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Latest parkinsons articles"Latest parkinsons articles are scanned daily from major neurology journals and updated here"
"Recent publications on the subject of Parkinson Disease are scanned daily from major neurology journals and updated here" Archive of parkinsons articles Dec 2007:-A population-based study of mortality in essential tremor. Related Articles
A population-based study of mortality in essential tremor.
Neurology. 2007 Nov 20;69(21):1982-9 Louis ED, Benito-León J, Ottman R, Bermejo-Pareja F,
BACKGROUND: Although data are sparse, people with essential tremor (ET) are usually assumed to have mortality rates similar to those in the general population. Because ET is common, particularly among older adults, an influence of ET on the life span would have important public health implications. The authors compared the risks of mortality in patients with ET and control subjects without ET. METHODS: A prospective, population-based design was used to compare the risk of mortality in participants with ET vs controls in three communities in central Spain. Participants were evaluated at baseline (1994 to 1995) and at follow-up 3 years later (1997 to 1998). The relative risk (RR) of mortality (ET vs controls) was estimated using Cox proportional hazards models that excluded participants with Parkinson disease or dementia. RESULTS: Mean baseline age was 73.5 +/- 6.4 years. There were 33 (16.4%) deaths among 201 ET cases and 465 (13.9%) among 3,337 controls. In an unadjusted Cox model, risk of mortality was increased in ET (RR = 1.59, 95% CI = 1.11 to 2.27, p = 0.01). In a Cox model that adjusted for baseline age, gender, educational category, current ethanol drinking, use of antidepressant medication, and community, RR = 1.45, 95% CI = 1.01 to 2.08, p = 0.04. In an adjusted Cox model restricted to persons with longer (>3 years) follow-up, RR = 4.69 (95% CI = 2.18 to 10.07, p = 0.001). CONCLUSIONS: In this longitudinal, prospective study, the risk of mortality was increased in essential tremor. Additional studies of incident cases are needed to confirm these results.
Latest parkinsons articles PMID: 18025392 [PubMed - in process]Sensorimotor integration is abnormal in asymptomatic Parkin mutation carriers: a TMS study. Related Articles
Sensorimotor integration is abnormal in asymptomatic Parkin mutation carriers: a TMS study.
Neurology. 2007 Nov 20;69(21):1976-81
Latest parkinsons articles Latest parkinsons articles Authors: Bäumer T, Pramstaller PP, Siebner HR, Schippling S, Hagenah J, Peller M, Gerloff C, Klein C, Münchau A
BACKGROUND: In patients with Parkinson disease (PD), transcranial magnetic stimulation (TMS) studies have consistently demonstrated a reduced inhibitory tone in the sensorimotor cortex. It remains unclear whether this is related to motor symptoms or represents adaptive compensatory changes to degeneration of dopaminergic neurons. Here we used short-interval afferent inhibition after digital stimulation (dSAI) and intracortical paired-pulse inhibition and facilitation to probe intracortical sensorimotor excitability in clinically asymptomatic carriers of a single mutant Parkin allele who have a latent nigrostriatal dopaminergic dysfunction. METHODS: Nine heterozygous mutation carriers and nine healthy controls were investigated. For dSAI testing, electrical pulses were applied to the right index finger followed by TMS pulses over the left motor cortex at interstimulus intervals (ISI) of 25, 30, and 40 msec. Intracortical paired-pulse excitability was tested at ISIs of 2 to 15 msec. RESULTS: dSAI was reduced at an ISI of 25 msec in carriers of a single mutant Parkin allele, whereas paired-pulse TMS was normal. CONCLUSION: The relative decrease in sensorimotor inhibition may be a direct consequence of the Parkin mutation or represent adaptive changes at the cortical level in response to a subcortical dysfunction, but is not caused by motor symptoms.
Latest parkinsons articles PMID: 18025391 [PubMed - in process]Transcranial brain sonography findings in discriminating between parkinsonism and idiopathic Parkinson disease. Related Articles
Transcranial brain sonography findings in discriminating between parkinsonism and idiopathic Parkinson disease.
Arch Neurol. 2007 Nov;64(11):1635-40
Latest parkinsons articles Latest parkinsons articles Authors: Walter U, Dressler D, Probst T, Wolters A, Abu-Mugheisib M, Wittstock M, Benecke R
BACKGROUND: In several pilot studies, transcranial brain sonography findings of substantia nigra and lenticular nucleus discriminated between idiopathic Parkinson disease (PD) and atypical parkinsonian disorders. OBJECTIVE: To study the use of transcranial brain sonography in excluding the diagnosis of idiopathic PD in patients with sporadic parkinsonism. DESIGN AND SETTING: All patients with parkinsonism admitted to our movement disorder clinic from January 1, 2003, through December 31, 2005, who fulfilled clinical diagnostic criteria for definite PD, probable parkinsonian variant of multiple-system atrophy (MSA-P), or probable progressive supranuclear palsy (PSP) were prospectively studied with transcranial brain sonography by an investigator blinded to clinical diagnoses. Patients Eligible patients included 138 with sporadic idiopathic PD (82 men and 56 women; mean +/- SD age, 67.1 +/- 9.8 years; mean +/- SD disease duration, 7.5 +/- 6.3 years; mean +/- SD motor score on the Unified Parkinson Disease Rating Scale, 32.6 +/- 18.1), 21 with MSA-P (10 men and 11 women; mean +/- SD age, 65.4 +/- 9.5 years; mean +/- SD duration of disease, 3.1 +/- 2.0 years; mean +/- SD motor score, 33.5 +/- 16.1), and 22 with PSP (13 men and 9 women; mean +/- SD age, 71.2 +/- 5.5 years; mean +/- SD duration of disease, 3.4 +/- 2.4 years; mean +/- SD motor score, 46.2 +/- 18.9). In 7 patients, transcranial brain sonography was not possible owing to insufficient temporal acoustic bone windows. MAIN OUTCOME MEASURES: Sensitivity, specificity, and predictive value of transcranial brain sonography in indicating an atypical parkinsonian syndrome rather than idiopathic PD in patients with sporadic parkinsonism. RESULTS: Normal echogenic substantia nigra indicated MSA-P rather than PD (sensitivity, 90%; specificity, 98%; positive predictive value, 86%), whereas third-ventricle dilatation of more than 10 mm in combination with lenticular nucleus hyperechogenicity indicated PSP rather than PD (sensitivity, 84%; specificity, 98%; positive predictive value, 89%). Normal echogenic substantia nigra combined with lenticular nucleus hyperechogenicity indicated MSA-P or PSP (sensitivity, 59%; specificity, 100%; positive predictive value, 100%). In parkinsonism with age at onset younger than 60 years, normal echogenic substantia nigra alone indicated MSA-P or PSP (sensitivity, 75%; specificity, 100%; positive predictive value, 100%). CONCLUSIONS: Distinct transcranial brain sonography findings can exclude the diagnosis of PD in patients with sporadic parkinsonism. Sonographic discrimination of atypical parkinsonian syndromes from PD is clearer in patients with onset of parkinsonism at younger than 60 years.
Latest parkinsons articles PMID: 17998447 [PubMed - in process]The reluctant patient: Parkinson's disease. Related Articles
The reluctant patient: Parkinson's disease.
BMJ. 2007 Nov 10;335(7627):989-90
Latest parkinsons articles Latest parkinsons articles Authors: Helsing E
Latest parkinsons articles PMID: 17991981 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Prospective study of dietary pattern and risk of Parkinson disease. Related Articles
Prospective study of dietary pattern and risk of Parkinson disease.
Am J Clin Nutr. 2007 Nov;86(5):1486-94
Latest parkinsons articles Latest parkinsons articles Authors: Gao X, Chen H, Fung TT, Logroscino G, Schwarzschild MA, Hu FB, Ascherio A
BACKGROUND: Several studies have shown associations between Parkinson Disease (PD) risk and individual foods and nutrients with inconsistent results. OBJECTIVE: We examined associations between dietary patterns and risk of PD in the Health Professionals Follow-Up Study (1986-2002) and the Nurses' Health Study (1984-2000). DESIGN: We included 49 692 men and 81 676 women free of PD at baseline and used principal components analysis to identify major dietary patterns and the Alternate Healthy Eating Index (AHEI) and the alternate Mediterranean Diet Score (aMed) to assess diet quality. Relative risks (RRs) were computed by using Cox proportional hazards models within each cohort and were pooled by using a random-effects model. RESULTS: We documented 508 new PD cases after 16 y of follow-up. The principal components analysis identified 2 dietary patterns: prudent and Western. The prudent dietary pattern, characterized by high intakes of fruit, vegetables, and fish, was inversely associated with PD risk, but the Western pattern was not. The pooled multivariate-adjusted RR for the top compared with the bottom quintiles of the prudent score was 0.78 (95% CI: 0.56, 1.07; P for trend = 0.04). For the AHEI, the pooled multivariate-adjusted RR for the top compared with the bottom quintile was 0.70 (95% CI: 0.51, 0.94; P for trend = 0.01) and for aMED was 0.75 (95% CI: 0.57, 1.00; P for trend = 0.07). CONCLUSIONS: Dietary patterns with a high intake of fruit, vegetables, legumes, whole grains, nuts, fish, and poultry and a low intake of saturated fat and a moderate intake of alcohol may protect against PD. Benefits of a plant-based dietary pattern including fish to PD merit further investigation.
Latest parkinsons articles PMID: 17991663 [PubMed - in process]REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia. Related Articles
REM sleep behavior disorder predicts cognitive impairment in Parkinson disease without dementia.
