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)

Whilst the association between dementia and poorer health-related quality of life (Hr-QoL) in Parkinson's disease (PD) has been well established, we aimed to explore the relationship between cognitive performance and Hr-QoL in PD without dementia. Consecutive PD patients (n = 124, 54% men, age 60.4 +/- 10.3 years) judged as non-demented based on DSM-IV criteria and Mini Mental State Examination, free of other neurodegenerative diseases or psychotic difficulties and antipsychotic/antidepressive/anxyolitic treatment were assessed in a battery of neuropsychological tests. We used Parkinson's disease questionnaire (PDQ-39) to asses Hr-QoL and Beck's Depression Inventory (BDI) to quantify depression. In the univariate analysis, better performance in each of the tests evaluating visual attention/memory or visuospatial and executive functions was associated with better Hr-QoL. In multivariate analysis [adjustment for BDI score, PD severity and duration, l-dopa dose, age, sex, education, employment status and early PD onset (<50 years of age)] in which these tests were either represented by a common variable identified in a principal components analysis or were considered individually, better cognitive performance was independently associated with better Hr-QoL. The association was conditional on the level of depression, i.e., apparent only in patients with low(er) BDI scores. Cognitive performance appears associated with Hr-QoL even in non-demented PD patients.
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PMID:Is quality of life in non-demented Parkinson's disease patients related to cognitive performance? A clinic-based cross-sectional study. 1821 83

The prevalence of dementia in Parkinson's disease (PD) is close to 30%, and its incidence is 4 to 6 times higher than in age-matched general population. PD with dementia (PDD) is mainly characterized by a predominant and progressive frontal-subcortical impairment. The Mattis Dementia Rating Scale (MDRS) is a commonly used screening test that sensitively measures the degree of frontal-subcortical defects. Although the MDRS has been validated as a screening test of cognitive dysfunction in nondemented PD patients (PD-ND), its utility for screening dementia in PD is unknown. In order to validate the MDRS for diagnosis of PDD it was prospectively administered to 92 PD patients (57 PD-ND, 35 PDD) fulfilling UK-PDSBB criteria. Dementia was diagnosed according to DSM-IV-TR and a Clinical Dementia Rating (CDR) scale score >or=1. Univariate, logistic regression, and ROC curve analysis were carried out to measure the discriminative power of MDRS in PDD. Regression analysis showed MDRS total scores to independently differentiate PD-ND from PDD (P < 0.001). Age and education did not predict the presence of dementia. ROC curve analysis showed a cut-off score of <or=123 on the MDRS total scores to yield high sensitivity (92.65%), specificity (91.4%), positive and negative predictive values (PPV 83.3%, NPV 96.4%). A brief version of the MDRS obtained by the addition of the memory, initiation/perseveration, and conceptualization subscores yielded similar discriminant properties. The MDRS has an excellent discriminant ability to diagnose dementia in PD and provides an objective measure to distinguish PD-ND from PDD.
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PMID:Cut-off score of the Mattis Dementia Rating Scale for screening dementia in Parkinson's disease. 1854 26

Moclobemide, a potent reversible monoamine-oxidase A (MAO-A) inhibitor, is an effective antidepressant that does not cause impairment of cognitive function in elderly patients and might be beneficial to motor deficits in Parkinson's disease (PD). In a 12-week open-label prospective study, we administered moclobemide (300-600 mg day(-1)) as an add-on medication to twelve PD patients who met DSM-III-R criteria for depressive illness. There were two early drop-outs due to subjective worsening of Parkinsonism associated with insomnia and anorexia, respectively. The Beck Depression Inventory score decreased significantly in the ten patients who completed the study, and clinical global assessment of efficacy recorded 'good' or 'excellent' responses or in nine of the ten patients. Mean parkinsonian disability, as assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab-England Daily Life Activities scales, remained unchanged throughout the study in the group as a whole. However, worsening or onset of resting tremor occurred in five patients and the UPDRS tremor subscore in the group overall was significantly higher by week 8 (p = 0.03) when dose titration was optimal. There was a trend toward improvement in UPDRS bradykinesia subscores that did not attain statistical significance. Compared to baseline, patients complained more often of insomnia, anorexia, increased perspiration, and restlessness. Though these preliminary results need to be replicated in a large controlled trial, we suggest that moclobemide may be an effective alternative in the treatment of PD associated depression.
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PMID:Treatment of depression in Parkinson's disease with moclobemide: A pilot open-label study. 1859 Oct 80

