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Cognitive dysfunction in Parkinson's disease: from early symptoms to diagnosis
Get PDFParkinson’s disease (PD) is a chronic neurodegenerative disorder that affects over six million people worldwide. It is classically characterized by the emergence of motor symptoms including bradykinesia/akinesia, rigidity, tremor, and postural instability. In the past decade, PD has increasingly been recognized as a mixed motor, non-motor and multiorgan disorder rather than a pure movement disorder. Cognitive impairment is a common non-motor complication of PD that is associated with significant disability in patients and caregiver burden. The thesis covers three aspects of cognitive dysfunction in PD through three studies.
The first study, “Cognitive dysfunction in prodromal Parkinson’s disease: a qualitative review,” focuses on cognitive symptoms in prodromal PD. Today it is known that, by the time motor symptoms allow for clinical diagnosis, 40-60% of the dopaminergic neurons have already degenerated. The period of time in which neurodegeneration progresses in the absence of classical motor symptoms that allow a clinical diagnosis is termed the “prodromal phase of PD.” While other non-motor symptoms that represent possible prodromal symptoms of PD have been described in some detail, the occurrence and characteristics of cognitive decline in this early phase of the disease are less well understood. The aim of the review was to summarize the current state of research on cognitive changes in prodromal PD. It shows that only a small number of longitudinal studies have been conducted that examine cognitive functions in individuals with a subsequent PD diagnosis. However, when considering data from at-risk groups, the evidence suggests that cognitive decline may occur in a substantial number of individuals who have the potential for developing PD. In terms of specific cognitive domains, executive function in particular and, less frequently, memory scores, were reduced. Prospective, longitudinal studies are thus needed to clarify whether cognitive, and specifically executive, decline might be added to the prodromal non-motor symptom complex that may precede motor manifestation of PD by years. Such information may help in updating the risk scores used for early identification of PD.
The second study, “Verbal Memory Declines More in Female Patients with Parkinson’s Disease: the Importance of Gender-Corrected Normative Data,” concerns gender-specific profiles of cognitive function in patients with PD. So far, little data is available, the findings have been inconsistent, and possible disease-confounding factors have not been adequately considered. The LANDSCAPE study on cognition in PD enrolled 656 PD patients; raw values and age-, education-, and gender-corrected Z-scores were compared between genders. Motor symptoms, disease duration, levodopa equivalent daily dose, depression, and age and education for the raw value analysis were taken as covariates. The raw score analysis replicated the results of previous studies in that female PD patients were superior in terms of verbal memory, while men outperformed women in visuoconstruction and figural memory. In contrast, the gender-corrected Z-scores showed the men to be superior in verbal memory, while no difference was found for the visuospatial tests. It can be concluded that normative data corrected for gender and other sociodemographic variables are relevant, since they may elucidate a markedly different cognitive profile compared to raw scores. Our study also suggests that verbal memory decline is greater in women than in men with PD. Future studies are needed to replicate these findings, to examine the progression of gender-specific cognitive decline in PD, and to define the different underlying mechanisms of this dysfunction.
The third study, “Screening for Cognitive Impairment in Parkinson’s Disease: Improving the Diagnostic Utility of the MoCA through Subtest Weighting,” deals with cognitive screening in PD, which is highly relevant to clinical practice. The Montreal Cognitive Assessment (MoCA) is a screening test that is frequently used in PD to detect mild cognitive impairment (PD-MCI) and Parkinson’s disease dementia (PD-D). However, the subtests’ proportional representation in the MoCA total score does not seem reasonable. An empirically based alternative scoring system of the MoCA that is based on subtests´ individual sensitivity and specificity, and which aims to increase the instrument’s overall diagnostic accuracy, was developed and underwent preliminary evaluation. Diagnostic accuracy increased with the new MoCA scoring algorithm. In the first substudy, the sensitivity of detecting cognitive impairment increased from 62.5% to 92%, while specificity decreased only slightly from 77.7% to 73%; in the second substudy, sensitivity increased from 68.8% to 81.3%, while specificity remained stable at 75%. It can be concluded that the sensitivity of the MoCA can be enhanced substantially by an empirically based weighting procedure, and that the proposed scoring algorithm may better serve the MoCA’s purpose as a screening tool for the detection of cognitive dysfunction in PD patients than the original scoring. Further research with larger sample sizes is necessary to establish the efficacy of the alternate scoring system
Bachelorstudiengang Combined Studies, Teilstudiengang: Sozialwissenschaften, Prüfungsordnung : Neunzehnte Änderung
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Wir (und) die Anderen. Zugehörigkeitsbemühungen junger Männer mit Migrationshintergrund und Delinquenzerfahrung im ländlich geprägten Raum.