Neurology. 2007 Nov 6;69(19):1843-9
Latest parkinsons articles Latest parkinsons articles Authors: Vendette M, Gagnon JF, Décary A, Massicotte-Marquez J, Postuma RB, Doyon J, Panisset M, Montplaisir J
OBJECTIVE: To assess the relationship between the presence of REM sleep behavior disorder (RBD) and the cognitive profile of nondemented patients with Parkinson disease (PD). BACKGROUND: Cognitive impairment is an important nonmotor symptom in PD. Waking EEG slowing in nondemented PD has been related to the presence of RBD, a parasomnia affecting brainstem structures and frequently reported in PD. For this reason, RBD may be associated with cognitive impairment in PD. METHODS: Thirty-four patients with PD (18 patients with polysomnographic-confirmed RBD and 16 patients without RBD) and 25 healthy control subjects matched for age and educational level underwent sleep laboratory recordings and a comprehensive neuropsychological assessment. RESULTS: Patients with PD and concomitant RBD showed significantly poorer performance on standardized tests measuring episodic verbal memory, executive functions, as well as visuospatial and visuoperceptual processing compared to both patients with PD without RBD and control subjects. Patients with PD without RBD had no detectable cognitive impairment compared to controls. CONCLUSIONS: This study shows that cognitive impairment in nondemented patients with Parkinson disease (PD) is closely related to the presence of REM sleep behavior disorder, a sleep disturbance that was not controlled for in previous studies assessing cognitive deficits in PD.
Latest parkinsons articles PMID: 17984452 [PubMed - in process]Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease. Related Articles
Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease.
Neurology. 2007 Nov 6;69(19):1836-42
Latest parkinsons articles Latest parkinsons articles Authors: Wahner AD, Bronstein JM, Bordelon YM, Ritz B
OBJECTIVE: Markers of neuroinflammation, including activated microglia and increased levels of circulating proinflammatory cytokines, have been observed in the brains and CSF of patients with Parkinson disease (PD). Yet the link between anti-inflammatory agents and PD in humans remains uncertain, despite indications that neuroinflammation may contribute to cell death in the PD brain and experimental evidence of anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) exerting neuroprotective effects in animal models. METHODS: Using a population-based approach, we studied NSAID use among 293 incident idiopathic PD cases and 286 age-, race-, and gender-matched controls from three rural California counties. RESULTS: Our data suggested a decreased risk of PD among regular (>or=2 pills/week for at least 1 month) aspirin NSAID users (OR, 0.80; 95% CI, 0.56 to 1.15). A stronger protective effect was observed for regular nonaspirin NSAID users (OR, 0.52; 95% CI, 0.35 to 0.79), particularly those who reported 2 or more years of use (OR, 0.44; 95% CI, 0.26 to 0.74). The aspirin effect estimates differed by gender, showing a protective effect only in women, especially among long term (>or=24 months) regular users (OR, 0.51; 95% CI, 0.26 to 1.02). CONCLUSION: Our study contributes to the growing body of literature suggesting a protective role for nonsteroidal anti-inflammatory drugs (NSAIDs) in Parkinson disease (PD). Given our results and the biologic plausibility of a neuroprotective function for NSAIDs there is a pressing need for further studies elucidating the protective role such drugs may play in PD.
Latest parkinsons articles PMID: 17984451 [PubMed - in process]Orange and green monkeys jumping around the room. Related Articles
Orange and green monkeys jumping around the room.
Lancet. 2007 Nov 3;370(9598):1588
Latest parkinsons articles Latest parkinsons articles Authors: Guptha SH, Han T, Arafat Q, Deyo O
Latest parkinsons articles PMID: 17980737 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Incidence of symptomatic hemorrhage after stereotactic electrode placement. Related Articles
Incidence of symptomatic hemorrhage after stereotactic electrode placement.
J Neurosurg. 2007 Nov;107(5):998-1003
Latest parkinsons articles Latest parkinsons articles Authors: Sansur CA, Frysinger RC, Pouratian N, Fu KM, Bittl M, Oskouian RJ, Laws ER, Elias WJ
OBJECT: Intracranial hemorrhage (ICH) is the most significant complication associated with the placement of stereotactic intracerebral electrodes. Previous reports have suggested that hypertension and the use of microelectrode recording (MER) are risk factors for cerebral hemorrhage. The authors evaluated the incidence of symptomatic ICH in a large cohort of patients with various diseases treated with stereotactic electrode placement. They examined the effect of comorbidities on the risk of ICH and independently assessed the risks associated with age, sex, use of MER, diagnosis, target location, hypertension, and previous use of anticoagulant medications. The authors also evaluated the effect of hemorrhage on length of hospital stay and discharge disposition. METHODS: Between 1991 and 2005, 567 electrodes were placed by two neurosurgeons during 337 procedures in 259 patients. Deep brain stimulation (DBS) was performed in 167 procedures, radiofrequency lesioning (RFL) of subcortical structures in 74, and depth electrodes were used in 96 procedures in patients with epilepsy. Electrodes were grouped according to target, patient diagnosis, use of MER, patient history of hypertension, and patient prior use of anticoagulant medication (stopped 10 days before surgery). The Charlson Comorbidity Index (CCI) was used to evaluate the effect of comorbidities. The CCI score, patient age, length of hospital stay, and discharge status were continuous variables. Symptomatic hemorrhages were grouped as transient or leading to permanent neurological deficits. RESULTS: The risk of hemorrhage leading to permanent neurological deficits in this study was 0.7%, and the risk of symptomatic hemorrhage was 1.2%. A patient history of hypertension was the most significant factor associated with hemorrhage (p = 0.007). Older age, male sex, and a diagnosis of Parkinson disease (PD) were also significantly associated with hemorrhage (p = 0.01, 0.04, 0.007, respectively). High CCI scores, specific target locations, and prior use of anticoagulant therapy were not associated with an increased risk of hemorrhage. The use of MER was not found to be correlated with an increased hemorrhage rate (p = 0.34); however, the number of hemorrhages in the patients who underwent DBS was insufficient to draw definitive conclusions. The mean length of stay for the DBS, RFL, and depth electrode patient groups was 2.9, 2.6, and 11.0 days, respectively. For patients who received DBS and RFL, the mean duration of hospitalization in cases of symptomatic hemorrhage was 8.2 days compared with 2.7 days in those without hemorrhaging (p < 0.0001). Three of the seven patients with symptomatic hemorrhages were discharged home. CONCLUSIONS: The placement of stereotactic electrodes is generally safe, with a symptomatic hemorrhage rate of 1.2%, and a 0.7% rate of permanent neurological deficit. Consistent with prior reports, this study confirms that hypertension is a significant risk factor for hemorrhage. Age, male sex, and diagnosis of PD were also significant risk factors. Patients with symptomatic hemorrhage had longer hospital stays and were less likely to be discharged home.
Latest parkinsons articles PMID: 17977273 [PubMed - in process]Beating a dead horse: dopamine and Parkinson disease. Related Articles
Beating a dead horse: dopamine and Parkinson disease.
Neurology. 2007 Oct 23;69(17):1701-11
Latest parkinsons articles Latest parkinsons articles Authors: Ahlskog JE
Our collective thinking about Parkinson disease (PD) has been heavily influenced by the dramatic response to dopamine replacement therapy. For progress to continue, however, we need to take a broad view of this disorder, which includes recognition of the following. First, substantial evidence now indicates that dopamine oxidation is unlikely to substantially contribute to the pathogenesis of PD. Second, levodopa therapy is not associated with neurotoxicity. Third, the first neurons affected in PD are nondopaminergic; the substantia nigra and other dopaminergic nuclei are affected only later in the course. Thus, PD is much more than degeneration of the dopaminergic nigrostriatal system. Fourth, in the current era, most of the disability of advancing PD is from involvement of nondopaminergic systems, including levodopa-refractory motor symptoms, dementia, and dysautonomia. Motor complications associated with levodopa therapy can be problematic, but they can be controlled in most, using available medications and deep brain stimulation surgery. We have reached the point of diminishing therapeutic returns with drugs acting on dopamine systems; more dopaminergic medications will provide only modest incremental benefit over current therapies. Finally, the benefits from transplantation surgeries aimed at restoring dopaminergic neurotransmission will be limited because later-stage PD disability comes from nondopaminergic substrates. Scale.
Latest parkinsons articles PMID: 17954785 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Gout and risk of Parkinson disease: a prospective study. Related Articles
Gout and risk of Parkinson disease: a prospective study.
Neurology. 2007 Oct 23;69(17):1696-700
Latest parkinsons articles Latest parkinsons articles Authors: Alonso A, Rodríguez LA, Logroscino G, Hernán MA
BACKGROUND: Several reports suggest that higher levels of serum uric acid are associated with a lower risk of Parkinson disease (PD). None of these studies, however, evaluated the potential association between gout, a condition characterized by hyperuricemia, and the risk of PD. OBJECTIVE: To estimate prospectively the association between gout diagnosis and the risk of PD. METHODS: We conducted a case-control study nested in the General Practice Research Database, a computerized database that gathers information on more than 3 million Britons followed up by their general practitioners. PD cases occurring between January 1995 and December 2001 were identified, and matched with up to 10 controls by sex, age, practice, and start of follow-up. We obtained information on history of gout and use of anti-gout medication using the computerized medical records. RESULTS: During the study period, we identified 1,052 PD cases and 6,634 controls. Individuals with previous history of gout had a lower risk of developing PD (OR 0.69, 95% CI 0.48, 0.99). This association was evident among men (OR 0.60, 95% CI 0.40, 0.91) but not among women (OR 1.26, 95% CI 0.57, 2.81; p for interaction: 0.11). Initiation of anti-gout medication was associated with a lower risk of PD (OR 0.57, 95% CI 0.19, 1.70). CONCLUSION: Gout is associated with a lower risk of Parkinson disease (PD). Our findings provide additional support for a potential link between uric acid and PD. Further research is required to explore a potential effect modification by sex.
