1,721,020 research outputs found
Increased lipid peroxidation in cerebrospinal fluid and plasma from patients with Creutzfeldt-Jakob disease
No full textOxidative pathomechanisms play an important role in neurodegenerative diseases like Alzheimer's disease (AD). It has been shown that lipid peroxidation in cerebrospinal fluid (CSF) and plasma is increased in AD. To assess the role of oxidative stress in Creutzfeldt-Jakob disease (CJD), we investigated the oxidizability of lipids, the lipid composition and the levels of the antioxidants ascorbate and alpha-tocopherol in CSF and plasma of 15 CJD patients and 12 neurologically healthy controls. CSF and plasma lipid peroxidation was increased in CJD patients and polyunsaturated fatty acids were reduced in CSF of these patients. Ascorbate levels were lower in CSF and plasma of CJD patients, while alpha-tocopherol was found to be decreased in CSF but not in plasma. These results support the hypothesis that oxidative mechanisms are involved in the pathogenesis of CJD and provide a rationale for the use of antioxidants in the therapy of this disease. (C) 2002 Elsevier Science (USA)
Cannabinoide in der Parkinson-Therapie – Eine fragebogenbasierte Umfrage unter Patienten
No full textEffect of Neurostimulation on Camptocormia in Parkinson's Disease Depends on Symptom Duration
No full textAlthough some reports on neurostimulation are positive, no effective treatment method for camptocormia in Parkinson's disease (PD) is known to date. We aim to identify prognostic factors for a beneficial DBS effect on camptocormia. In an observational cohort study, we investigated 25 idiopathic PD patients, who suffered additionally from camptocormia, and underwent bilateral neurostimulation of the subthalamic nucleus (STN) to improve classical PD symptoms. Using an established questionnaire, we examined deep brain stimulation (DBS) effects on camptocormia in addition to general neurostimulation effects. A beneficial neurostimulation effect on camptocormia was defined as an improvement in the bending angle of a least 50%. In 13 patients, the bending angle of camptocormia improved, in 12 patients it did not. A multifactorial analysis revealed a short duration between onset of camptocormia and start of neurostimulation to be the relevant factor for outcome. All patients with duration of camptocormia up to 1.5 years showed a beneficial effect; patients between 1.5 and approximate to 3 years showed mixed results, but none with a duration of more than 40 months improved except for 1 patient whose camptocormia was levodopa responsive. The bending angle was not a prognostic factor. Our data indicate that the main prognostic factor for a beneficial DBS effect on camptocormia is its short duration. As an explanation, we suggest that neurostimulation may improve camptocormia only as long as muscle pathology is limited. Our findings may help to elucidate the mode of action of neurostimulation. A prospective study is necessary. (c) 2015 International Parkinson and Movement Disorder Societ
Do impulse control disorders affect driving performance in patients with Parkinson's disease?
No full textUm den Einfluss von Impulskontrollstörungen (IKS) auf die Fahrkompetenz bei Parkinson-Patienten zu untersuchen, verglichen wir prospektiv die Fahrleistung im Fahrsimulator von Parkinson-Patienten mit (n=23) und ohne klinisch definierte IKS (n=23). Die Patienten wurden nach Alter, Geschlecht und Schweregrad der motorischen Symptome gematcht. Die IKS musste im Alltag individuell kompensiert sein. Als Post-hoc-Analyse wurde das Vorliegen einer IKS nach dem Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS; mit IKS: n=28 bzw. ohne IKS: n=18) definiert und zusätzlich ein Gruppenvergleich der Fahreignung nach dieser Definition durchgeführt. Weiterhin wurden neuropsychologische Aspekte und deren Einfluss auf die Fahrkompetenz zwischen den Gruppen verglichen.
Die Fahrparameter unterschieden sich nicht signifikant zwischen PD-Patienten mit und ohne IKS, weder bei der klinischen Definition von IKS noch bei der QUIP-RS-basierten Definition. Der Fahrfehler-Composite-Score korrelierte signifikant negativ mit MoCA und TAP-M „Flexi-bilität“ und positiv mit DBQ „Fehler“ und dem TMT-A.
