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)

This review focuses on restless legs syndrome (RLS) and Parkinson's disease (PD). These conditions are frequently encountered in clinical sleep medicine and are among the most important of the "nonapnea" sleep disorders. RLS and PD share many features, including derangement of central dopaminergic systems as the putative cause, akathisia, and nocturnal motor fluctuations. In addition, both conditions increase in prevalence with aging, exhibit a beneficial response to dopaminergic therapy, and cause marked sleep disturbances. They frequently overlap, with about 20% of patients with PD having symptoms of RLS. Both conditions appear to have a genetic predisposition that is "turned on" by environmental factors. Adverse responses to levodopa occur in both RLS and PD, manifested as rebound and augmentation in RLS and as fluctuations in motor response and dyskinesias in PD. Newer dopaminergic agents are helpful in the management of both conditions.
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PMID:Movement disorders: a sleep specialist's perspective. 1500 59

Sleep disturbances are common in extrapyramidal diseases, including not only insomnia but excessive daytime sleepiness and parasomnias. In particular, complaints related to sleep are extremely common among patients affected by Parkinson's disease (PD). The underlying causes may include: patient age, associated illnesses, cognitive impairment, motor dysfunction caused by disease, neurochemical changes related to the disease, drugs, and secondary psychological responses to the disease. The exact prevalence of sleep disorders in PD is difficult to ascertain, due to the heterogeneity of patients as well as to the different criteria and methods used to diagnose and classify sleep disturbances. In this study, we will attempt to review the epidemiological data and to describe the various sleep disorders, which have been identified in extrapyramidal diseases, with particular reference to PD. There are no data available at present as to the role of gender in sleep disturbances. Finally, the benefit of sleep on extrapyramidal diseases will be addressed, taking into account that the above causes may modify the effects of sleep.
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PMID:Epidemiology and clinical features of sleep disorders in extrapyramidal disease. 1503 40

Sleep disorders and fatigue are common problems in Parkinson's disease (PD). Although they frequently appear together, they are often distinct symptoms that must be understood separately. Fatigue has been reported to be the most bothersome aspect of PD in about one-third of patients, yet it is poorly understood and not clearly treatable. Sleep disorders, while more common, are less bothersome to the patients and often responsive to therapy. An overview of sleep disorders in PD and an approach to therapy will also be outlined. The little that is known about fatigue in PD will be reviewed.
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PMID:Sleep and fatigue in Parkinson's disease. 1510 84

Psychiatric, cognitive and sleep disorders are the most frequent and disabling non-motor complications of Parkinson's disease (PD). To improve the description of sleep and mental disorders in PD patients, we set out to develop a simple and reliable data collection tool (questionnaire) for the screening of large samples of PD patients. The first draft of the questionnaire was administered to a consecutive series of 120 PD patients from the outpatient department of our unit, who were instructed to fill it in with the help of their caregivers. Subsequent drafts of the questionnaire were evaluated together with the patients and their caregivers, until a final, satisfactory version was obtained. This final version was named the Questionnaire on Sleep and Mental Disorders in PD (QSMDPD). This questionnaire--we used the Italian version, named Questionario sui Disturbi del Sonno e Mentali nella Malattia di Parkinson, ODSMMP--consists of 119 questions with multiple-choice answers. The QSMDPD was mailed or handed to 400 PD patients followed at our unit's outpatient department. Three hundred and twenty (80%) were returned to us. A review of these completed questionnaires, conducted by a neurologist together with the patients, showed 90% of them (289) to be complete and to provide reliable data. This high compliance suggests that the QSMDPD is a promising tool for collecting data on sleep and mental disorders in large samples of PD patients. A short version will be administered as a follow-up tool.
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PMID:A questionnaire on sleep and mental disorders in Parkinson's disease (QSMDPD): development and application of a new screening tool. 1527 15