Latest parkinsons articles PMID: 17954784 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]The LRRK2 G2019S mutation in Ashkenazi Jews with Parkinson disease: is there a gender effect? Related Articles
The LRRK2 G2019S mutation in Ashkenazi Jews with Parkinson disease: is there a gender effect?
Neurology. 2007 Oct 16;69(16):1595-602
Latest parkinsons articles Latest parkinsons articles Authors: Orr-Urtreger A, Shifrin C, Rozovski U, Rosner S, Bercovich D, Gurevich T, Yagev-More H, Bar-Shira A, Giladi N
BACKGROUND: Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are the most common genetic determinant of Parkinson disease (PD) identified to date, and have been implicated in both familial and sporadic forms of the disease. The G2019S change in LRRK2 exon 41 has been associated with disease at varying frequencies in Asian, European, North American, and North African populations, and is particularly prevalent among Ashkenazi Jews. METHODS: We assessed the occurrence of the LRRK2 G2019S, I2012T, I2020T, and R1441G/C/H mutations in our cohort of Jewish Israeli patients with PD, and determined the LRRK2 haplotypes in 76 G2019S-carriers detected and in 50 noncarrier Ashkenazi patients, using six microsatellite markers that span the entire gene. RESULTS: Only the G2019S mutation was identified among our patients with PD, 14.8% in the Ashkenazi and 2.7% in the non-Ashkenazi patients, and in 26% and 10.6% of the Ashkenazi familial and apparently sporadic cases. The carrier frequencies in the Ashkenazi and non-Ashkenazi control samples were 2.4% and 0.4%. A common shared haplotype was detected in all non-Ashkenazi and half-Ashkenazi carriers and in all full-Ashkenazi carriers tested, except two. Women and patients with a positive family history of PD were significantly over-represented among the G2019S mutation carriers. Age at disease onset was similar in carriers and noncarriers. CONCLUSIONS: Our data suggest that the LRRK2 G2019S mutation plays an important role in the causality of familial and sporadic Parkinson disease (PD) in Israel and that gender affects its frequency among patients. Although testing symptomatic patients may help establish the diagnosis of PD, the value of screening asymptomatic individuals remains questionable until the penetrance and age-dependent risk of this mutation are more accurately assessed, and specific disease prevention or modifying interventions become available.
Latest parkinsons articles PMID: 17938369 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Hemiparkinsonism-hemiatrophy syndrome. Related Articles
Hemiparkinsonism-hemiatrophy syndrome.
Neurology. 2007 Oct 16;69(16):1585-94
Latest parkinsons articles Latest parkinsons articles Authors: Wijemanne S, Jankovic J
OBJECTIVE: To characterize the clinical and radiologic features of hemiparkinsonism-hemiatrophy syndrome (HPHA). METHODS: Medical records of patients with evidence of unilateral parkinsonism and ipsilateral body atrophy, evaluated at the Baylor College of Medicine Movement Disorders Clinic, were reviewed. RESULTS: The mean age at onset of the 30 patients who satisfied the criteria was 44.2 (15 to 63) years with a mean duration of symptoms for 9.7 (2 to 20) years. Half of all patients had dystonia at onset and dystonia was present in 21 (70%) patients during the course of the syndrome. Eleven (37%) also had scoliosis. Brain asymmetry on imaging studies was noted in 9 (30%) patients. Response to levodopa was rated as good in 18, moderate in 6, and poor in 6. Nine of 19 (47%) patients in whom birth history was available had difficult birth or had severe febrile illness in the first few months of life. Overall 10 (33%) patients had difficulty in walking during early childhood. CONCLUSION: Although the clinical features of hemiparkinsonism-hemiatrophy syndrome are variable, suggesting a heterogeneous pathogenesis, perinatal and early childhood cerebral injury appears to play an important role in about half of the cases.
Latest parkinsons articles PMID: 17938368 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Connectivity of the human pedunculopontine nucleus region and diffusion tensor imaging in surgical targeting. Related Articles
Connectivity of the human pedunculopontine nucleus region and diffusion tensor imaging in surgical targeting.
J Neurosurg. 2007 Oct;107(4):814-20
Latest parkinsons articles Latest parkinsons articles Authors: Muthusamy KA, Aravamuthan BR, Kringelbach ML, Jenkinson N, Voets NL, Johansen-Berg H, Stein JF, Aziz TZ
OBJECT: The pedunculopontine nucleus (PPN) region of the brainstem has become a new stimulation target for the treatment of gait freezing, akinesia, and postural instability in advanced Parkinson disease (PD). Because PD locomotor symptoms are probably caused by excessive gamma-aminobutyric acidergic inhibition of the PPN, low-frequency stimulation of the PPN may overcome this inhibition and improve the symptoms. However, the anatomical connections of this region in humans are not known in any detail. METHODS: Diffusion weighted magnetic resonance (MR) images were acquired at 1.5 teslas, and probabilistic tractography was used to trace the connections of the PPN region in eight healthy volunteers. A single seed voxel (2 x 2 x 2 mm) was chosen in the PPN just lateral to the decussation of the superior cerebellar peduncle, and the Diffusion Toolbox of the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain was used to process the acquired MR images. The connections of each volunteer's PPN region were analyzed using a human brain MR imaging atlas. RESULTS: The PPN region was connected with the cerebellum and spinal cord below and to the thalamus, pallidum, subthalamic nucleus, and motor cortex above. The regions of the primary motor cortex that control the trunk and upper and lower extremities had the highest connectivity compared with other parts of motor cortex. CONCLUSIONS: These findings suggest that connections of the PPN region with the primary motor cortex, basal ganglia, thalamus, cerebellum, and spinal cord may play important roles in the regulation of movement by the PPN region. Diffusion tensor imaging tractography of the PPN region may be used preoperatively to optimize placement of stimulation electrodes and postoperatively it may also be useful to reassess electrode positions.
Latest parkinsons articles PMID: 17937229 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Peripheral edema and dopamine agonists in Parkinson disease. Related Articles
Peripheral edema and dopamine agonists in Parkinson disease.
Arch Neurol. 2007 Oct;64(10):1546-7; author reply 1547
Latest parkinsons articles Latest parkinsons articles Authors: Tan EK
Latest parkinsons articles PMID: 17923645 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Sleepwalking in patients with Parkinson disease. Related Articles
Sleepwalking in patients with Parkinson disease.
Arch Neurol. 2007 Oct;64(10):1524-7
Latest parkinsons articles Latest parkinsons articles Authors: Poryazova R, Waldvogel D, Bassetti CL
OBJECTIVE: To report the occurrence of adult-onset (de novo) sleepwalking in a series of 6 patients with idiopathic Parkinson disease (PD). DESIGN: Case series. SETTING: Outpatient clinic for movement disorders. Patients and METHODS: Of 165 consecutive patients with PD seen for 2 years, 6 patients with adult-onset sleepwalking were identified. These patients underwent a systematic clinical assessment of their extrapyramidal and sleep problems, which included standard questionnaires, clinical examination, and estimation of PD severity (motor score of the Unified PD Rating Scale and Hoehn and Yahr stage). Five of 6 patients had a video-polysomnography recording that was scored according to international criteria. RESULTS: Patients included 3 women and 3 men with a mean (+/-SD) age of 66 +/- 12 years (range, 46-78 years). The mean (+/-SD) Unified PD Rating Scale score was 25 +/- 9 (range, 10-35) and the mean (+/-SD) Hoehn and Yahr stage was 2.5 +/- 1.0 (range, 1.0-4.0). Medications in these patients included levodopa (n = 6), dopamine agonists (n = 4), selective serotonin reuptake inhibitor antidepressants (n = 3), and hypnotics (n = 3). All patients had at least 1 concomitant sleep-wake disorder, including rapid eye movement sleep behavior disorder (n = 4) and insomnia (n = 4). In 2 of 6 patients, the latency between onset of PD and appearance of sleepwalking was more than 4 years. CONCLUSION: Neurodegenerative changes associated with PD at the brainstem level can affect the "ascending" control of state transition (leading to dissociated arousals from non-rapid eye movement and/or rapid eye movement sleep) and the "descending" control of locomotion and muscle tone, together giving rise to various sleep-associated behavioral disturbances including sleepwalking, rapid eye movement sleep behavior disorder, and overlap parasomnia.
Latest parkinsons articles PMID: 17923637 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Importance of low-range CAG expansion and CAA interruption in SCA2 Parkinsonism. Related Articles
Importance of low-range CAG expansion and CAA interruption in SCA2 Parkinsonism.