The objective of this study was to investigate the prevalence of dementia and regional brain syndromes in a community-based sample including 65 patients with long-standing Parkinson's disease (PD). A range of rating scales, among them a modification of the Stepwise Comparative Status Analysis, was used. Twenty-one patients (32%) met the DSM-III criteria for dementia. Thirty-one of the patients (48%) exhibited regional brain syndromes: nine had anterior; eight posterior; and three global regional brain syndromes; and one had another complex regional brain syndrome. The posterior brain syndrome was significantly more common in the group with dementia (P<0.001).
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PMID:Prevalence of dementia and regional brain syndromes in long-standing Parkinson's disease. 1859 Nov 28

Psychotic symptoms such as hallucinations, delusions and confusion are well known side-effects of levodopa (LD) therapy of Parkinson's disease (PD), even if there is much confusion regarding the variability of the psychotic manifestations. We studied 18 patients clinically treated with LD associated with an inhibitor of peripheral aminoacid decarboxylase (DI). Daily dosage of LD ranged between 250 and 1750 mg; the mean age of patients was 72.7 years; the age at the onset of the disease was 63.3 and duration of the disease 8.4 years. In all patients any possible etiology of Parkinsonism were excluded. Brain CT scan excluded focal lesions in all cases. Psychotic complications were seen in 8 patients: using DSM-III-R-criteria, the various LD-induced psychotic states can be classified in two groups: simple (including or hallucinations with preserved insight) and complex ones (including chronic confusion without preserved insight). Patients with complex symptoms were younger at the onset of the disease and they developed these symptoms later, and these patients were also more susceptible to dyskinesias developed before psychotic complications.
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PMID:Psychotic complications of long term levodopa treatment of Parkinson's disease. 1865 10

Pathological gambling (PG) is defined by the DSM IV criteria as inappropriate, persistent, and maladaptive gambling behavior that has repercussions on family, personal, and professional life. It is classified as an impulse control disorder and is widely understood as a nonpharmacological addiction. PG has been reported as a complication in the treatment of Parkinson disease (PD). The prevalence of PG in PD has been reported to range between 1.7 and 7% compared to a prevalence of approximately 1% in the general population. Though there is no survey that indicates the prevalence of PG in Japanese PD patients, problematic gambling behaviors in PD are occasionally observed. In addition to PG other impulse control behaviors and punding (repetitive stereotyped behavior) are recognized as components of the dopamine dysregulation syndrome (DDS), which is characterized by the compulsive use of dopaminergic medications, including levodopa and subcutaneous apomorphine. Though PG can occur with DDS it often occurs in isolation. The vast majority of PG seen in PD is related to dopamine agonists (DA). With regard to the administration of oral DA, pramipexole may induce a higher degree of PG than other types of oral DA due to its disproportionate stimulation of dopamine D3 receptors. However, the differences between the observed effects of various classes of oral DA were insignificant. PG associated with levodopa mono-therapy is uncommon, but in the majority of cases levodopa is co-prescribed. Subthalamic nucleus deep brain stimulation (STN-DBS) was recently introduced to treat advanced PD. An improvement in PG symptoms following STN-DBS has been reported due to a marked decrease in dopaminergic medications. However, in some patients, PG developed following STN-DBS despite the significant reduction or discontinuation of DA. STN-DBS per se may be a potential initiator of PG. Younger age of PD onset, novelty seeking personality traits, history of alcohol abuse, and impulsivity traits were significant predictors of PG. Patients especially those with individual susceptibility to PG should be warned of the potential risks of PG before DA treatment is initiated.
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PMID:[Pathological gambling and Parkinson disease]. 1880 38

