A personal account of being diagnosed with Parkinson's by someone I know

Clearly written account by Roddy Lee which will resonate with others with PD. Raising awareness is so so important...

http://www.telegraph.co.uk/health/11037816/Time-to-speak-out-on-the-illness-Robin-Williams-kept-secret.html#disqus_thread

Basal ganglia echogenicity in tauopathies

Can be useful potentially for differentiating PD from PSP-P...

J Neural Transm. 2014 Sep 10. [Epub ahead of print]

Sadowski K, Serafin-Król M, Szlachta K, Friedman A.

Abstract

Accumulating data confirm the usefulness of transcranial sonography (TCS) in the diagnosis of Parkinson's disease. The relevance of basal ganglia abnormalities depicted by TCS in atypical parkinsonian syndromes still needs further assessment. In the present study, 20 patients with progressive supranuclear palsy (PSP) and 13 patients with corticobasal syndrome (CBS) were studied with the use of transcranial sonography. Echogenicity of the substantia nigra (SN) and lenticular nucleus (LN) were assessed. 0/20 patients with PSP and 8/12 (66.6 %) patients with CBS were characterized with SN hyperechogenicity. LN hyperechogenicity was observed in 9/20 patients diagnosed with PSP and 0/11 of CBS patients. The combination of SN isoechogenicity and LN hyperechogenicity reached 100 % sensitivity and positive predictive value for the diagnosis of PSP. The results of this study point out that CBS has to be taken into consideration when SN hyperechogenicity is depicted in a patient with parkinsonian syndrome. Normal echogenicity of the SN coexisting with LN hyperechogenicity practically excludes CBS.

Dietary fat intake and risk for Parkinson's disease

Mov Disord. 2014 Sep 3. doi: 10.1002/mds.26032. [Epub ahead of print]

Dong J, Beard JD, Umbach DM, Park Y, Huang X, Blair A, Kamel F, Chen H.

Abstract

Previous epidemiological studies have generated inconsistent results regarding the associations between dietary fat intakes and risk for Parkinson's disease (PD). We therefore prospectively examined these associations in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study. A 124-item food frequency questionnaire was administered at baseline in1995 to 1996, and PD diagnosis was self-reported at the follow-up survey in 2004 to 2006. A total of 1,087 cases with a PD diagnosis between 2000 and 2006 and 299,617 controls were included in the analyses. Overall, intakes of fats and other macronutrients were not associated with PD risk. However, we found a weak positive association between n-6 polyunsaturated fatty acids (PUFA) and the risk for PD. After adjusting for potential confounders, the odds ratio (OR) and 95% confidence interval (CI) between extreme quintiles of n-6 PUFA intake was 1.23 (95% CI = 1.02-1.49, P for trend = 0.02). A similar association was observed for the intake of linoleic acid. Results were similar among men and among women. Our study suggests that fat intake in general is not related to the risk for PD. The weak positive association between intake of n-6 PUFA and PD risk needs further investigation.

Lifetime exposure to estrogens and Parkinson's disease in California teachers

Previous studies in other cohorts/samples have found similar things, but not all...

Parkinsonism Relat Disord. 2014 Aug 19. pii: S1353-8020(14)00299-5. doi: 10.1016/j.parkreldis.2014.08.003. [Epub ahead of print]

Gatto NM, Deapen D, Stoyanoff S, Pinder R, Narayan S, Bordelon Y, Ritz B.

INTRODUCTION:

Parkinson's disease (PD) is consistently observed to occur less frequently in women than men, prompting investigation into whether estrogen protects against neurodegeneration of dopaminergic neurons.

METHODS:

We used baseline data in the California Teachers Study, a prospective cohort of women, to investigate whether reproductive factors indicating higher long-term estrogen levels are associated with PD using a nested case-control approach. We identified 228 PD cases and 3349 unaffected controls frequency matched by age and race.