Arch Neurol. 2007 Oct;64(10):1510-8
Latest parkinsons articles Latest parkinsons articles Authors: Kim JM, Hong S, Kim GP, Choi YJ, Kim YK, Park SS, Kim SE, Jeon BS
OBJECTIVES: To examine the presence of an ATXN2 mutation in patients with parkinsonism in the Korean population and to find the difference in the ATXN2 mutation between ataxic and parkinsonian phenotypes. DESIGN: Survey. SETTING: Seoul National University Hospital (a referral center). Patients Patients with Parkinson disease (PD) (n = 468) and the Parkinson variant of multiple system atrophy (MSA-P) (n = 135) who were seen at our Department of Neurology during the past 3 years. MAIN OUTCOME MEASURES: CAG expansion in spinocerebellar ataxia type 2 (SCA2) alleles was assessed by polymerase chain reaction amplification and fragment analysis, and its size and interruption were verified by cloning and sequencing. SCA2 was tested also in the family members of the probands. Striatal dopamine transporter (DAT) and D(2) receptor status were evaluated in the probands and their SCA2-positive family members using iodine I 123 [(123)I]-radiolabeled fluoropropyl (FP) 2-carbomethoxy-3-(4-iodophenyl) tropane (CIT) with single-photon emission computed tomography (SPECT) and carbon C 11 [(11)C]-radiolabeled raclopride positron emission tomography (PET). RESULTS: We found 3 patients with apparently sporadic disease with expanded CAG repeats in the ATXN2 locus. Two patients had a PD phenotype. The third patient showed an MSA-P phenotype. The CAG repeats in the ATXN2 locus of the patients were 35/22, 34/22, and 32/22, respectively (range in normal population, 19-27). The size of repeats was lower than the CAG repeats (38-51) in ataxic SCA2 in our population. The sequence of expanded CAG repeats was interrupted by CAA as (CAG)(n)(CAA)(CAG)(8) in all the patients. DNA analyses in 2 families showed 2 asymptomatic carriers in each family. In the patient with the PD phenotype, striatal DAT loss was more severe in the putamen than the caudate, and [(11)C]raclopride PET showed an increased relative putamen-caudate binding ratio. The patient with the MSA-P phenotype had severe DAT loss throughout the striatum. Two of 3 asymptomatic carriers had striatal DAT loss. CONCLUSIONS: This study demonstrates that SCA2 is one of the genetic causes of PD and MSA-P. All 3 patients had apparently sporadic disease, emphasizing the need to screen even in patients with nonfamilial disease. CAG repeats were in the low expansion range and interrupted by CAA in all patients in the low-range expansion. Therefore, accurate determination of CAG expansion and ATXN2 sequencing are warranted. [(123)I]FP-CIT SPECT and [(11)C]raclopride PET provide a useful way to evaluate the degree of nigrostriatal dopaminergic damage in SCA2-related parkinsonism and gene carriers.
Latest parkinsons articles PMID: 17923635 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease. Related Articles
Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease.
Arch Neurol. 2007 Oct;64(10):1458-64
Latest parkinsons articles Latest parkinsons articles Authors: Rocca WA, Bower JH, Ahlskog JE, Elbaz A, Grossardt BR, McDonnell SK, Schaid DJ, Maraganore DM
BACKGROUND: The evidence for increased risk of dementia in relatives of patients with Parkinson disease (PD) remains conflicting. OBJECTIVE: To study the risk of cognitive impairment or dementia in first-degree relatives of patients with PD. Design, Setting, and PARTICIPANTS: We conducted a historical cohort study of 1019 first-degree relatives of 162 patients with PD and of 858 relatives of 147 matched controls representative of the population of Olmsted County, Minnesota. In addition, we studied 2716 first-degree relatives of 411 patients with PD referred to Mayo Clinic. MAIN OUTCOME MEASURES: We administered via telephone a cognitive test directly to relatives or a dementia questionnaire to proxies. For relatives reported by proxies to have dementia, we obtained copies of their medical records to confirm the diagnosis. We also obtained dementia information from a medical records-linkage system. RESULTS: In the overall population-based sample, the risk of cognitive impairment or dementia was increased in relatives of patients with PD compared with relatives of controls (hazard ratio, 1.37; 95% confidence interval, 1.03-1.81; P = .03) and was particularly increased in relatives of patients with onset of PD at age 66 years or younger (youngest tertile; hazard ratio, 1.73; 95% confidence interval, 1.21-2.46; P = .003). The findings were consistent in several sensitivity analyses. In the referral-based sample, the risk of cognitive impairment or dementia in relatives increased with younger age at onset of PD but did not vary by other clinical characteristics. CONCLUSION: Cognitive impairment or dementia may share familial susceptibility factors with PD (genetic or nongenetic).
Latest parkinsons articles PMID: 17923629 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Alzheimer and Parkinson diagnoses in progranulin null mutation carriers in an extended founder family. Related Articles
Alzheimer and Parkinson diagnoses in progranulin null mutation carriers in an extended founder family.
Arch Neurol. 2007 Oct;64(10):1436-46
Latest parkinsons articles Latest parkinsons articles Authors: Brouwers N, Nuytemans K, van der Zee J, Gijselinck I, Engelborghs S, Theuns J, Kumar-Singh S, Pickut BA, Pals P, Dermaut B, Bogaerts V, De Pooter T, Serneels S, Van den Broeck M, Cuijt I, Mattheijssens M, Peeters K, Sciot R, Martin JJ, Cras P, Santens P, Vandenberghe R, De Deyn PP, Cruts M, Van Broeckhoven C, Sleegers K
BACKGROUND: Progranulin gene (PGRN) haploinsufficiency was recently associated with ubiquitin-positive frontotemporal lobar degeneration linked to chromosome 17q21 (FTLDU-17). OBJECTIVE: To assess whether PGRN genetic variability contributed to other common neurodegenerative brain diseases, such as Alzheimer disease (AD) or Parkinson disease (PD). DESIGN: Mutation analysis of PGRN. SETTING: Memory Clinic of the Middelheim General Hospital. Patients We analyzed 666 Belgian patients with AD and 255 with PD. MAIN OUTCOME MEASURES: Results of PGRN sequencing, PGRN transcript analysis, short tandem repeat genotyping, and neuropathologic analysis. RESULTS: We identified 2 patients with AD and 1 patient with PD who carried the null mutation IVS0 + 5G>C, which we reported earlier in an extensively characterized Belgian founder family, DR8, segregating FTLDU. Postmortem pathologic diagnosis of the patient with PD revealed both FTLDU and Lewy body pathologic features. In addition, we identified in PGRN only 1 other null mutation, the nonsense mutation p.Arg535X, in 1 patient with probable AD. However, in vitro analysis predicted a PGRN C-truncated protein, although it remains to be elucidated if this shortened transcript leads to haploinsufficiency. CONCLUSIONS: Our mutation data indicated that null mutations are rare in patients with AD (3/666 = 0.45%) and PD (1/255 = 0.39%). Also, AD and PD clinical diagnoses in patients who carry PGRN null mutations likely result from etiologic heterogeneity rather than PGRN haploinsufficiency.
Latest parkinsons articles PMID: 17923627 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]I can't get no satisfaction: still no neuroprotection for Parkinson disease. Related Articles
I can't get no satisfaction: still no neuroprotection for Parkinson disease.
Neurology. 2007 Oct 9;69(15):1476-7
Latest parkinsons articles Latest parkinsons articles Authors: Ahlskog JE
Latest parkinsons articles PMID: 17923609 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Predictors of fitness to drive in people with Parkinson disease. Related Articles
Predictors of fitness to drive in people with Parkinson disease.
Neurology. 2007 Oct 2;69(14):1434-41
Latest parkinsons articles Latest parkinsons articles Authors: Devos H, Vandenberghe W, Nieuwboer A, Tant M, Baten G, De Weerdt W
OBJECTIVE: To develop an efficient clinical screening battery to accurately predict the fitness to drive in people with Parkinson disease (PD). METHODS: This prospective study included 80 participants: 40 patients with PD and 40 healthy age- and sex-matched control subjects. All participants were assessed using a driving simulator, a driving history survey, and the Clinical Dementia Rating. The patients with PD also underwent a clinical test battery and an evaluation of fitness to drive performed by an official center, which included visual, cognitive, and on-road tests. A two-class decision from this driving assessment center was the main outcome measure. RESULTS: A screening battery assessing four clinical variables (disease duration, contrast sensitivity, Clinical Dementia Rating, and motor part of the Unified Parkinson's Disease Rating Scale) provided the best model (R(2) = 0.52) to predict the fitness to drive and correctly classified 36 (90%) of the patients with PD as pass or fail (sensitivity = 91%, specificity = 90%). The Test Ride for Investigating Practical fitness to drive (TRIP) driving simulator score discriminated significantly between drivers with PD and their healthy peers (p = 0.0008). When the TRIP driving simulator score was added to the clinical model, the total explained variance increased (R(2) = 0.60) and correctly classified 39 (97.5%) of drivers with PD into the pass/fail category (sensitivity = 91%, specificity = 100%). CONCLUSIONS: A short clinical screening battery that measures disease duration, contrast sensitivity, cognitive and motor functions can predict fitness to drive in people with Parkinson disease with a high degree of accuracy.
Latest parkinsons articles PMID: 17909156 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Fast-track programming and rehabilitation model: a novel approach to postoperative deep brain stimulation patient care. Related Articles
Fast-track programming and rehabilitation model: a novel approach to postoperative deep brain stimulation patient care.
