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)

Traffic accidents (TA) are, after heart disease, cancer and stroke, the fourth death cause among the general population. Although the number of AT caused by diseases-excluding alcoholism- seems to be reduced, interaction between organic pathology and functional ability increases the importance of this problem. This paper revises the literature on the relation between AT and specific neurological diseases: epilepsy, obstructive sleep apnea syndrome (SAS), stroke, dementia and Parkinson disease. Also, the problems and the role of the neurologist in assessing driving ability in patients with brain damage is analyzed, with special reference to the legal condition in Spain. The insufficiency of diagnostic labels as predictors of driving ability is stressed; the group of patients affected by these pathologies does not present greater TA risk than young drivers twice that of the general population. In the cases of epilepsy, SAS and ECV, which can cause episodic driving inability, defining recurrence probabilities and finding regulation formulas is the task of clinical epidemiologists and the regulative authorities. In the case of dementia, Parkinson disease and ECV, causing psychomotor performance deterioration, the basic problem, complicated by the presence of comorbility in these patients, is the development of valid clinical scales for driving ability assessment. The regulative authorities need simple measures which are often difficult to develop. Meanwhile, it is the task of the neurologist, as part of the therapeutic intervention during the medical encounter, to discuss driving risks with each patient.
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PMID:[Neurological diseases and driving]. 749 90

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

Sleep disturbances in the elderly may not be a result of the aging process per se, but rather are likely caused by many factors that are amenable to treatment. These factors include medical and psychiatric problems, medications, and circadian rhythm changes, all of which can cause difficulties during sleep at night, and can lead to complaints of insomnia. Other factors that cause disturbances include a high prevalence of specific sleep disorders such as sleep disordered breathing (SDB), periodic limb movements during sleep (PLMS) and rapid eye movement (REM) sleep behavior disorder (RBD). Although these disorders are more prevalent in the older than younger population, they are not exclusive to this age group, and treatment options that are applicable to young adults are also applicable to older adults. On the other hand, dementia and Parkinson's disease are two neurologic disorders that are almost exclusive to the elderly and most often involve sleep disturbances. Because there are many causes of sleep complaints, when considering treatment options one must identify the underlying problem. If caused by illness, effective treatment of a specific medical or psychiatric problem should help alleviate the sleep problem as well. Changes in the timing of drug administration may improve sleep. For the treatment of chronic insomnia, behavior techniques should always be used in combination with pharmacologic therapy, and sedative-hypnotic medications should be considered when appropriate. The treatment of choice for obstructive sleep apnea is continuous positive airway pressure (CPAP). For PLMS, dopaminergic agents are most effective. For RBD, clonazepam effectively controls the aversive sleep behaviors. Sleep disturbances secondary to dementia and Parkinson's disease are usually problematic for the patient as well as the caregiver, whether in the home or in the nursing home. Proper management of these disturbances is beneficial in terms of delaying institutionalization and reducing nursing care costs, as well as improving the quality of life for both patient and caregiver.
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PMID:Sleep Disorders in the Elderly. 1112 56

Although the current guidelines for the clinical diagnosis of multiple system atrophy (MSA) do not require structural or functional brain imaging, investigations utilizing positron emission tomography (PET) have been helpful diagnostically in differentiating between MSA and primary autonomic failure; idiopathic Parkinson's disease; and sporadic olivopontocerebellar atrophy. These investigations have demonstrated different patterns of cerebral glucose utilization and of nigrostriatal projection abnormalities among these disorders and between the cerebellar and parkinsonian forms of MSA. Most of the studies have focused upon patients with well-established disease and none have examined the utility of PET imaging in early stage patients with follow-up of clinical course and autopsy verification to ensure accuracy of diagnosis and to determine the sensitivity and specificity of PET techniques for diagnosis. Recent PET studies have revealed denervation of myocardial post-ganglionic sympathetic neurons in some MSA patients, indicating that this disorder can affect the peripheral autonomic as well as the central nervous system. Investigations utilizing ligands to quantify central nervous system dopaminergic and cholinergic terminals have begun to provide insight into the neurochemical disorders that may underlie two of the sleep disturbances common in MSA, rapid eye movement sleep behavior disorder and obstructive sleep apnea.
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PMID:Functional imaging with positron emission tomography in multiple system atrophy. 1608 7