RESULTS:

Women who reported using combined estrogen/progesterone therapy or progesterone only formulations had a 57% increase in PD risk (OR = 1.57, 95% CI = 1.06, 2.34) compared to never having used HT. Compared to women with menopause at 50-52 years, menopause at younger (<35-46 years: OR = 0.59, 95% CI = 0.37, 0.94) and older ages (≥53 years: OR = 0.54, 95% CI = 0.36, 0.83) had lower PD risk. A derived composite estrogen summary score for women's exposure to both endogenous and exogenous estrogens throughout life indicated that women with presumed higher cumulative lifetime levels of estrogen (a score of 3-5) had a significantly reduced PD risk [(OR = 0.57, 95% CI = 0.35, 0.91) relative to those with lower lifetime estrogen exposure or a composite estrogen summary score of 0-1].

CONCLUSIONS:

These results provide some support for the hypothesis that lifelong high estrogen is protective in PD, suggesting that the level and persistence of exposure over the long term may be important in PD risk reduction.

APOE, MAPT, and SNCA Genes and Cognitive Performance in Parkinson Disease

JAMA Neurol. 2014 Sep 1. doi: 10.1001/jamaneurol.2014.1455. [Epub ahead of print]

Mata IF, Leverenz JB, Weintraub D, Trojanowski JQ, Hurtig HI, Van Deerlin VM, Ritz B, Rausch R, Rhodes SL, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Peterson AL, Espay AJ, Revilla FJ, Devoto J, Hu SC, Cholerton BA, Wan JY, Montine TJ, Edwards KL, Zabetian CP.

IMPORTANCE:

Cognitive impairment is a common and disabling problem in Parkinson disease (PD) that is not well understood and is difficult to treat. Identification of genetic variants that influence the rate of cognitive decline or pattern of early cognitive deficits in PD might provide a clearer understanding of the etiopathogenesis of this important nonmotor feature.

OBJECTIVE:

To determine whether common variation in the APOE, MAPT, and SNCA genes is associated with cognitive performance in patients with PD.

DESIGN, SETTING, AND PARTICIPANTS:

We studied 1079 PD patients from 6 academic centers in the United States who underwent assessments of memory (Hopkins Verbal Learning Test-Revised [HVLT-R]), attention and executive function (Letter-Number Sequencing Test and Trail Making Test), language processing (semantic and phonemic verbal fluency tests), visuospatial skills (Benton Judgment of Line Orientation test), and global cognitive function (Montreal Cognitive Assessment). Participants underwent genotyping for the APOE ε2/ε3/ε4 alleles, MAPT H1/H2 haplotypes, and SNCA rs356219. We used linear regression to test for association between genotype and baseline cognitive performance with adjustment for age, sex, years of education, disease duration, and site. We used a Bonferroni correction to adjust for the 9 comparisons that were performed for each gene.

MAIN OUTCOMES AND MEASURES:

Nine variables derived from 7 psychometric tests.

RESULTS:

The APOE ε4 allele was associated with lower performance on the HVLT-R Total Recall (P = 6.7 × 10-6; corrected P [Pc] = 6.0 × 10-5), Delayed Recall (P = .001; Pc = .009), and Recognition Discrimination Index (P = .004; Pc = .04); a semantic verbal fluency test (P = .002; Pc = .02); the Letter-Number Sequencing Test (P = 1 × 10-5; Pc = 9 × 10-5); and Trail Making Test B minus Trail Making Test A (P = .002; Pc = .02). In a subset of 645 patients without dementia, the APOE ε4 allele was associated with lower scores on the HVLT-R Total Recall (P = .005; Pc = .045) and the semantic verbal fluency (P = .005; Pc = .045) measures. Variants of MAPT and SNCA were not associated with scores on any tests.

CONCLUSIONS AND RELEVANCE:

Our data indicate that the APOE ε4 allele is an important predictor of cognitive function in PD across multiple domains. Among PD patients without dementia, the APOE ε4 allele was only associated with lower performance on word list learning and semantic verbal fluency, a pattern more typical of the cognitive deficits seen in early Alzheimer disease than PD.