Arch Phys Med Rehabil. 2007 Oct;88(10):1320-4
Latest parkinsons articles Latest parkinsons articles Authors: Cohen DB, Oh MY, Baser SM, Angle C, Whiting A, Birk C, Whiting DM
OBJECTIVE: To propose a new model of integrated, multidisciplinary postoperative care of the patients with deep brain stimulation (DBS). DESIGN: Observational cohort study with follow-up at 3 months and 1 year. SETTING: Academic medical center movement disorder clinic. PARTICIPANTS: Seventy-three consecutive patients with medically refractory Parkinson's disease underwent bilateral DBS. Patients were then transferred directly to an inpatient rehabilitation facility. INTERVENTION: DBS and inpatient programming and rehabilitation. Simultaneous programming and rehabilitation was carried out by a multidisciplinary team. MAIN OUTCOME MEASURES: The FIM instrument, Unified Parkinson Disease Rating Scale (UPDRS), and levodopa dosage. RESULTS: The average rehabilitation stay was 17.3 days, with a mean of 6.2 stimulator adjustments during that time. FIM scores improved from 62.1 (admission) to 98.5 (discharge), an average improvement of 36.4 (58.6%). Average UPDRS scores improved from 52.5 (preoperative off) and 30.1 (preoperative on) to 20.4 (3mo postoperative on-medication, on-stimulation), a 32.2% improvement from the preoperative on score. Levodopa dosages decreased by an average of 48.3% (all P<.001). CONCLUSIONS: We describe our fast-track protocol, which allows for rapid DBS programming and tapering of Parkinson's medications. It also provides for treatment of concomitant medical and psychologic problems and optimized physical performance.
Latest parkinsons articles PMID: 17908576 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Validity of the trunk impairment scale as a measure of trunk performance in people with Parkinson's disease. Related Articles
Validity of the trunk impairment scale as a measure of trunk performance in people with Parkinson's disease.
Arch Phys Med Rehabil. 2007 Oct;88(10):1304-8
Latest parkinsons articles Latest parkinsons articles Authors: Verheyden G, Willems AM, Ooms L, Nieuwboer A
OBJECTIVE: To evaluate construct validity of the Trunk Impairment Scale (TIS) as a measure of trunk performance in Parkinson's disease (PD). DESIGN: A cross-sectional study of PD patients and healthy subjects. SETTING: University rehabilitation research unit. PARTICIPANTS: Twenty-six PD patients (Hoehn and Yahr stages 2-4) and 26 healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TIS and its subscales; static and dynamic sitting balance and trunk coordination. RESULTS: Compared with healthy controls, PD patients showed significantly lower scores on the total TIS, static sitting balance, and coordination subscale. Healthy subjects scored significantly better on the total TIS and coordination subscale compared with patients in the early stage of PD. Patients with PD in the early stage scored significantly higher for the total TIS as well as static and dynamic sitting balance in comparison with PD patients in a later stage. Forward stepwise multiple linear regression analysis showed that trunk impairment in PD patients was significantly related to a combination of older age and a higher score on part III of the Unified Parkinson's Disease Rating Scale, which assesses motor impairments. CONCLUSIONS: Early detection of trunk deficits and the significant relation with PD severity advocates further evaluation and use of the TIS in PD.
Latest parkinsons articles PMID: 17908573 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Presentation and management of psychosis in Parkinson's disease and dementia with Lewy bodies. Related Articles
Presentation and management of psychosis in Parkinson's disease and dementia with Lewy bodies.
Am J Psychiatry. 2007 Oct;164(10):1491-8
Latest parkinsons articles Latest parkinsons articles Authors: Weintraub D, Hurtig HI
Latest parkinsons articles PMID: 17898337 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Glial cell-derived neurotrophic factor protects against proteasome inhibition-induced dopamine neuron degeneration by suppression of endoplasmic reticulum stress and caspase-3 activation. Related Articles
Glial cell-derived neurotrophic factor protects against proteasome inhibition-induced dopamine neuron degeneration by suppression of endoplasmic reticulum stress and caspase-3 activation.
J Gerontol A Biol Sci Med Sci. 2007 Sep;62(9):943-50
Latest parkinsons articles Latest parkinsons articles Authors: Li X, Peng C, Li L, Ming M, Yang D, Le W
Evidence has shown that ubiquitin proteasome system (UPS) impairment plays an important role in the dopamine (DA) neurodegeneration in Parkinson's disease (PD). It has been reported that application of proteasomal inhibitor lactacystin in ventral mesencephalon (VM) cultures can cause DA neurodegeneration, although the underlying mechanisms are not clear. Herein, we used the lactacystin-induced DA cell degeneration model to study the neuroprotection of glial cell-derived neurotrophic factor (GDNF) in VM cultures. We measured the expression of endoplasmic reticulum stress (ERS)-related genes, and determined the caspase-3 activation, apoptotic cell death, as well as alpha-synuclein-positive inclusions in DA neurons. We found that GDNF treatment significantly suppressed the expression of ERS-related genes and inhibited the activation of caspase-3 and apoptotic cell death without affecting alpha-synuclein-positive inclusions in DA neurons. Our study suggests that the protection of GDNF against DA neurodegeneration in the UPS impairment model is associated with ERS and caspase-3 suppression.
Latest parkinsons articles PMID: 17895431 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Black substance. Related Articles
Black substance.
Neurology. 2007 Sep 25;69(13):1380
Latest parkinsons articles Latest parkinsons articles Authors: McGuire D
Latest parkinsons articles PMID: 17893299 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Characteristics and distribution of somatosensory evoked potentials in the subthalamic region. Related Articles
Characteristics and distribution of somatosensory evoked potentials in the subthalamic region.
J Neurosurg. 2007 Sep;107(3):548-54
Latest parkinsons articles Latest parkinsons articles Authors: Kitagawa M, Murata J, Uesugi H, Hanajima R, Ugawa Y, Saito H
OBJECT: The aim of the present study is to evaluate the topographical distribution of somatosensory evoked potentials (SSEPs) in the subthalamic area, including the zona incerta (ZI). Determination of this distribution may help in the correct placement of deep brain stimulation (DBS) leads. METHODS: Intraoperative SSEPs were recorded from contacts of DBS electrodes at 221 sites in 41 patients: three patients with essential tremor and 38 with Parkinson disease who underwent implantation of DBS electrodes for the relief of severe tremor or parkinsonism. RESULTS: Two distinct SSEPs were recorded in the subthalamic area. One was a monophasic positive wave with a mean latency of 15.8 +/- 0.9 msec, which the authors designated subthalamic P16. Using both cephalic and noncephalic references, subthalamic P16 was only recorded in the ventral part of the ZI (mean 6.6 +/- 1.3 mm posterior to the midcommissure point, 4.8 +/- 1.2 mm inferior to the anterior commissure-posterior commissure line, and 9.7 +/- 0.6 mm lateral to the midline). When bipolar recordings were made, the traces showed a phase reversal at the caudal part of the ZI. The second potential is a positive-negative SSEP recorded throughout the entire subthalamic area. The mean latencies of the initial positive peak and the major negative peak were 13.6 +/- 1.1 msec and 16.4 +/- 1.1 msec, respectively. Several small notches were superimposed on the peaks, and their amplitudes were largest at the contact close to the medial lemniscus. CONCLUSIONS: The results indicate that intraoperative SSEPs from DBS electrodes are helpful in refining stereotactic targets in the thalamus and subthalamic areas.
Latest parkinsons articles PMID: 17886554 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Molecular neuroimaging: from conventional to emerging techniques. Related Articles
Molecular neuroimaging: from conventional to emerging techniques.
Radiology. 2007 Oct;245(1):21-42
Latest parkinsons articles Latest parkinsons articles Authors: Hammoud DA, Hoffman JM, Pomper MG
The use of molecular imaging techniques in the central nervous system (CNS) has a rich history. Most of the important developments in imaging-such as computed tomography, magnetic resonance imaging, single photon emission computed tomography, and positron emission tomography-began with neuropsychiatric applications. These techniques and modalities were then found to be useful for imaging other organs involved with various disease processes. Molecular imaging of the CNS has enabled scientists and researchers to understand better the basic biology of brain function and the way in which various disease processes affect the brain. Unlike other organs, the brain is not easily accessible, and it has a highly selective barrier at the endothelial cell level known as the blood-brain barrier. Furthermore, the brain is the most complex cellular network known to exist. Various neurotransmitters act in either an excitatory or an inhibitory fashion on adjacent neurons through a multitude of mechanisms. The various neuronal systems and the myriad of neurotransmitter systems become altered in many diseases. Some of the most devastating diseases, including Alzheimer disease, Parkinson disease, brain tumors, psychiatric disease, and numerous degenerative neurologic diseases, affect only the brain. Molecular neuroimaging will be critical to the future understanding and treatment of these diseases. Molecular neuroimaging of the brain shows tremendous promise for clinical application. In this article, the current state and clinical applications of molecular neuroimaging will be reviewed.
Latest parkinsons articles PMID: 17885179 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Mixed lineage kinase inhibitor CEP-1347 fails to delay disability in early Parkinson disease.
Mixed lineage kinase inhibitor CEP-1347 fails to delay disability in early Parkinson disease.
Neurology. 2007 Oct 9;69(15):1480-90
Latest parkinsons articles Latest parkinsons articles Authors:
BACKGROUND: CEP-1347 inhibits mixed lineage kinases that activate apoptotic pathways implicated in the pathogenesis of Parkinson disease (PD). CEP-1347 enhances neuronal survival in a variety of nonclinical models and was found to be safe and well tolerated during 4 weeks in PD patients. We conducted the Parkinson Research Examination of CEP-1347 Trial (PRECEPT) to assess its disease-modifying potential in early PD. METHODS: Consenting PD patients not yet requiring dopaminergic therapy (n = 806) were randomized equally to CEP-1347 in dosages of 10 mg BID, 25 mg BID, or 50 mg BID, or matching placebo, and were evaluated blindly and prospectively. The primary clinical end point was time to the development of disability requiring dopaminergic therapy. Secondary end points included changes in the Unified Parkinson's Disease Rating Scale (UPDRS) and beta-CIT SPECT imaging of striatal dopamine transporters. RESULTS: The study was concluded early, after an average of 21.4 months of follow-up, when a planned interim analysis demonstrated that it would be futile to continue experimental treatment. At that time, 108 of 191 subjects randomized to placebo (57%) had reached the primary end point of disability requiring dopaminergic therapy compared with active CEP-1347: 133 of 205 (65%) on 10 mg BID, 126 of 212 (59%) on 25 mg BID, and 127 of 198 (64%) on 50 mg BID. Changes in UPDRS scores and beta-CIT imaging showed similar patterns. CONCLUSIONS: In contrast to research in animal models that predicted favorable disease-modifying outcomes, we found CEP-1347 to be an ineffective treatment in early Parkinson disease.
