEDDs; 31 with
dystonic tremor (DT), six indeterminate tremor syndrome, one essential
tremor, one vascular parkinsonism). All handwriting analysis was
performed blind to clinical details. Subjective classification was made
as: (1) micrographia, (2) normal, or (3) macrographia. In addition, a
range of objective metrices were measured on standardized handwriting
specimens. Subjective assessments found micrographia more frequently in
PD than SWEDDs (p = 0.0352) and in akinetic-rigid than tremulous PD
(p = 0.0259). Macrographia was predominantly seen in patients with
dystonic tremor and not other diagnoses (p = 0.007). Micrographia had a
mean sensitivity of 55 % and specificity of 84 % for distinguishing PD
from SWEDDs and mean sensitivity of 90 % and specificity of 55 % for
distinguishing akinetic-rigid PD from tremulous PD. Macrographia had a
sensitivity of 26 % and specificity of 96 % for distinguishing DT from
all other diagnoses. The best of the objective metrices increased
sensitivity for the distinction of SWEDDs from PD with a reduction in
specificity. We conclude that micrographia is more indicative of PD
than SWEDDs and more characteristic of akinetic-rigid than tremulous
PD. In addition, macrographia strongly suggests a diagnosis of dystonic
Parkinson's disease (PD) is a common neurodegenerative disease with a
chronic disease course. The increase in life expectancy of humans
worldwide is expected to increase the prevalence and duration of PD;
therefore, it is important to determine factors that contribute to the
caregiver burden for both clinical and social reasons. Methods: We
surveyed 91 main caregivers of patients, and compared factors
contributing to caregiver burden between 50 spouses and 41 offspring of
patients. We determined Burden Interview, Depression Scale,
Health-Related Quality of Life, and Obligation Scale scores, as well as
the degree of functional social support of caregivers. Results:
Interestingly, the burden scores of the two groups were not
significantly different. Correlation analysis revealed that depression,
health-related quality of life, social support, subdivided parts of the
Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale,
score of Mini-Mental State Examination, and Barthel index were
correlated with burden in both spouses and offspring. However, in
multiple regression, depression score and part 1 of the UPDRS were more
significant predictors of burden in the spousal group, whereas social
support of community and part 3 of the UPDRS were more important
correlated factors in the offspring group. Conclusions: The caregiver
burden of spousal and offspring caregivers of PD patients was not
significantly different. However, different factors contributed to
caregiver burden according to the caregiver's relationship with the
Ann Neurol. 2012 Mar;71(3):362-9. doi: 10.1002/ana.22616.
Marras C, Gruneir A, Rochon P, Wang X, Anderson G, Brotchie J, Bell CM, Fox S, Austin PC.
A study was undertaken to test the association between dihydropyridine calcium channel blocker use and the time to important milestones of disease progression among patients with parkinsonism.
Data were obtained from Ontario's health care administrative databases. Within a cohort of hypertensive individuals older than 65 years who developed parkinsonism, we examined the effect of the length of exposure to less brain-penetrant dihydropyridines (amlodipine) and more brain-penetrant dihydropyridines (eg, nifedipine, felodipine) on parkinsonism milestones as measured by time to requiring drug treatment for parkinsonism, nursing home admission, and death.
Among 4,733 hypertensive individuals with parkinsonism, longer treatment with any dihydropyridine was associated with a decreased risk of each of the 3 outcomes. There was no difference, however, between amlodipine (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.42-0.50 for initiation of drug treatment; HR, 0.68; 95% CI, 0.63-0.73 for application for nursing home admission; and HR, 0.75; 95% CI, 0.70-0.80 for death) and nonamlodipine dihydropyridines (adjusted HRs [95% CIs], 0.45 [0.39-0.53], 0.74 [0.67-0.81], and 0.74 [0.64-0.85] for the 3 milestones, respectively).
We found no specific beneficial effect of treatment with brain-penetrant dihydropyridines on delaying parkinsonism progression milestones. Dihydropyridine calcium channel blockers are unlikely to have a clinically significant effect on the course of parkinsonism, particularly Parkinson disease, in the doses used to treat hypertension.
Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE.
To assess whether high school football played between 1946 and 1956, when headgear was less protective than today, was associated with development of neurodegenerative diseases later in life.
All male students who played football from 1946 to 1956 in the high schools of Rochester, Minnesota, plus a non-football-playing referent group of male students in the band, glee club, or choir were identified. Using the records-linkage system of the Rochester Epidemiology Project, we reviewed (from October 31, 2010, to March 30, 2011) all available medical records to assess later development of dementia, Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS). We also compared the frequency of dementia, PD, or ALS with incidence data from the general population of Olmsted County, Minnesota.
We found no increased risk of dementia, PD, or ALS among the 438 football players compared with the 140 non-football-playing male classmates. Parkinson disease and ALS were slightly less frequent in the football group, whereas dementia was slightly more frequent, but not significantly so. When we compared these results with the expected incidence rates in the general population, only PD was significantly increased; however, this was true for both groups, with a larger risk ratio in the non-football group.
Our findings suggest that high school students who played American football from 1946 to 1956 did not have an increased risk of later developing dementia, PD, or ALS compared with non-football-playing high school males, despite poorer equipment and less regard for concussions compared with today and no rules prohibiting head-first tackling (spearing).
To explore how amantadine transitioned from an anti-flu drug to antiparkinsonian agent.
A review of the historical literature on the use of amantadine from 1966 to the present was performed.
Amantadine was originally introduced and utilized as an antiviral medication. A single patient noticed relief in her Parkinson disease (PD) symptoms after taking amantadine for a flu infection, and this observation sparked an interest, and several important studies that eventually led to a new drug indication.
Amantadine has over the years fallen out of favor as a drug to address influenza infection; however, it has become part of the arsenal utilized for early symptomatic treatment of PD, as well an option for treating dyskinesia.