The authors performed a prospective, unbiased analysis of a cohort of young patients assessed consecutively with the question of dementia. The onset of patients' cognitive symptoms was prior to the age of 65 years. A study group of 226 patients was followed for a mean duration of 4.59 +/- 2.23 years (1 SD; range, 0.04-7.86 years). The diagnoses were established using published diagnostic criteria. A diagnosis of dementia was made in 112 patients (49.56%). Psychiatric disease was the most common diagnosis in those who did not have dementia (24.3%) followed by frontotemporal lobar degeneration (19.0%), Alzheimer's disease (11.9%), patients with cognitive symptoms who obtained normal neuropsychometric profiles (10.6%), nonneurological disorders (eg, obstructive sleep apnea [8.4%]), neurological disorders (eg, Parkinson's disease [4.9%]), and mild cognitive impairment (4.9%). The frequencies of frontotemporal lobar degeneration and psychiatric disease were higher than Alzheimer's disease, unlike in older populations.
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PMID:Course and causes of suspected dementia in young adults: a longitudinal study. 1753 2

Reduction of olfactory function in idiopathic rapid-eye-movement (REM) sleep behavior disorder (iRBD) is of the same magnitude as that found in patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). We assessed olfactory function using the Odor Stick Identification Test for Japanese (OSIT-J) in 48 Japanese patients with iRBD, 21 with PD, and 34 with obstructive sleep apnea syndrome (OSAS). Possible score of the OSIT-J ranges from 0 to 12. OSIT-J scores were 4.9 +/- 2.8 in patients with iRBD, 4.8 +/- 2.8 in patients with PD, and 9.9 +/- 1.4 in OSAS patients. An OSIT-J score of 8.5 was associated with a sensitivity of 88.2 and 85.3%, respectively, and specificity of 83.3 and 85.7%, respectively, in differentiating iRBD or PD patients from OSAS patients. Odor identification is impaired in Japanese patients with iRBD and PD. The results suggest that OSIT-J, which is a short and simple nonlexical olfactory identification test, can be useful as a clinical indicator for iRBD with Lewy body formation and is appropriate in the Japanese elderly population.
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PMID:Odor identification test as an indicator of idiopathic REM sleep behavior disorder. 1897 47

REM sleep behavior disorder (RBD) is characterized by vigorous movements associated with unpleasant dreams and increased electromyographic activity during REM sleep. Polysomnography with audiovisual recording is needed to confirm the diagnosis of RBD and to exclude other sleep disorders that can mimic its symptoms including obstructive sleep apnea, nocturnal hallucinations and confusional awakenings. RBD may be idiopathic or related to neurodegenerative diseases, particularly multiple system atrophy, Parkinson's disease and dementia with Lewy bodies. RBD may be the first manifestation of these disorders, antedating the onset of parkinsonism, cerebellar syndrome, dysautonomia, and dementia by several years. RBD should thus be considered an integral part of the disease process. When effective, neuroprotective strategies should be considered in subjects with idiopathic RBD. Patients with other neurodegenerative diseases, though, such as spinocerebellar ataxias, may also present with RBD. When clinically required, clonazepam at bedtime is effective in decreasing the intensity of dream-enacting behaviors and unpleasant dreams in both the idiopathic and secondary forms. When part of a neurodegenerative disorder the development of RBD is thought to reflect the location and extent of the underlying lesions involving the REM sleep centers of the brain (e.g., locus subceruleus, amygdala, etc.), leading to a complex multiple neurotransmitter dysfunction that involves GABAergic, glutamatergic and monoaminergic systems. RBD is mediated neither by direct abnormal alpha-synuclein inclusions nor by striatonigral dopaminergic deficiency alone.
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PMID:The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. 1939 52