Latest parkinsons articles PMID: 17881719 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Mutations in the glucocerebrosidase gene are associated with early-onset Parkinson disease. Related Articles
Mutations in the glucocerebrosidase gene are associated with early-onset Parkinson disease.
Neurology. 2007 Sep 18;69(12):1270-7
Latest parkinsons articles Latest parkinsons articles Authors: Clark LN, Ross BM, Wang Y, Mejia-Santana H, Harris J, Louis ED, Cote LJ, Andrews H, Fahn S, Waters C, Ford B, Frucht S, Ottman R, Marder K
OBJECTIVE: To evaluate the frequency of glucocerebrosidase (GBA) mutations in cases and controls enrolled in the Genetic Epidemiology of Parkinson's Disease (GEPD) study. METHODS: We sequenced all exons of the GBA gene in 278 Parkinson disease (PD) cases and 179 controls enrolled in GEPD, with a wide range of age at onset (AAO), and that included a subset of 178 Jewish cases and 85 Jewish controls. Cases and controls were recruited without knowledge of family history of PD, and cases were oversampled in the AAO < 50 years category. RESULTS: 13.7% of PD cases (38/278) carried GBA mutations, compared with 4.5% of controls (8/179) (odds ratio [OR] 3.4, 95% CI 1.5 to 7.4). The frequency of GBA mutations was 22.2% in 90 cases with AAO < or = 50 years, compared with 9.7% in 185 cases with AAO > 50 years (OR 2.7, 95% CI 1.3 to 5.3). Adjusting for age at the time of evaluation, sex, family history of PD, and Jewish ancestry, GBA carriers had a 1.7-year-earlier AAO of PD (95% CI 0.5 to 3.3, p < 0.04) than noncarriers. The average AAO of PD was 2.5 years earlier in carriers with an AAO < or = 50 years compared with noncarriers (95% CI 0.6 to 4.5, p < 0.01) and this was not seen in the AAO > 50 years group. The frequency of GBA mutations was higher in a subset of 178 cases that reported four Jewish grandparents (16.9%) than in cases who did not report Jewish ancestry (8.0%) (p < 0.01). Nine different GBA mutations were identified in PD cases, including 84insGG, E326K, T369M, N370S, D409H, R496H, L444P, RecNciI, and a novel mutation, P175P. CONCLUSIONS: This study suggests that the Glucocerebrosidase gene may be a susceptibility gene for Parkinson disease and that Glucocerebrosidase mutations may modify age at onset.
Latest parkinsons articles PMID: 17875915 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]alpha-Synuclein and Parkinson disease susceptibility. Related Articles
alpha-Synuclein and Parkinson disease susceptibility.
Neurology. 2007 Oct 30;69(18):1745-50
Latest parkinsons articles Latest parkinsons articles Authors: Winkler S, Hagenah J, Lincoln S, Heckman M, Haugarvoll K, Lohmann-Hedrich K, Kostic V, Farrer M, Klein C
BACKGROUND: Mutations in the alpha-synuclein (SNCA) gene have been shown to be responsible for a rare familial form of Parkinson disease (PD). Furthermore, polymorphic variants in multiple regions of the gene have been associated with susceptibility to idiopathic PD in different populations. OBJECTIVE: To evaluate and to confirm the role of SNCA variants in PD pathogenesis. METHODS: We included 667 subjects (397 cases with idiopathic PD and 270 healthy, ethnically matched controls) of Northern Central and Southeastern European origin. We analyzed genotypes at 14 markers spanning the SNCA locus and its major haplotype blocks and conducted a haplotype analysis for four promoter markers including the microsatellite marker Rep1. RESULTS: The three single nucleotide polymorphisms (SNPs) of the promoter region (rs2583988, rs2619364, rs2619363) and a SNP in the 3'UTR (rs356165) of the SNCA gene showed the greatest evidence for an association with PD (p
Latest parkinsons articles PMID: 17872362 [PubMed - in process]Neuromuscular specializations within human pharyngeal constrictor muscles. Related Articles
Neuromuscular specializations within human pharyngeal constrictor muscles.
Ann Otol Rhinol Laryngol. 2007 Aug;116(8):604-17
Latest parkinsons articles Latest parkinsons articles Authors: Mu L, Sanders I
OBJECTIVES: At present it is believed that the pharyngeal constrictor (PC) muscles are innervated by the vagus (X) nerve and are homogeneous in muscle fiber content. This study tested the hypothesis that adult human PCs are divided into 2 distinct and specialized layers: a slow inner layer (SIL), innervated by the glossopharyngeal (IX) nerve, and a fast outer layer (FOL), innervated by nerve X. METHODS: Eight normal adult human pharynges (16 sides) obtained from autopsies were studied to determine 1) their gross motor innervation by use of Sihler's stain; 2) their terminal axonal branching by use of acetylcholinesterase (AChE) and silver stain; and 3) their myosin heavy chain (MHC) expression in PC muscle fibers by use of immunocytochemical and immunoblotting techniques. In addition, the specialized nature of the 2 PC layers was also studied in developmental (newborn, neonate, and senescent humans), pathological (adult humans with idiopathic Parkinson's disease [IPD]), and comparative (nonhuman primate [adult macaque monkey]) specimens. RESULTS: When nerves IX and X were traced from their cranial roots to their intramuscular termination in Sihler's-stained specimens, it was seen that nerve IX supplied the SIL, whereas branches of nerve X innervated the FOL in the adult human PCs. Use of AChE and silver stain confirmed that nerve IX branches supplying the SIL contained motor axons and innervated motor end plates. In addition to distinct motor innervation, the SIL contained muscle fibers expressing slow-tonic and alpha-cardiac MHC isoforms, whereas the FOL contained muscle fibers expressing developmental MHC isoforms. In contrast, the FOL became obscured in the elderly and in the adult humans with IPD because of an increased proportion of slow muscle fibers. Notably, distinct muscle fiber layers were not found in the human newborn and nonhuman primate (monkey), but were identified in the 2-year-old human. CONCLUSIONS: Human PCs appear to be organized into functional fiber layers, as indicated by distinct motor innervation and specialized muscle fibers. The SIL appears to be a specialized layer unique to normal humans. The presence of the highly specialized slow-tonic and alpha-cardiac MHC isoforms, together with their absence in human newborns and nonhuman primates, suggests that the specialization of the SIL maybe related to speech and respiration. This specialization may reflect the sustained contraction needed in humans to maintain stiffness of the pharyngeal walls during respiration and to shape the walls for speech articulation. In contrast, the FOL is adapted for rapid movement as seen during swallowing. Senescent humans and patients with IPD are known to be susceptible to dysphagia; and this susceptibility may be related to the observed shift in muscle fiber content.
Latest parkinsons articles PMID: 17847729 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Mitochondrial DNA polymerase gamma variants in idiopathic sporadic Parkinson disease. Related Articles
Mitochondrial DNA polymerase gamma variants in idiopathic sporadic Parkinson disease.
Neurology. 2007 Sep 11;69(11):1152-9
Latest parkinsons articles Latest parkinsons articles Authors: Luoma PT, Eerola J, Ahola S, Hakonen AH, Hellström O, Kivistö KT, Tienari PJ, Suomalainen A
OBJECTIVE: Dysfunction of mitochondrial DNA polymerase gamma (POLG) has been recently recognized as an important cause of inherited neurodegenerative diseases. We have reported dominant and recessive inheritance of parkinsonism, mitochondrial myopathy, and premature amenorrhea in five ethnically distinct families with POLG1 mutations. This prompted us to carry out a detailed analysis of the coding region and intron-exon boundaries of POLG1 in Finnish patients with idiopathic sporadic Parkinson disease (PD) and in nonparkinsonian controls. METHODS: The coding region of POLG1 was analyzed in 140 Finnish patients with PD and their 127 spouses as age- and ethnically matched controls. Further, we analyzed the intragenic CAG-repeat region of POLG1 in 126 additional patients with nonparkinsonian neurologic disorders and in 516 Finnish population controls. RESULTS: We found clustering of rare variants of the POLG1 CAG-repeat, encoding a polyglutamine tract, in Finnish patients with idiopathic PD as compared to their spouses (p = 0.003; OR 3.01, 95% CI 1.35 to 6.71), population controls (p = 0.001; OR 2.45, 95% CI 1.45 to 4.14), and patients with nonparkinsonian neurologic disorders (p = 0.05, OR 1.98, 95% CI 0.97 to 4.05). We found several amino acid substitutions, none of them associating with PD. These included a previously parkinsonism-associated POLG variant Y831C, found in one patient with PD, but also in five controls, suggesting that it is a neutral amino acid polymorphism. CONCLUSIONS: Our results suggest that POLG polyglutamine tract variants should be considered as a predisposing genetic factor in idiopathic sporadic Parkinson disease.
