1,721,401 research outputs found
Advances in the pharmacotherapeutic management of dementia with Lewy bodies
No full textDementia with Lewy bodies (DLB) is the second most common type of dementia in people over 65 years of age. Given the complex clinical phenotype, the management of DLB may be challenging, especially considering that there is limited evidence about specific interventions, and there are currently no Food and Drug Administration (FDA)/European Medicines Agency (EMA)-approved medications. Areas covered: This article provides an overview of the current pharmacotherapy in DLB and gives review to the most recent drug candidates in clinical trials. Expert opinion: Commonly prescribed drugs are primarily aimed at treating the most troublesome clinical features of DLB. Although these medications provide some benefit to symptoms, there is, unfortunately, a lack of DLB-specific evidence on effective treatments and their off-label use. Indeed, most treatments used come from clinical trials on patients with Alzheimer's disease or Parkinson's disease. Thus, there is an urgent need for randomized clinical trials in DLB patients. Despite several challenges, potential new drugs are in ongoing clinical trials; furthermore, as our understanding of molecular and cellular mechanisms underlying DLB broaden, it is likely that we will identify novel drug targets for the development of better and more effective symptomatic products and disease-modifying therapies
Non-pharmacological interventions for Parkinson's disease mild cognitive impairment: future directions for research
Full text linkMovement disorders: Role of imaging in diagnosis
No full textMagnetic resonance imaging (MRI and single-photon emission computed tomography (SPECT) have a considerable role in the diagnosis of the single patient with movement disorders. Conventional MRI demonstrates symptomatic causes of parkinsonism but does not show any specific finding in Parkinson's disease (PD). However, SPECT using tracers of the dopamine transporter (DAT) demonstrates an asymmetric decrease of the uptake in the putamen and caudate from the earliest clinical stages. In other degenerative forms of parkinsonism, including progressive supranuclear palsy (PSP), multisystem atrophy (MSA), and corticobasal degeneration (CBD), MRI reveals characteristic patterns of regional atrophy combined with signal changes or microstructural changes in the basal ganglia, pons, middle and superior cerebellar peduncles, and cerebral subcortical white matter. SPECT demonstrates a decreased uptake of tracers of the dopamine D2 receptors in the striata of patients with PSP and MSA, which is not observed in early PD. MRI also significantly contributes to the diagnosis of some inherited hyperkinetic conditions including neurodegeneration with brain iron accumulation and fragile-X tremor/ataxia syndrome by revealing characteristic symmetric signal changes in the basal ganglia and middle cerebellar peduncles, respectively. A combination of the clinical features with MRI and SPECT is recommended for optimization of the diagnostic algorithm in movement disorders. © 2011 Wiley Periodicals, Inc
Apomorphine hydrochloride for the treatment of Parkinson's disease.
No full textApomorphine (APO) is a potent D1 and D2 dopamine agonist. Plasma maximal concentration
is reached in 8–16 min with a plasma half-life of 34–70 min. Bioavailability is close to 100%.
It has a rapid antiparkinsonian action after subcutaneous (sc.) administration with a size effect
comparable with that of levodopa. Trials of sc., oral, sublingual, intravenous, rectal, intranasal
and iontophoretic transdermal administration of APO have been attempted in Parkinson’s
disease (PD), each of these routes have shown some potential for clinical effectiveness but
the majority of studies indicate that APO intermittent sc. administration, on which this review
is mainly focused, is an effective therapy for the management of motor symptoms in PD,
particularly in advanced phases mainly characterized by motor fluctuations, such as wearing
OFF and unpredictable “off”. Data on the effect of APO on non-motor symptoms in PD
patients are limited but there is strong suggestion of a beneficial effect that warrants further
investigation
Molecular Imaging of the Dopamine Transporter
No full textDopamine transporter (DAT) single-photon emission tomography (SPECT) with (123)Ioflupane is a widely used diagnostic tool for patients with suspected parkinsonian syndromes, as it assists with differentiating between Parkinson's disease (PD) or atypical parkinsonisms and conditions without a presynaptic dopaminergic deficit such as essential tremor, vascular and drug-induced parkinsonisms. Recent evidence supports its utility as in vivo proof of degenerative parkinsonisms, and DAT imaging has been proposed as a potential surrogate marker for dopaminergic nigrostriatal neurons. However, the interpretation of DAT-SPECT imaging may be challenged by several factors including the loss of DAT receptor density with age and the effect of certain drugs on dopamine uptake. Furthermore, a clear, direct relationship between nigral loss and DAT decrease has been controversial so far. Striatal DAT uptake could reflect nigral neuronal loss once the loss exceeds 50%. Indeed, reduction of DAT binding seems to be already present in the prodromal stage of PD, suggesting both an early synaptic dysfunction and the activation of compensatory changes to delay the onset of symptoms. Despite a weak correlation with PD severity and progression, quantitative measurements of DAT binding at baseline could be used to predict the emergence of late-disease motor fluctuations and dyskinesias. This review addresses the possibilities and limitations of DAT-SPECT in PD and, focusing specifically on regulatory changes of DAT in surviving DA neurons, we investigate its role in diagnosis and its prognostic value for motor complications as disease progresses
Il contributo della tomografia ad emissione di singolo fotone nella diagnosi della malattia di Parkinson e delle sindromi parkinsoniane
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Impulse control disorders in Parkinson's disease: definition, epidemiology, risk factors, neurobiology and management
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