Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to examine the influence of response fluctuations with dyskinesia on the 24-h motor activity pattern and measures of diurnal and nocturnal activity and immobility. Motor activity was recorded during 5 successive days in 5 patients with advanced Parkinson's disease (PD) suffering from severe response fluctuations with dyskinesia, as well as in 10 PD patients with a stable levodopa response and 10 healthy subjects. The 24-h motor activity pattern of the patients with response fluctuations provides insight into the relationship between the therapeutic regimen and 1) the frequency and duration of "on" and "off" periods, 2) the severity of the dyskinesias, and 3) the degree of sleep disruption. In accordance with the severity of their motor fluctuations, patients with response fluctuations showed a large intra- and interindividual variability of diurnal motor activity measures. Overall, the nocturnal motor activity measures in the patients with response fluctuations indicated a severely disturbed sleep when compared with the two control groups. Factors as simplicity and the potential to record unrestrained motor activity for several days continuously in all settings, make activity monitoring a welcomed acquisition in the assessment of response fluctuations in PD.
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PMID:Assessment of response fluctuations in Parkinson's disease by ambulatory wrist activity monitoring. 847 85

This article summarizes sleep disturbances in a variety of neuro-degenerative diseases, including Parkinson's disease, multiple system atrophy, and amyotrophic lateral sclerosis. Sleep complaints in these conditions include insomnia, hypersomnia, abnormal motor activity and behavior during sleep, sleep-related breathing problems, and circadian rhythm sleep disturbances. Clinical examination followed in selected cases by polysomnographic, multiple sleep latency, and other laboratory tests is essential for correct diagnosis and treatment of these sleep disturbances.
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PMID:Sleep and degenerative neurologic disorders. 892 96

Patients with advanced Parkinson's disease often develop severe fluctuations and dyskinesias while receiving long-term levodopa therapy. These complications can prove increasingly difficult to control. Here we review our strategies for coping with such problems. These include establishing the best rational schedule of levodopa treatment, optimizing levodopa absorption, the use of oral dopaminergic agonists, and the use of subcutaneous injections or infusions of apomorphine or lisuride. The problems of severe dyskinesias, sleep disturbances, psychotoxicity, and urinary difficulties also are considered. Finally, the role of new surgical procedures to treat Parkinson's disease is reviewed.
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PMID:Strategies for treating patients with advanced Parkinson's disease with disastrous fluctuations and dyskinesias. 909 62

Sleep disorders occur in 74-98% of patients with idiopathic Parkinson's disease (PD), adversely affecting their quality of life. Sleep disruption takes the form of sleep fragmentation with frequent and prolonged awakenings and daytime sleepiness. Nocturia, difficulty in turning over in bed, painful leg cramps, vivid dreams/nightmares, back pain, limb/facial dystonia and leg jerks are the main causes of nocturnal awakening in PD patients. Sleep disturbance gradually worsens with disease progression, suggesting that it is related to the severity of the disease. Sleep disturbances may be generally considered as part of the normal aging process, being more common in the elderly. However, no significant associations between sleep disturbances and either age or disease duration was found in a survey of 100 PD patients. Disturbed sleep maintenance in PD patients was more severe than in age-matched controls, and nocturnal awakening was frequently caused by nocturia, pain, stiffness and difficulty in turning over in bed. Sleep disturbance is also a complication of chronic levodopa therapy. Recent data suggest that controlled-release levodopa is less likely to cause nocturnal symptoms than standard levodopa, particularly in mild-to-moderate disease. Depression, which is common in PD patients, contributes to sleep disturbance but has a lesser influence than the disease process itself. Hypnotic and sedative agents, as well as anti-depressants if required, are useful in ameliorating sleep disturbances in PD patients; intranasal desmopressin appears to be effective in reducing nocturia.
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PMID:Sleep disorder related to Parkinson's disease. 911 82

In a hospital-based case-control study 29 patients with idiopathic Parkinson's disease (PD) and visual hallucinations (VH) were compared with 58 PD patients matched for age and disease duration, but without VH. VH patients had more frequently sleep disturbances and dementia, higher PD-related disability (Schwab-England scale), and took selegiline more frequently as an anti-Parkinsonian drug. The patient groups did not differ in age at PD onset, Webster score, treatment duration, dosage of any anti-Parkinsonian drug, frequency of levodopa-associated movement disorders, or measures on brain CT. After a median follow-up period of 27 months more VH patients had developed wearing-off and freezing phenomena, while their scores in the Mini Mental State Examination were lower. Nursing home placement during the follow-up period was associated with higher PD-related disability in VH patients.
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PMID:A study of visual hallucinations in patients with Parkinson's disease. 924 22