The aim of this study is to investigate the changes of the pupil's light reflex (PLR) and mobility in Parkinson's disease (PD) patients with and without cognitive disorder. Twenty two (22) patients (ten males, twelve females, mean age: 72.7+/-7.3 years) with identified PD entered the study. The patients were examined with the Mini Mental State Examination (MMSE), the Wechsler II Memory Scale (WMS II) and the Hamilton Depression Scale (HAM-D17). Eleven (11) patients (five males, six females, mean age: 72.09+/-7.06 years) were free of any cognitive deficits and eleven (11) patients (five males, six females, mean age: 73.36+/-7.55 years) had cognitive disorder according to the aforementioned scales. None of the patients satisfied the DSM-IV-TR criteria for depression or anxiety disorder. The patients underwent a pupillometric study in both eyes with single flash stimuli of 24.6 candelas/m(2) intensity and 20 ms duration. The pupillometric parameters that were studied were: Latency for the onset of Constriction (T1), Baseline Pupil Radius (R1), Minimum Pupil Radius after the pupil reaction to light (R2), Amplitude (AMP, R1-R2), Time for maximum Miosis (T2), Maximum Constriction Velocity (VCmax) and Maximum Constriction Acceleration (ACmax). The pupillometric findings of each group were compared to those of an age and sex matched group of eleven healthy subjects. Furthermore, a comparison between the findings of the two groups was conducted. ACmax and VCmax were significantly lower in patients without (PD) and with coexisting cognitive impairment (PDC) compared to normal subjects (NC) (p<0.001). Patients with cognitive impairment (PDC) had significantly lower levels of ACmax, VCmax and AMP than patients without cognitive deficits (PD). Cognitive impairment in PD, which mainly reflects a central cholinergic deficit, may be a crucial pathogenetic factor for the decrease in the aforementioned pupillometric parameters. VCmax and ACmax can be considered as the most sensitive indicators of this central cholinergic deficiency.
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PMID:Pupillometric findings in patients with Parkinson's disease and cognitive disorder. 1904 1

Valid tools are needed to assess depression across the spectrum of cognitive impairment in Parkinson's disease (PD). The validity of the Cornell scale for depression in dementia (CSDD) was tested in a PD sample with a range of cognitive impairment. Psychiatric diagnoses were established according to DSM-IV-TR. Receiver operating characteristic curves tested the discriminant validity of the CSDD compared to the clinical diagnoses of major and minor depression. The curve for symptomatic depression had an area under the curve of 0.82. For the cut-off score >or= 6, sensitivity was 0.83 and specificity was 0.73; for the cut-off score >or= 8, sensitivity was 0.75 and specificity was 0.82. There was no evidence for differential measurement with respect to cognitive impairment or any other demographic or clinical variables. This study suggests that the CSDD is a valid tool for identifying depressive disorders in patients with PD across a spectrum of cognitive impairment.
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PMID:Validity of the Cornell scale for depression in dementia in Parkinson's disease with and without cognitive impairment. 1911 58

The purpose of this study was to investigate the neuropsychological correlates of pathological gambling (PG) in Parkinson's disease (PD). Fifteen patients with PD affected by PG (identified based on DSM-IV criteria; PD+PG) without clinically evident dementia were compared with 15 nondemented patients with PD not affected by PG (PD-PG). Two groups of patients with PD were matched for age, length of education, and gender. Clinical and neuropsychiatric features were assessed; several cognitive domains, mainly related to executive functions, were explored by means of standardized neuropsychological tasks. PD+PG and PD-PG did not differ on clinical and neuropsychiatric aspects. PD+PG patients performed significantly worse than PD-PG patients on cognitive tasks that evaluated visuo-spatial long-term memory and several frontal lobe functions. After Bonferroni correction, differences remained significant on the Frontal Assessment Battery (FAB) (P = 0.001), on phonological fluency task (P = 0.003), and on the Trail Making Test, part B minus part A (P = 0.002). Logistic regression analysis demonstrated that low scores on the FAB were the only independent predictor of PG (odds ratio, 27.9; 95% CI: 2.82-277.95, P = 0.004). The results indicate an association between PG and frontal lobe dysfunctions in nondemented patients with PD. Low scores on the FAB indicate patients with PD at high risk for PG.
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PMID:Cognitive dysfunctions and pathological gambling in patients with Parkinson's disease. 1920 72

The objective of this study is to investigate the safety and tolerability of memantine, a glutamatergic modulator, in patients suffering from dementia associated with Parkinson's disease (PDD), an increasingly common complication of PD. This was a 22-week trial of 25 participants with a DSM-IV diagnosis of PDD who were randomized to either placebo or 20 mg/day of memantine. Memantine was well tolerated by participants at 20 mg/day dosing. No participant was withdrawn due to memantine-related adverse events. Six weeks after drug withdrawal, a significantly greater proportion (P = 0.04) of memantine-treated participants deteriorated globally compared with those treated with placebo. These findings suggest that continued treatment with memantine may be needed to maintain global level of functioning over time. Based on the findings of this pilot study, memantine is safe and very well-tolerated in PDD.
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PMID:Randomized controlled trial of memantine in dementia associated with Parkinson's disease. 1937 Jul 37


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