Which features of Parkinson's disease predict earlier exit from the workforce?

Evidence to further back up how markedly anxiety and depression can affect all aspects of daily life in PD patients...

Parkinsonism Relat Disord. 2014 Aug 20. pii: S1353-8020(14)00303-4. doi: 10.1016/j.parkreldis.2014.08.005. [Epub ahead of print]

Armstrong MJ, Gruber-Baldini AL, Reich SG, Fishman PS, Lachner C, Shulman LM.

INTRODUCTION:

Few objective data exist regarding predictors of leaving the workforce (LWF) in Parkinson's disease (PD).

METHODS:

Employed PD patients were followed prospectively. Baseline demographics, disease duration, and measures of disease severity, cognition, disability, and mental health were compared between patients working at last follow-up versus those who left the workforce using student's t-tests and multivariate analyses controlling for age, gender, and PD duration.

RESULTS:

Of 419 employed patients, 224 had left the workforce by last follow-up. Patients who left the workforce were more likely to be older, female, have lower-income, and have longer PD duration. LWF patients had greater baseline depression, anxiety, and overall psychiatric distress. PD severity did not differ between groups.

CONCLUSION:

Demographics, disease duration, and mental health contribute to LWF, but not motor severity. Age, gender and income contributions are difficult to modify but important to recognize. Worse baseline mental health is associated with LWF, suggesting a potential target for intervention.

A population-based study of the association between bullous pemphigoid and neurologic disorders

J Am Acad Dermatol. 2014 Aug 29. pii: S0190-9622(14)01783-6. doi: 10.1016/j.jaad.2014.07.052. [Epub ahead of print]

Brick KE, Weaver CH, Savica R, Lohse CM, Pittelkow MR, Boeve BF, Gibson LE, Camilleri MJ, Wieland CN.

BACKGROUND:

Bullous pemphigoid (BP) has been associated with neurologic disorders.

OBJECTIVE:

We sought to analyze the association between BP and neurologic disorders.

METHODS:

We retrospectively identified residents of Olmsted County, Minnesota, with a first lifetime diagnosis of BP between January 1, 1960, and December 31, 2009. Three age- and sex-matched Olmsted County, Minnesota, residents without BP were selected as control subjects for each patient. We compared history of or development of neurologic disorders (dementia, Alzheimer disease, Parkinson disease, multiple sclerosis, cerebrovascular disease, and seizures) between groups using case-control and cohort designs.

RESULTS:

In all, 87 patients with BP were identified and matched to 261 control subjects. The odds of a previous diagnosis of any neurologic disorder or a history of dementia were significantly increased among cases compared with controls (odds ratio 6.85; 95% confidence interval [CI] 3.00-15.64; P < .001; and odds ratio 6.75; 95% CI 2.08-21.92; P = .002, respectively). Both Parkinson disease (hazard ratio 8.56; 95% CI 1.55-47.25; P = .01) and any type of neurologic disorder (hazard ratio 2.02; 95% CI 1.17-3.49; P = .01) were significantly more likely to develop during follow-up in patients with than without BP.

LIMITATIONS:

Small geographic area and retrospective study design are limitations.

CONCLUSION:

Findings confirmed an association of BP with neurologic disorders, especially dementia and Parkinson disease.

Montreal Cognitive Assessment for the screening and prediction of cognitive decline in early Parkinson's disease

More evidence supporting the MoCA as the cognitive screening test of choice in early PD...

Parkinsonism Relat Disord. 2014 Aug 14. pii: S1353-8020(14)00298-3. doi: 10.1016/j.parkreldis.2014.08.002. [Epub ahead of print]

Kandiah N, Zhang A, Cenina AR, Au WL, Nadkarni N, Tan LC.

BACKGROUND:

Early diagnosis of cognitive impairment in PD would allow appropriate monitoring and timely intervention to reduce the progression to dementia (PDD).

OBJECTIVE:

To study the usefulness of the Montreal Cognitive Assessment (MoCA) in the screening for mild cognitive impairment (PD-MCI) and its predictive utility in determining longitudinal cognitive decline in PD.