Despite common reports in Parkinson's disease (PD), in other parkinsonian syndromes, sleep disturbances have been less frequently described. This study evaluated and compared sleep disturbances in patients with PD, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) and analyzed associations with brain magnetic resonance imaging (MRI) morphometry. This was a cross-sectional study of 16 PD cases, 13 MSA, 14 PSP and 12 control. Sleep disturbances were evaluated by Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), Restless Legs Scale and Berlin questionnaire. Pons area, midbrain area, medial cerebellar peduncle (MCP) width, and superior cerebellar peduncle width were measured using MRI. Poor quality sleep, risk of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) were detected in all groups. Patients with MSA showed higher risk of OSA and less frequent RLS. In MSA, a correlation between PSQI scores and Hoehn and Yahr stage was observed (p<0.05). In PSP, RLS was frequent (57%) and related with reduced sleep duration and efficiency. In PD, excessive daytime sleepiness was related to atrophy of the MCP (p=0.01). RLS was more frequent in PD and PSP, and in PSP, was associated with reduced sleep efficiency and sleep duration. Brain morphometry abnormalities were found in connection with excessive daytime sleepiness and risk of OSA in PD and PSP suggesting widespread degeneration of brainstem sleep structures on the basis of sleep abnormalities in these patients.
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PMID:Sleep disturbances and brain MRI morphometry in Parkinson's disease, multiple system atrophy and progressive supranuclear palsy - a comparative study. 2018 56

This paper reviews the characteristics of sleep disorders found in people at a greater risk of dementia: the elderly adult, patients with mild cognitive impairment (MCI) and those with neurodegenerative diseases. The frequency of sleep architecture modifications and circadian rhythm sleep disturbances increases with age. Although around 40% of older adults complain of poor sleep, true sleep disorders are far less prevalent in healthy older adults and are frequently associated with comorbidities. The sleep disorders observed in Alzheimer's disease (AD) patients are often similar to (but more intense than) those found in non-demented elderly people. Poor sleep results in an increased risk of significant morbidities and even mortality in demented patients and constitutes a major source of stress for caregivers. The prevalence of primary sleep disorders such as rapid eye movement (REM) sleep behavior disorders (RBDs), restless legs syndrome (RLS), periodic limb movements (PLMs) and sleep-disordered breathing increases with age. There are no published data on RLS and PLMs in demented persons but RBDs and sleep apnea syndrome have been studied more extensively. In fact, RBDs are suggestive of Lewy body dementia (LBD) and are predictive for neurodegeneration in Parkinson's disease. Obstructive sleep apnea (OSA) shares common risk factors with AD and may even be an integral part of the pathological process in AD. In MCI patients, the hypotheses in which (i) sleep disorders may represent early predictive factors for progression to dementia and (ii) MCI is symptomatic of a non-diagnosed sleep disorder remain to be elucidated. Guidelines for drug and non-drug treatments of sleep disorders in the elderly and in demented patients are also considered in this review. In healthy but frail elderly people and in early-stage AD patients, sleep should be more thoroughly characterized (notably by using standardized interviews and polysomnographic recording).
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PMID:Sleep disorders in aging and dementia. 2019 Dec 56

Pulmonary function abnormalities in Parkinson's disease (PD) might predispose patients to obstructive sleep apnea (OSA) and daytime sleepiness. Fifty-five idiopathic PD patients (mean age = 63.9) underwent three consecutive nights of in-laboratory polysomnography on their usual dopaminergic medications. Sleep apnea severity was compared to published, normative, population-based data from the Sleep Heart Health Study. Demographic and clinical data were compared in patients with and without OSA. The apnea-hyponea index (AHI) was stable across nights in PD patients, and was not different between PD patients and normative controls. Epworth Sleepiness Scale scores, Body Mass Index, and snoring did not correlate with AHI. Severity of OSA is stable across multiple nights in PD patients. Rates of OSA in PD are similar to those seen in the general population. Daytime sleepiness, snoring, and obesity may not be helpful in identifying OSA in PD.
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PMID:No increased risk of obstructive sleep apnea in Parkinson's disease. 2066 89


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