Get PDFDas Empfinden von Zugehörigkeit gilt als Grundbedürfnis des Menschen. Heimat- und
Wir-Gefühle erfüllen diesen Wunsch. In Verbindung mit Anderen zu sein und als Mitglied
einer Gemeinschaft anerkannt zu werden, hat eine identitätsstiftende Wirkung,
scheint den eigenen Wert und Lebenssinn zu bestätigen.
Aspekte von Fremdheit und Anderssein in der Biographie einer Person können die
Erfüllung dieses Grundbedürfnisses nach Zugehörigkeit jedoch in Frage stellen. Davon
in besonderem Maße betroffen sind sowohl Personen, die in irgendeiner Weise als
delinquent oder zumindest deviant in Erscheinung treten, als auch Personen, die aufgrund
von Zuwanderungserfahrungen von der Mehrheitsgesellschaft als anders und
fremd erlebt werden.
Die vorliegende Studie beschäftigt sich mit der Perspektive junger Männer, die beide
Attribute erfüllen. Sie haben einen Migrationshintergrund und Delinquenzerfahrung und
werden zuweilen mit dem Etikett der Nicht-Zugehörigkeit oder in der heutigen Zeit gerne
auch mit dem Stempel nicht-integrierbar konfrontiert. Aufgrund des besonders ausgeprägten
Gemeinschaftssinns, der ländlichen Räumen eigen ist, wurde die Untersuchung
bewusst in einer solchen Region durchgeführt und geht u.a. der Frage nach, ob
und inwiefern sich die jungen Männer mit Migrationshintergrund in einer so stark geschlossenen
sozialen Umgebung zugehörig fühlen.
Die subjektive Wahrnehmung derjenigen nachvollziehbar zu machen, über die viel gesprochen
und denen von außen oftmals zugeschrieben wird, integrationsunwillig zu
sein, ist ein Ziel der Untersuchung. Mittels eines explorativen, qualitativen Methodendesigns,
das eine system-theoretisch fundierte Auswertung umfasst, wird dieses Ziel
verfolgt und so ein Einblick in die Perspektive junger Männer mit Migrationshintergrund
und Delinquenzerfahrung im ländlichen Raum gewonnen
Sustainability in Poultry Production: A Comparative Study between Germany and Thailand
Get PDFGermany’s poultry sector plays an important role in the EU, while Thailand is one of the main broiler exporters on the global market. The intensive production systems used in the vertically integrated poultry industry have increased its competitiveness on the world market. However, concerns are increasingly being raised over the industry’s environmental impact, food safety and animal welfare in such highly concentrated and integrated production systems. It is therefore necessary to improve the production systems with a view to sustainability. Thailand and Germany’s poultry industries face different agro-ecological and socio-economic circumstances, as well as a variety of regional and national policies on sustainability in poultry production. As a result, this comparative study of Germany and Thailand can contribute to broadening the view on sustainability. This study aims to present recommendations on improving the sustainability of poultry production in the two countries. The two-round Delphi method was used to identify and rank the major sustainability concerns in poultry production by eliciting the opinions of participating experts through successive rounds of questionnaires. A combination of secondary data analysis and in-depth e-mail interviews was employed to analyse the roles of NGOs, animal welfare groups and leading integrated poultry companies in the sustainability of poultry production in order to assess why some sustainability issues are considered highly concerning. Results showed that social, animal welfare and economic issues dominate the current debate on sustainable poultry production. The use of antibiotics in poultry production, the killing of male layer chicks and the role of food retailers are considered highly concerning by the German experts, whilst the Thai experts considered the outbreak of avian influenza and other highly infectious diseases, disease control in neighbouring countries, the use of antibiotics in poultry production, the contamination of meat and eggs with zoonotic microorganisms, and standards for poultry products set by import partners as the most concerning issues. The German poultry companies mainly employed reactive strategies to improve sustainability in response to pressure exerted by NGOs and animal welfare groups. In Thailand, the poultry companies proactively adopted strategies to improve their production systems due to a lack of active NGOs and animal welfare groups within this sector. However, a number of limitations exist in regard to addressing concerning issues in the two countries, such as the use of antibiotics and outbreak of avian influenza due to the trade-offs between economic efficiency and consumer preference, the current availability of technology and innovation, the role of social media, and the level of direct communications between producers and consumers. This study makes a number of recommendations for improving the sustainability of poultry production, including to restrict the use of antibiotics in poultry production; to improve consumer perceptions on the poultry industry; to improve prevention strategies against avian influenza; to support the compartmentalisation of poultry production during avian influenza or Newcastle disease outbreaks; to support the geographic dispersion of genetic stock; to increase international collaboration on the prevention and control of contagious diseases in border areas; to improve existing technologies and practices by developing new technology and innovation; and to promote research on animal feed supply