METHODS:

Prospective longitudinal study of patients with mild PD. PD-MCI and PDD was diagnosed based on the Movement Disorder taskforce (MDS) criteria. Receiver Operating Characteristic analyses and Cox regression analyses were performed.

RESULTS:

95 patients; mean age 66.37 (SD 7.86); mean H&Y score of 1.99 (SD 0.45) were studied. At baseline, 34 patients fulfilled the MDS criteria for PD-MCI. MoCA, compared to the MMSE had a high discriminatory power in detecting PD-MCI [Area Under Curve (AUC) of 0.912, p < 0.001]. A MoCA score of ≤26 provided a sensitivity of 93.1% for the diagnosis of PD-MCI. In the longitudinal cohort over 2 years, baseline MOCA was useful in predicting cognitive decline (AUC of 0.707, p = 0.05). With Cox regression analyses, a 1-point lower score on baseline MoCA was associated with a 34% increased risk of cognitive decline [Hazard ratio (HR) 1.34; 95% CI: 1.03-1.74: p = 0.029]. A baseline MoCA ≤26 was highly predictive of progressive cognitive decline (HR 3.47, 95% CI: 2.38-5.07; p < 0.01).

CONCLUSIONS:

MoCA is a reliable tool in predicting cognitive decline in early PD. A MoCA score of ≤26 significantly increases the risk for progressive cognitive decline.

Predictors of dementia in Parkinson disease: A prospective cohort study

Useful prospective study which supports some of the observations made in the clinic...

Neurology. 2014 Aug 29. pii: 10.1212/WNL.0000000000000842. [Epub ahead of print]

Anang JB, Gagnon JF, Bertrand JA, Romenets SR, Latreille V, Panisset M, Montplaisir J, Postuma RB.

OBJECTIVE:

We investigated an array of possible markers of early dementia in Parkinson disease.

METHODS:

We performed a comprehensive assessment of autonomic, sleep, psychiatric, visual, olfactory, and motor manifestations in 80 patients with Parkinson disease who were dementia-free at baseline. After 4.4 years' follow-up, patients were evaluated for dementia. Predictive variables were assessed using logistic regression adjusting for disease duration, follow-up duration, age, and sex.

RESULTS:

Of 80 patients, 27 (34%) developed dementia. Patients destined to develop dementia were older and more often male (odds ratio [OR] = 3.64, p = 0.023). Those with baseline mild cognitive impairment had increased dementia risk (OR = 22.5, p < 0.001). REM sleep behavior disorder at baseline dramatically increased dementia risk (OR = 49.7, p = 0.001); however, neither daytime sleepiness nor insomnia predicted dementia. Higher baseline blood pressure increased dementia risk (OR = 1.37 per 10 mm Hg, p = 0.032). Orthostatic blood pressure drop was strongly associated with dementia risk (OR = 1.84 per 10 mm Hg, p < 0.001); having a systolic drop of >10 mm Hg increased dementia odds 7-fold (OR = 7.3, p = 0.002). Abnormal color vision increased dementia risk (OR = 3.3, p = 0.014), but olfactory dysfunction did not. Among baseline motor variables, proportion of gait involvement (OR = 1.12, p = 0.023), falls (OR = 3.02, p = 0.042), and freezing (OR = 2.63, p = 0.013), as well as the Purdue Pegboard Test (OR = 0.67, p = 0.049) and alternate tap test (OR = 0.97, p = 0.033) predicted dementia.

CONCLUSION:

Cardiovascular autonomic dysfunction, REM sleep behavior disorder, color discrimination ability, and gait dysfunction strongly predict development of dementia in Parkinson disease.

Olfactory dysfunction in incidental Lewy body disease and Parkinson's disease.

Small number of pathologically defined PD and ILBD cases who had smell testing in life. Reassuring that 50% of ILBD cases had olfactory dysfunction if this is the precursor...