Latest parkinsons articles PMID: 17846414 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]The relationship of Parkinson disease with aging. Related Articles
The relationship of Parkinson disease with aging.
Arch Neurol. 2007 Sep;64(9):1242-6
Latest parkinsons articles Latest parkinsons articles Authors: Levy G
Twentieth-century hypotheses attributing a substantive role to aging in Parkinson disease (PD) pathogenesis have been countered by evidence from clinical, pathological, and biochemical investigations. However, age influences the clinical progression of PD. Several studies have demonstrated that advancing age is associated with a faster rate of motor progression, decreased levodopa responsiveness, more severe gait and postural impairment, and more severe cognitive impairment and the development of dementia in patients with PD. A model for the relationship between PD and aging is proposed that incorporates the following 3 elements: (1) There occurs a superposition of a topographic gradient of neuronal loss in brainstem and basal forebrain structures related to the disease process and an aging-related temporal gradient. (2) While PD is a chronic progressive disorder, the most important determinant of clinical progression is advancing age rather than disease duration. (3) The effects of the disease process and aging on nondopaminergic structures involve a biologic interaction. The model implies that understanding the degenerative process in nondopaminergic structures in PD as it relates to molecular mechanisms accompanying the aging of the nervous system may create opportunities for interventions affecting the clinical progression of the disease.
Latest parkinsons articles PMID: 17846263 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson's disease: a pilot study. Related Articles
Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson's disease: a pilot study.
Arch Phys Med Rehabil. 2007 Sep;88(9):1154-8
Latest parkinsons articles Latest parkinsons articles Authors: Herman T, Giladi N, Gruendlinger L, Hausdorff JM
OBJECTIVE: To evaluate the effects of 6 weeks of intensive treadmill training on gait rhythmicity, functional mobility, and quality of life (QOL) in patients with Parkinson's disease (PD). DESIGN: An open-label, before-after pilot study. SETTING: Outpatient movement disorders clinic. PARTICIPANTS: Nine patients with PD who were able to ambulate independently and were not demented. Mean age was 70+/-6.8 years. Patients had mild to moderate PD (Hoehn and Yahr stage range, 1.5-3). INTERVENTIONS: Patients walked on a treadmill for 30 minutes during each training session, 4 training sessions a week, for 6 weeks. Once a week, usual overground walking speed was re-evaluated and the treadmill speed was adjusted accordingly. MAIN OUTCOME MEASURES: The 39-item Parkinson's Disease Questionnaire (PDQ-39), motor part of the Unified Parkinson's Disease Rating Scale (UPDRS), gait speed, stride time variability, swing time variability, and the Short Physical Performance Battery (SPPB). RESULTS: A comparison of the measures taken before and after the treadmill intervention indicates general improvement. QOL, as measured by the PDQ-39, was reduced (improved) from 32 to 22 (P<.014). Parkinsonian symptoms, as measured by the UPDRS, decreased (improved) from 29 to 22 (P<.043). Usual gait speed increased from 1.11 to 1.26 m/s (P<.014). Swing time variability was lower (better) in all but one patient, changing from 3.0% to 2.3% (P<.06). Scores on the SPPB also improved (P<.008). Interestingly, many of the improvements persisted even 4 weeks later. CONCLUSIONS: These results show the potential to enhance gait rhythmicity in patients with PD and suggest that a progressive and intensive treadmill training program can be used to minimize impairments in gait, reduce fall risk, and increase QOL in these patients.
Latest parkinsons articles PMID: 17826461 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]LRRK2 mutation analysis in Parkinson disease families with evidence of linkage to PARK8. Related Articles
LRRK2 mutation analysis in Parkinson disease families with evidence of linkage to PARK8.
Neurology. 2007 Oct 30;69(18):1737-44
Latest parkinsons articles Latest parkinsons articles Authors: Nichols WC, Elsaesser VE, Pankratz N, Pauciulo MW, Marek DK, Halter CA, Rudolph A, Shults CW, Foroud T,
BACKGROUND: Pathogenic mutations in the leucine-rich repeat kinase 2 gene (LRRK2) have been found to cause typical, later-onset Parkinson disease (PD). Although G2019S is the most common mutation, other mutations have also been reported. It is critical to catalog the types of mutations found in LRRK2 that can cause PD, so as to provide insight regarding disease susceptibility and potential novel treatments. METHODS: We performed a comprehensive study of all 51 exons of the LRRK2 gene in one PD patient from each of 88 multiplex PD families who had the highest family-specific multipoint lod score at the LRRK2 locus from a cohort of 430 PD families without the G2019S mutation. RESULTS: Five families (5.7%) harbored what seem to be novel, pathogenic mutations (L1795F, I1192V, E10K, E334K, Q1111H). Three of these apparent mutations were in known, functional domains of the LRRK2 protein, where other studies have also identified disease producing mutations. However, two of the novel variants were found in the N-terminal region of LRRK2, where no pathogenic substitutions have yet been reported. Similar to previous studies, all subjects with an LRRK2 mutation had classic symptoms of PD and typical, later age at onset. CONCLUSIONS: We have identified five novel variants in LRRK2, with two of these in the N-terminal region of LRRK2, where no pathogenic substitutions have been previously reported. If confirmed to be causative, these mutations would broaden the potential mechanisms whereby mutations in LRRK2 result in Parkinson disease.
Latest parkinsons articles PMID: 17804834 [PubMed - in process]Parkinson's disease. Related Articles
Parkinson's disease.
BMJ. 2007 Sep 1;335(7617):441-5
Latest parkinsons articles Latest parkinsons articles Authors: Clarke CE
Latest parkinsons articles PMID: 17762036 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Parkinson disease, 10 years after its genetic revolution: multiple clues to a complex disorder. Related Articles
Parkinson disease, 10 years after its genetic revolution: multiple clues to a complex disorder.
Neurology. 2007 Nov 27;69(22):2093-104
Latest parkinsons articles Latest parkinsons articles Authors: Klein C, Schlossmacher MG
Over the last 10 years, an unprecedented number of scientific reports have been published that relate to the pathogenesis of parkinsonism. Since the discovery in 1997 of the first heritable form of parkinsonism that could be linked to a mutation in a single gene, SNCA, many more genetic leads have followed (Parkin, DJ-1, PINK1, LRRK2, to name a few); these have provided us with many molecular clues to better explore the etiology of parkinsonism and have led to the dismantling of many previously held dogmas about Parkinson disease (PD). Epidemiologic studies have delineated an array of environmental modulators of susceptibility to parkinsonism, which can now be examined in the context of gene expression. Furthermore, in vivo imaging data and postmortem results have generated concepts that greatly expanded our appreciation for the phenotypic spectrum of parkinsonism from its presymptomatic to advanced stages. With this plethora of new information emerged the picture of a complex syndrome that raises many questions: How many forms of classic parkinsonism/Parkinson disease(s) are there? Where does the disease begin? What causes late-onset, "idiopathic" PD? What are the caveats related to genetic testing? What is the role of Lewy bodies? What will be the best disease model to accommodate the now known genetic and environmental contributors to parkinsonism? What will be the ideal markers and targets for earlier diagnosis and cause-directed therapy? In the following article we highlight some of the burning issues surrounding the understanding of classic parkinsonism, a complex puzzle of genes, environment, and an aging host.
Latest parkinsons articles PMID: 17761553 [PubMed - in process]Hypertension, hypercholesterolemia, diabetes, and risk of Parkinson disease. Related Articles
Hypertension, hypercholesterolemia, diabetes, and risk of Parkinson disease.
Neurology. 2007 Oct 23;69(17):1688-95
Latest parkinsons articles Latest parkinsons articles Authors: Simon KC, Chen H, Schwarzschild M, Ascherio A
OBJECTIVE: To determine whether history of hypertension, hypercholesterolemia, or diabetes is associated with risk of Parkinson disease (PD). METHODS: Prospective study among participants in two large cohorts: the Nurses' Health Study (121,046 women) and the Health Professionals Follow-up Study (50,833 men). Mean duration of follow-up was 22.9 years in women, aged 30 to 55 years at baseline, and 12.6 years in men, aged 40 to 75 years at baseline. Relative risks (RRs) of PD were estimated from a Cox proportional hazards model adjusting for potential confounders. RESULTS: We identified a total of 530 incident cases of PD during the follow-up. Risk of PD was not associated with self-reported history of hypertension (RR = 0.96, 95% CI = 0.80 to 1.15), high cholesterol (RR = 0.98, 95% CI = 0.82 to 1.19), or diabetes (RR = 1.04, 95% CI = 0.74 to 1.46), after adjusting for age and smoking in pack-years. Risk of PD decreased modestly with increasing levels of self-reported total cholesterol (RR for a 50-mg/dL increase in total cholesterol = 0.86, 95% CI = 0.78 to 0.95, p for trend = 0.02), but use of cholesterol-lowering drugs was not associated with PD risk (RR comparing users with nonusers = 0.85, 95% CI = 0.59 to 1.23). Among individuals with PD, systolic blood pressure was similar to noncases up to the time of diagnosis but declined afterward. CONCLUSIONS: Results of this large prospective study suggest that Parkinson disease risk is not significantly related to history of hypertension, hypercholesterolemia, or diabetes but may modestly decline with increasing blood cholesterol levels.
Latest parkinsons articles PMID: 17761552 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Disease targets and strategies for the therapeutic modulation of endogenous neural stem and progenitor cells. Related Articles
Disease targets and strategies for the therapeutic modulation of endogenous neural stem and progenitor cells.