Fazit dieser Studie ist, dass ein klinisch kompensierte IKS die Fahrtauglichkeit und somit Fahrsicherheit nicht negativ zu beeinflussen scheint. Unsere Daten bestätigen frühere Untersuchungen, dass insbesondere kognitive Störungen und Aufmerksamkeitsdefizite klinische Marker für Fahrunsicherheit sind. In der täglichen Routine könnte eine Testbatterie, die MoCA, TAP-M „Flexibilität“, TMT-A und DBQ „Fehler“ umfasst, ein geeigneter Screening-Prädiktor sein, um Patienten mit Morbus Parkinson mit einem Risiko für das Autofahren zu erkennen.To determine the influence of impulse control disorders (ICD) on driving ability in patients with Parkinson’s disease (PD), we prospectively compared driving simulator performance of PD patients with (n=23) and without clinically defined ICD (n=23). Subjects were matched by age, gender and motor symptom severity. The ICD had to be compensated individually in daily life. As post-hoc analysis, the diagnosis of ICD was defined according to the Questionnaire for Im-pulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS; with ICD: n=28 and without ICD: n=18, respectively) and we performed additionally a group comparison of driving ability according to this definition. Furthermore, neuropsychological aspects and their influence on driving competence were compared between the groups.
Driving parameters did not differ significantly between PD patients with and without ICD in either the clinical definition of ICD or the QUIP-RS-based definition. Driving ability was signif-icantly negatively correlated with MoCA and TAP-M “flexibility” and positively with Driving Behavior Questionnaire (DBQ) “error” and the TMT-A.
The conclusion of this study is that clinically compensated ICD does not seem to negatively affect driving ability and thus driving safety. Our data confirm previous research that especially cognitive impairment and attentional deficits are clinical markers of driving unsafety. In daily routine, a test battery applying MoCA, TAP-M “flexibility”, TMT-A and the DBQ “error” might be a suitable screening predictor to detect PD patients at risk for driving
Future therapeutic options in Parkinson's disease
No full textFuture symptomatic treatment of Parkinson's disease (PD) must aim to reduce the nonphysiologic pulsatile stimulation of striatal dopamine receptors, produced by most of the currently available dopaminergic drugs. Promising nondopaminergic compounds include NMDA and AMPA antagonists and drugs acting on 5-HT-2A, (alpha 2-adrenergic, and adenosine A2 receptors. A sustained benefit appears to evolve from the early use of MAOB inhibitors, dopaminagonists and perhaps levodopa itself. Novel insight into the pathogenesis of PD beyond mechanisms responsible for nigral dopaminergic cell death is required to develop disease modifying drugs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Prevalence and degree of dysphagia at different stages of Parkinson's disease
No full textFragestellung: Eine Dysphagie hat bei Parkinsonpatienten durch Komplikationen wie Mangelernährung und Aspirationspneumonie wesentlichen Anteil an eingeschränkter Lebensqualität und erhöhter Mortalität. Es sollte erhoben werden, ob sich die Selbstwahrnehmung der Patienten mit der technischen Untersuchung deckt und Prädiktoren abgeleitet werden, um gefährdete Patienten frühzeitig zu entdecken.
Methoden: Im Zeitraum vom 30.03.2016 bis 02.05.2016 stellten sich 146 konsekutive ambulante Patienten mit einem idiopathischen Parkinsonsyndrom vor. Hiervon konnten 122 (84%) rekrutiert werden. Nach Ausschluss von 3 Patienten verblieben 119. Diese waren über alle Krankheitsstadien verteilt, 40 bis 88 Jahre alt und wiesen eine Erkrankungsdauer von 0-32 Jahren auf. Die Patienten schätzten ihr Schluckvermögen auf drei verschiedenen Skalen ein und wurden umfangreich klinisch und mit der FEES (flexibel endoskopische Evaluation des Schluckakts) untersucht. Die FEES-Befunde wurden mit 32 Kontrollpersonen ohne offensichtliche Schluckstörung verglichen.