Parkinsonism Relat Disord. 2014 Aug 16. pii: S1353-8020(14)00304-6. doi: 10.1016/j.parkreldis.2014.08.006. [Epub ahead of print]

Driver-Dunckley E, Adler CH, Hentz JG, Dugger BN, Shill HA, Caviness JN, Sabbagh MN, Beach TG; the Arizona Parkinson Disease Consortium.

BACKGROUND:

Olfactory dysfunction in Parkinson's disease (PD) is well-established and may represent one of the earliest signs of the disease.

OBJECTIVE & METHODS:

The objective of this study was to evaluate the relationship of olfactory dysfunction, using the University of Pennsylvania Smell Identification Test (UPSIT), to clinical and pathological parameters of clinicopathologically diagnosed PD (n = 10), incidental Lewy body disease (ILBD) (n = 13), and identically assessed controls who lacked a neurodegenerative disease (n = 69).

RESULTS:

Mean UPSIT scores were significantly lower in PD (16.3, p < 0.001) and ILBD (22.2, p = 0.004) compared to controls (27.7). Using an UPSIT cutoff score of <22 (the 15th percentile) the sensitivity for detecting PD was 9/10 (90%) and ILBD 6/13 (46%), while the specificity was 86% (Controls with score of <22 = 10/69).

CONCLUSIONS:

These results add to the growing body of evidence suggesting that olfactory testing could be useful as a screening tool for identifying early, pre-motor PD.

Effect of Advancing Age on Outcomes of Deep Brain Stimulation for Parkinson Disease

JAMA Neurol. 2014 Aug 25. doi: 10.1001/jamaneurol.2014.1272. [Epub ahead of print]

DeLong MR, Huang KT, Gallis J, Lokhnygina Y, Parente B, Hickey P, Turner DA, Lad SP.

IMPORTANCE:

Deep brain stimulation (DBS) is a well-established modality for the treatment of advanced Parkinson disease (PD). Recent studies have found DBS plus best medical therapy to be superior to best medical therapy alone for patients with PD and early motor complications. Although no specific age cutoff has been defined, most clinical studies have excluded patients older than 75 years of age. We hypothesize that increasing age would be associated with an increased number of postoperative complications.

OBJECTIVE:

To evaluate the stepwise effect of increasing age (in 5-year epochs) on short-term complications following DBS surgery.

DESIGN, SETTING, AND PARTICIPANTS:

A large, retrospective cohort study was performed using the Thomson Reuters MarketScan national database that examined 1757 patients who underwent DBS for PD during the period from 2000 to 2009.

MAIN OUTCOMES AND MEASURES:

Primary measures examined included hospital length of stay and aggregate and individual complications within 90 days following surgery. Multivariate logistic regression analysis was used to calculate complication-related odds ratios (ORs) for each 5-year age epoch after controlling for covariates.

RESULTS:

Overall, 132 of 1757 patients (7.5%) experienced at least 1 complication within 90 days, including wound infections (3.6%), pneumonia (2.3%), hemorrhage or hematoma (1.4%), or pulmonary embolism (0.6%). After adjusting for covariates, we found that increasing age (ranging from <50 to 90 years of age) did not significantly affect overall 90-day complication rates (OR, 1.10 per 5-year increase [95% CI, 0.96-1.25]; P = .17). The 2 most common procedure-related complications, hemorrhage (OR, 0.82 [95% CI, 0.63-1.07]; P = .14) and infection (OR, 1.04 [95% CI, 0.87-1.24]; P = .69), did not significantly increase with age.

CONCLUSIONS AND RELEVANCE:

Older patients with PD (>75 years) who were selected to undergo DBS surgery showed a similar 90-day complication risk (including postoperative hemorrhage or infection) compared with younger counterparts. Our findings suggest that age alone should not be a primary exclusion factor for determining candidacy for DBS. Instead, a clear focus on patients with medication-refractory and difficult to control on-off fluctuations with preserved cognition, regardless of age, may allow for an expansion of the traditional therapeutic window.