Clin Pharmacol Ther. 2007 Oct;82(4):453-60
Latest parkinsons articles Latest parkinsons articles Authors: Goldman SA
Neural stem cells, able to self-renew and give rise to both neurons and glia, line the cerebral ventricles of the adult human brain. Humans also harbor lineage-restricted neuronal progenitors in the hippocampus and glial progenitor cells in both the gray and white matter of the forebrain. These various stem and progenitor cell types may provide targets for pharmacotherapy for a variety of disorders of the central nervous system. Each resident progenitor phenotype may be mobilized and induced to differentiate in vivo by the actions of both exogenous growth factors and small molecule modulators of progenitor-selective signaling pathways. This strategy may be particularly efficacious in neurodegenerations such as Huntington's disease, in which lost neurons may be replenished through the directed induction of progenitor cells lining the ventricular wall of the affected striatum. Similarly, the mobilization of glial progenitor cells may permit the introduction of new oligodendrocytes to demyelinated regions of adult white matter. Our rapidly increasing understanding of the molecular control of progenitor cell mobilization and differentiation should provide a wealth of new opportunities for recruiting endogenous progenitors as a means of treating neurological disease.
Latest parkinsons articles PMID: 17713467 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Transdermal rotigotine (Neupro) for Parkinson's disease. Related Articles
Transdermal rotigotine (Neupro) for Parkinson's disease.
Med Lett Drugs Ther. 2007 Aug 27;49(1268):69-70
Latest parkinsons articles Latest parkinsons articles Authors:
Latest parkinsons articles PMID: 17712291 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Neurosurgery at an earlier stage of Parkinson disease. Related Articles
Neurosurgery at an earlier stage of Parkinson disease.
Neurology. 2007 Aug 21;69(8):811-2; author reply 812
Latest parkinsons articles Latest parkinsons articles Authors: Beukers RJ, Weisfelt M, de Bie RM
Latest parkinsons articles PMID: 17709721 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Limb-kinetic apraxia in Parkinson disease. Related Articles
Limb-kinetic apraxia in Parkinson disease.
Neurology. 2007 Aug 21;69(8):810-1; author reply 811
Latest parkinsons articles Latest parkinsons articles Authors: Swash M
Latest parkinsons articles PMID: 17709719 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Gray matter atrophy in Parkinson disease with dementia and dementia with Lewy bodies. Related Articles
Gray matter atrophy in Parkinson disease with dementia and dementia with Lewy bodies.
Neurology. 2007 Aug 21;69(8):747-54
Latest parkinsons articles Latest parkinsons articles Authors: Beyer MK, Larsen JP, Aarsland D
BACKGROUND: The nosologic relationship between dementia with Lewy bodies (DLB) and Parkinson disease with dementia (PDD) is continuously being debated. We conducted a study using voxel-based morphometry (VBM) to explore the pattern of cortical atrophy in DLB and PDD. METHODS: Seventy-four patients and healthy elderly were imaged (healthy elderly n = 20, PDD n = 15, DLB n = 18, and Alzheimer dementia [AD] n = 21).Three dimensional T1-weighted MRI were acquired, and images analyzed using VBM. The following diagnostic criteria were used: criteria proposed by the third report of the DLB Consortium for DLB, the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Diseases Association criteria for AD, and Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for dementia in PDD. RESULTS: Overall dementia severity was similar in the dementia groups. We found more pronounced cortical atrophy in DLB than in PDD in the temporal, parietal, and occipital lobes. Patients with AD had reduced gray matter concentrations in the temporal lobes bilaterally, including the amygdala, compared to PDD. Compared to DLB, the AD group had temporal and frontal lobe atrophy. CONCLUSION: We found that despite a similar severity of dementia, patients with dementia with Lewy bodies (DLB) had more cortical atrophy than patients with Parkinson disease with dementia (PDD), indicating different brain substrates underlying dementia in the two syndromes. Together with previous studies reporting subtle clinical and neurobiologic differences between DLB and PDD, our findings support the hypothesis that PDD and DLB are not identical entities, but rather represent two subtypes of a spectrum of Lewy body disease.
Dementia with Lewy bodies and Parkinson disease with dementia: can MRI make the difference?
Dementia with Lewy bodies and Parkinson disease with dementia: can MRI make the difference?
Neurology. 2007 Aug 21;69(8):717-8
Latest parkinsons articles Latest parkinsons articles Authors: Seppi K, Rascol O
Are Parkinson disease patients protected from some but not all cancers? Related Articles
Are Parkinson disease patients protected from some but not all cancers?
Neurology. 2007 Oct 9;69(15):1542-50
Latest parkinsons articles Latest parkinsons articles Authors: Inzelberg R, Jankovic J
There is substantial evidence based on well designed epidemiologic studies for low cancer rates in patients with Parkinson disease (PD). This risk reduction cannot be attributed to the recognized low life-long incidence of smoking in patients with PD, as not only smoking-related cancers but also non-smoking-related ones are less common in PD. Whereas the risk for most cancers appears to be relatively low in patients with PD, breast cancer and melanomas occur more frequently in the PD population as compared with controls. The relationship between this peculiar pattern of cancer rates and PD might be related to the involvement of common genes in both diseases. Mutations in parkin gene, for example, have been reported in several types of cancer. Furthermore, genes involved in familial forms of PD appear to be abnormally expressed in cancers. Thus, parkin and PINK1 might be tumor suppressor genes, whereas DJ-1 is an oncogene. Cell survival signals may differ owing to mutated genes and represent two opposite extremes such as cell proliferation in cancer and cell death due to apoptosis in PD. Unraveling the link between PD and cancer may open a therapeutic window for both diseases.
The progression of Parkinson disease: a hypothesis. Related Articles
The progression of Parkinson disease: a hypothesis.
Neurology. 2007 Aug 14;69(7):710-1; author reply 711
Latest parkinsons articles Authors: Burke WJ
PMID: 17698800 [PubMed - indexed for MEDLINE: ]Medication-related impulse control and repetitive behaviors in Parkinson disease. Related Articles
Medication-related impulse control and repetitive behaviors in Parkinson disease.
Arch Neurol. 2007 Aug;64(8):1089-96
Latest parkinsons articles Latest parkinsons articles Authors: Voon V, Fox SH
A range of behaviors presumed to be related to aberrant or excessive dopaminergic medications are being increasingly recognized in Parkinson disease. These behaviors are linked by their incentive- or reward-based and repetitive natures and include pathological gambling, hypersexuality, compulsive shopping, compulsive eating, hobbyism, and compulsive medication use. Such behaviors can have potentially devastating psychosocial consequences and are often hidden. Whether these behaviors are simply related to dopaminergic medications interacting with an underlying individual vulnerability or whether the primary pathological features of Parkinson disease play a role is not known. We reviewed the literature on these behaviors in Parkinson disease, including definitions, epidemiological and potential pathophysiological features, and management. The study of these behaviors allows not only improved clinical management but also greater insight into a biologically mediated complex behavioral model.
Latest parkinsons articles PMID: 17698698 [PubMed - indexed for MEDLINE: ]Treatment options in the modern management of Parkinson disease. Related Articles
Treatment options in the modern management of Parkinson disease.
Arch Neurol. 2007 Aug;64(8):1083-8
Latest parkinsons articles Latest parkinsons articles Authors: Schapira AH
Latest parkinsons articles PMID: 17698697 [PubMed - indexed for Latest parkinsons articles MEDLINE: ]Impaired navigation in drivers with Parkinson's disease. Related Articles
Impaired navigation in drivers with Parkinson's disease.
Brain. 2007 Sep;130(Pt 9):2433-40
Latest parkinsons articles Authors: Uc EY, Rizzo M, Anderson SW, Sparks JD, Rodnitzky RL, Dawson JD
Navigating a new route during automobile driving uses the driver's cognitive resources and has the potential to impair driving ability in people with Parkinson's disease (PD). Our aim was to assess navigation and safety errors during a route following task (RFT) in drivers with the illness. Seventy-seven subjects with mild-moderate PD (median Hoehn-Yahr stage = 2.0) and 152 neurologically normal elderly adults, all active and licensed drivers, were tested with a battery of visual, cognitive and motor tests of abilities. Each driver also performed a RFT administered on the road in an instrumented vehicle. Main outcome variables included: number of incorrect turns, times lost and at-fault safety errors. All group comparisons were adjusted for age, gender, education and familiarity with the region. Drivers with PD performed significantly worse on cognitive, visual and motor tests compared to controls, and took longer to finish the RFT. Higher proportions of these drivers made incorrect turns {53.9% in PD versus 21.1% in controls, Odds Ratio (OR) [95% Confidence Interval (CI)] = 2.8 [1.4, 5.7], P = 0.006}, got lost (15.8% versus 2.0%, OR [95%CI] = 4.7 [1.1, 20.0], P = 0.037), or committed at-fault safety errors (84.2% versus 46.7%, OR [95%CI] = 7.5 [3.3, 17.0], P < 0.001). Within the patient group, the navigational and safety errors were predicted by poor performances on cognitive and visual tests, but not by the severity of motor dysfunction. Drivers with PD made more navigation and safety errors than neurologically normal drivers on a RFT that placed demands on driver memory, attention, executive functions and visual perception. The PD group driver safety was degraded possibly due to an increase in the cognitive load in patients with limited reserves. Navigational errors and lower driver safety were associated more with impairments in cognitive and visual function than the motor severity of their disease in drivers with PD.
Latest parkinsons articles PMID: 17686809 [PubMed - indexed for MEDLINE: ] "Recent publications on the subject of Parkinson Disease are scanned daily from major neurology journals and updated here"  Subscribe to latest parkinsons articles articles
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