The Parkinson's Disease Sleep Scale (PDSS) is the first published bedside clinical tool to specifically measure sleep disturbances in Parkinson's disease (PD). The objective of the present study was to carry out a metric analysis of a Spanish version (PDSS-SV) using a cross-sectional study of 100 PD patients who participated in the study. Usual measures for PD and mental status were applied by neurologists. Patients completed the Epworth Sleepiness Scale, Parkinson's Disease Questionnaire-39 Items (PDQ-39), and PDSS-SV. PDSS internal consistency (Cronbach's alpha, 0.77; significant item-total correlation for 11 items) was satisfactory. PDSS showed high test-retest reliability (intraclass correlation coefficient for items, 0.79-0.99; for total score, 0.94). Standard error of measurement was 9.80 (crossover) and 5.01 (longitudinal). Scores were distributed uniformly, with low floor and ceiling effect (1%). PDSS scores were correlated significantly with depression (Hamilton Depression Rating Scale, r(S) = -0.55; P < 0.0001) and quality of life (PDQ-39 Summary Index, r(S) = -0.26; P = 0.007), but not with clinical variables. Self-perception of mood disorder, pain, or hallucinations correlated individually with PDSS scores, and a factor explaining 65% of the variance was found. The assessment of PD sleep disorders with the PDSS met some basic standards required for health status measures.
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PMID:Parkinson's Disease Sleep Scale: validation study of a Spanish version. 1539 13

Approximately 74-94% patients with Parkinson's disease have sleep disorders: such as frequent awakening, excessive daytime sleepiness, nightmares, nocturnal cramps, REM sleep behavior disorders and so on. In contrast, the relationship between physiological mechanism of sleep and the dopamine systems are still obscure, because the dopamine systems are not directly related neither initiating or maintaining sleep system nor awaking system. However, most of all the dopaminergic drugs were reported to induce sleepiness or sleep attacks in the patients with Parkinson's disease. So, physicians must inform patients with Parkinson's disease warning the excessive daytime sleepiness and sleep attack. In this article, I suggest the mechanisms of sleep disorders on Parkinson's disease from the physiological points of view, and how to manage these problems.
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PMID:[Sleep disorders in Parkinson's disease]. 1546 82

Nocturnal disturbances are common in Parkinson's disease (PD) patients, with almost 70% of these patients reporting nocturnal disturbances. The etiology of sleep disturbances in patients with PD is still controversial. They might be dependent on dopaminergic drugs, on disease progression, or on a combination of these two factors. Nocturnal disturbances can be categorized in four groups: 1) PD-related motor symptoms, including nocturnal akinesia, early-morning dystonia, painful cramps, tremor, and difficulty turning in bed; 2) treatment-related nocturnal disturbances; 3) psychiatric symptoms, including hallucinations, vivid dreams, depression, dementia, insomnia, psychosis, and panic attacks; 4) other sleep disorders, including insomnia, REM behavioral disorder (RBD), restless legs syndrome (RLS), periodic leg movements (PLMS), and excessive daytime sleepiness (EDS). Specific treatment options are supplied for every group. A global evaluation of nocturnal disturbances would provide clinicians with a valuable tool to establish an optimal regimen that could positively influence all nocturnal disturbance categories and thus improve PD management on. However, it is important to consider that management of some nocturnal disturbances in a group may worsen nocturnal symptoms of another group or may increase EDS. PD-related symptoms can be treated with long-acting DA agonists to obtain continuous DA receptor stimulation during the night. Both treatment-related nocturnal disturbances and psychiatric symptoms may be related to drug treatment, and therefore, in both cases, drug reduction or discontinuance should be considered. Some sleep disorders, such as RLS and PLMS, may be controlled by DA agents, and others, such as insomnia and EDS, may be improved by reducing dopaminergic stimulation.
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PMID:Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson's disease. 1550 42