Disorders of excessive daytime sleepiness (EDS) constitute a major health hazard, since impaired alertness may lead to accidents and poor quality of life, and some of them are associated with increased cardiovascular morbidity and mortality. Many disorders of EDS are neurological diseases (e.g. narcolepsy and periodic limb movements in sleep, PLMS). The largest group of disorders causing EDS consists of sleep-related disturbances of breathing, where neuroregulatory mechanisms play a major role in pathophysiology. Many patients with neurodegenerative and neuromuscular diseases suffer from sleep disturbances associated with EDS. Therefore, neurologists must be acquainted with the differential diagnosis of EDS and the major categories of sleep disorders causing it. The present update focuses on major sleep disorders causing EDS, and approaches the topic from the neurologist's perspective. Rather than being an extensive review, this update includes recent data on epidemiology, pathophysiology, diagnosis and treatment of obstructive sleep apnea and related conditions (increased upper airway resistance syndrome, central sleep apnea), as well as of narcolepsy and PLMS. Also included are recent data concerning EDS in neurodegenerative (Alzheimer's disease, Parkinson's disease, multiple system atrophy) and neuromuscular disorders.
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PMID:Disorders of excessive daytime sleepiness--an update. 951 78

Tremor is commonly the first neurologic sign of Parkinson's disease (PD) that leads patients to see a physician. Knowing how to differentiate the resting tremor of PD from essential tremor is an important diagnostic skill. Unlike patients with essential tremor, those with PD have other neurologic findings. A diagnosis of PD is likely if the patient has two of three major clinical features: resting tremor, bradykinesia, and rigidity. Minor signs may also be seen, including cognitive slowing, speech abnormalities, depression, dysautonomia, and sleep disturbances. The history and physical exam can determine if the patient has parkinsonism and whether the cause is Parkinson's disease.
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PMID:Tremor: how to determine if the patient has Parkinson's disease. 959 78

The sense of well-being is central to the concept of quality of life (QoL), but there is not a universally accepted definition of health-related QoL. QoL refers to the patient's own evaluation of the impact of the disease. It includes physical, psychological and socioeconomic dimension, and its measurement is of paramount importance in evaluating research outcomes and in cost-benefit analyses. In addition, QoL assessment helps to identify problems and may be essential in chronic and disabling diseases such as in Parkinson's disease (PD). There are numerous reasons for the decrease in QoL suffered by PD patients: restrictions in mobility, falls, emotional disorders, social embarrassment, isolation, sleep disturbances, dyskinesias, and fluctuations. Many aspects of these disorders go unnoticed in clinical evaluation, and only QoL assessment allows them to be rated. Generic instruments have been used in a few studies measuring QoL in PD patients. Only recently have specific instruments as PDQ-39 and PDQL-37 been designed and validated. QoL assessment in PD is an important and expanding area, with a promising application in clinical trials and pharmacoeconomics.
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PMID:An introduction to the concept of "quality of life in Parkinson's disease". 961 14

Sleep disorders are common and well documented in patients with Parkinson's disease (PD). However, most data on sleep in patients with PD are derived from selected patient populations. This community-based survey evaluated the prevalence of and risk factors for sleep disturbances in an unselected group of 245 patients with PD and two control groups of similar age and sex distribution: 100 patients with another chronic disease (diabetes mellitus) and 100 healthy elderly persons. Nearly two thirds of the patients with PD reported sleep disorders, significantly more than among patients with diabetes (46%) and healthy control subjects (33%). About a third of the patients with PD rated their overall nighttime problem as moderate to severe. The most common sleep disorders reported by the patients with PD were frequent awakening (sleep fragmentation) and early awakening. Sleep initiation showed no significant difference compared with the control groups. Pain and cramps were not more prevalent among the patients with PD, but they were more likely to report sleep disturbed by myoclonic jerks. Use of sedatives was common in all three groups but significantly higher in the PD group than in the healthy elderly. Symptoms of depression and duration of levodopa treatment showed a significant correlation with sleep disorders in the PD group. This community-based study confirms that sleep disorders are common and distressing in patients with PD. The strong correlation between depression and sleep disorders in patients with PD underlines the importance of identifying and treating both conditions in these patients.
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PMID:A community-based study of sleep disorders in patients with Parkinson's disease. 982 12

Disturbances of autonomic functions are, without a doubt, part of the symptomatology of Parkinson's disease, but do have little importance as initial symptoms. They are more prominent in the advanced stages of the disease, when they then have an impact on the kind of patients' complaints and on the effects of the therapeutic measures. For example, pollakisuria and urge incontinence are restrictive for social activities and, simultaneously, nighttime akinesia disturbs sleep and recovery. Dysfunction of gastrointestinal mobility brings about a retardation in drug transport from the stomach to the upper intestine and thereby in drug absorption with the sequel of an inadequate response of the parkinsonian symptomatology. Detailed registration--there is a large number of methods--of autonomic functions provides insight into the extent of the degenerative process, but mainly helps to find ways to improve the resulting dysfunctions. Whereas some signs like thermoregulation, sebaceous secretion and sleep disturbances caused by night-time akinesia do improve under drug treatment, others like cardiovascular dysregulation and delayed colon transit-time may even be worsened.
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PMID:[Autonomic disturbances in Parkinson's disease and their treatment]. 1008 27


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