Ergebnisse: Eine klinisch kritische Dysphagie (Aspiration mit fehlender oder insuffizienter Reinigung) trat bei 28 Patienten (24%) auf, wobei 88% dieser Aspirationsereignisse unbemerkt abliefen (PAS 8). Hiervon sowie von einer notwendigen Umstellung der Nahrungsaufnahme (Kostanpassung und/oder Kompensationsmanöver) waren bereits Patienten in frühen Krankheitsstadien (ab Hoehn und Yahr 2) betroffen. Insgesamt musste bei 30 Patienten (25%) eine Umstellung der Nahrungsaufnahme und bei 10 Patienten (8%) sogar die Anlage einer PEG-Sonde empfohlen werden. Eine Mangelernährung lag bei 5 Patienten (4%) und eine Pneumonie innerhalb des letzten Jahres bei 2 Patienten (2%) vor. Die Selbsteinschätzung durch den Patienten erwies sich mit einer Sensitivität von 50% für eine klinisch kritische Dysphagie als ungeeignet. Hingegen erreichte die Kombination der drei Prädiktoren Alter (OR 1.10 in Jahren, 95% KI 1.03-1.18, p<0.01), Geschlecht (OR 0.31 für Frauen, 95% KI 0.08-0.97, p=0.04) und Aspirationszeichen (OR 8.59, 95% KI 3.05-26.52, p<0.001) eine Sensitivität von 86% und eine Spezifität von 79%. Aspirationszeichen umfassten Husten bzw. Räuspern beim oder kurz nach dem Schlucken, Verschlucken oder eine Pneumonie innerhalb des letzten Jahres.
Schlussfolgerung: Durch den konsekutiven Patienteneinschluss und die hohe Teilnahmequote von 84% wurde die Versorgungsrealität ambulanter Parkinsonpatienten bestmöglich abgebildet. Die drei Prädiktoren lassen sich schnell und einfach erheben. Sollten sich die Klassifizierungsergebnisse in einer Folgestudie prospektiv validieren lassen, ist eine effiziente Zuweisung zu einer Dysphagie-Diagnostik (klinische Schluckuntersuchung und FEES) möglich. Komplikationen einer Dysphagie ließen sich in unserem Patientenkollektiv nur selten beobachten. Das lässt vermuten, dass bei rechtzeitiger Diagnosestellung ein großes Interventionspotential durch logopädische Therapie und ggf. Kostanpassung besteht.Objective: Dysphagia in patients with Parkinson’s disease regularly leads to relevant complications like malnutrition and aspiration pneumonia. This results in decreased quality of life and high mortality. We put forward the question whether the patient’s self-perception corresponds with the results of a technical examination. Furthermore, we aimed at specifying predictors to detect patients at risk early.
Methods: 146 consecutive outpatients with Parkinson’s disease showed up over a five-week period. We recruited 122 patients (84%), from which 3 had to be excluded. Thus 119 patients remained for analysis. All disease stages were represented, age ranged from 40 to 88 years and disease duration ranged from 0 to 32 years. The patients rated their swallowing on three different scales and underwent a comprehensive clinical examination and FEES (flexible endoscopic evaluation of swallowing). The FEES results were compared to 32 controls who lacked an obvious swallowing disorder.
Results: Critical dysphagia was defined as aspiration without or with insufficient cleaning and was found in 28 patients (24%). 88% of these aspiration events were not recognized (PAS 8). Accordingly, the patient’s self-perception proved itself ineligible with a sensitivity of 50%. Critical dysphagia and recommendation of diet modifications even affected patients in early disease stages (Hoehn and Yahr 2). In total, diet modifications were recommended to 30 patients (25%) and in 10 cases (8%) a percutaneous endoscopic gastrostomy (PEG) was deemed necessary. Malnutrition was found in 5 patients (4%) and pneumonia within the last year in 2 patients (2%). There were three significant predictors for criticial dysphagia: age (OR 1.10 in years, 95% CI 1.03-1.18, p<0.01), sex (OR 0.31 for females, 95% CI 0.08-0.97, p=0.04) und aspiration signs (OR 8.59, 95% CI 3.05-26.52, p<0.001). Aspiration signs comprised the need to cough or harrumph during or shortly after swallowing, choking or pneumonia within the last year. These predictors as a whole reached a sensitivity of 86% and a specifity of 79%.
Conclusion: The high participation rate of 84% and the consecutive recruitement minimised bias. The three predictors can be collected easily and quickly. Provided that they prove valid in a future prospective study, these predictors allow efficient allocation to diagnostics (clinical swallowing examination and FEES). Complications of dysphagia were rarely found, suggesting that there is a high potential for intervention if dysphagia is diagnosed in due time
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