Parkinson's disease is associated with classical Parkinsonian features that respond to dopaminergic therapy. Neuropsychiatric sequelae include dementia, major depression, dysthymia, anxiety disorders, sleep disorders, and sexual disorders. Panic attacks are particularly common. With treatment, visual hallucinations, paranoid delusions, mania, or delirium may evolve. Psychosis is a key factor in nursing home placement, and depression is the most significant predictor of quality of life. Clozapine may be the safest treatment for psychotic features, but more research is needed to establish the efficacy of antidepressant treatments. Dementia with Lewy bodies, the second most common dementia in the elderly, may present in association with systematized delusions, depression, or RBD. Early evidence suggests the utility of rivastigmine, donepezil, low-dose olanzapine, and quetiapine in treating DLB. Parkinson-plus syndromes generally lack a good response to dopaminergic treatment and evidence additional features, including dysautonomia, cerebellar and pontine features, eye signs, and other movement disorders. MSA is associated with dysautonomia and RBD. SND (MSA-P) is associated with frontal cognitive impairments, but dementia, psychosis, and mood disorders have not been strikingly apparent unless additional pathological findings are present. In SDS (MSA-A), impotence is almost ubiquitous; urinary incontinence is frequent; depression is occasional, and sleep apnea should be treated to avoid sudden death during sleep. OPCA neuropsychiatric correlates await further definition. Progressive supranuclear palsy neuropsychiatric features include apathy, subcortical dementia, pathological emotionality, mild depression and anxiety, and lack of appreciable response to donepezil. CBD usually is recognized by early frontal dementia with ideomotor apraxia, often in the right upper extremity, attended later by poorly responsive unilateral Parkinsonism, with additional signs including cortical reflex myoclonus, limb dystonia, alien limb, oculomotor apraxia when asked to look horizontally, depression, personality changes, and, occasionally, Kluver-Bucy syndrome. The neuropsychiatry of FTDP-17 involves apraxia, executive impairment, personality changes, hyperorality, and occasional psychosis. Future research in these Parkinsonian disorders should target the characterization of neuropsychiatric sequelae and their treatment.
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PMID:The neuropsychiatry of Parkinson's disease and related disorders. 1555 Feb 93

Driving motor vehicles is a complex visuomotor task that challenges normal nervous system functioning. Indemnity of sensory organs and intact alertness are essential. In addition, safe driving is extremely sensitive to disturbances of attention as well as to some forms of cortical dysfunction. Epilepsy, cognitive impairment, Parkinson's disease, stroke and sleep disorders, among other conditions, may interfere with driving through different mechanisms. The individual rights to maintain important privileges such as having a driver's license may enter in conflict with a society demanding safer regulations. Current trends favor more liberal restrictions and may provide specific limits on an individual basis to patients with impairments caused by neurological diseases. So far, there is no information on the consequences in terms of rate of accidents following newly introduced changes in driver license regulations for neurological patients.
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PMID:[The neurologist and patients driving motor vehicles]. 1571 89

Sleep disorders are common in the general population and occur more frequently with advancing age. However, patients with Parkinson's disease (PD) have been known to have various sleep disturbances beyond those to be expected from the effect of aging alone. We tried to quantify the various aspects of nocturnal sleep problems in PD using the PD sleep scale (PDSS). 64 patients with PD and 60 age- and sex-matched controls completed the PDSS. After neurological examinations, we assessed the degree of sleep disorder by the PDSS. We evaluated the severity of PD by the Hoehn and Yahr Scale and the unified PD rating scale (UPDRS). To compare the various aspects of nocturnal sleep problems in PD between in Japan and in the United Kingdom (UK), we referenced and compared our results with those by Chaudhui et al. The PDSS scores in PD group were significantly different from those in controls. Individual items of the scale showed good discriminatory power between PD and controls. Overall tendencies were the same in Japan and in the UK, but there were some different points, especially absence of refreshing quality of sleep in Japan. We believe that the PDSS provides an objective method for targeted therapeutic approaches for the treatment of disturbed sleep in PD even among countries with different cultures, such as Japan and the UK.
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PMID:Sleep disturbances in Japanese patients with Parkinson's disease--comparing with patients in the UK. 1594 37


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