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)

Patients with Parkinson's disease (PD) become dependent upon caregivers because motor and cognitive disabilities interfere with their ability to carry out activities of daily living (ADLs). However, PD patients display diverse motor and cognitive symptoms, and it is not yet known which are most responsible for ADL dysfunction. The purpose of this study was to identify the contributions that specific cognitive and motor functions make to ADLs. Executive functioning, in particular sequencing, was a significant independent predictor of instrumental ADLs whereas simple motor functioning was not. By contrast, simple motor functioning, but not executive functioning, was a significant independent predictor of physical ADLs. Dementia severity, as measured by the Dementia Rating Scale, was significantly correlated with instrumental but not physical ADLs. The identification of selective relationships between motor and cognitive functioning and ADLs may ultimately provide a model for evaluating the benefits and limitations of different treatments for PD.
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PMID:Differential contributions of cognitive and motor component processes to physical and instrumental activities of daily living in Parkinson's disease. 1459 Jun 18

The internal consistency (Cronbach's alpha and item-total correlation) and construct validity (factor analysis, intercorrelations, and relationship with Hoehn and Yahr staging and Schwab and England's ADL scale) of the sections "motor examination" and "activities of daily living" of the Unified Parkinson's Disease Rating Scale (UPDRS) and of the Short Parkinson's Evaluation Scale (SPES) were analyzed in 59 subjects with Parkinson's disease (PD) with various degrees of disability. Our results indicate that the SPES is easier and quicker than UPDRS and that it maintains many psychometric properties similar to those of the UPDRS, but with the reduction of a number of items and ordinal levels of each item studied here (producing more homogenous sections than the original versions). The tremor items would be better represented as a separate section in both scales.
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PMID:Psychometric properties of the Unified Parkinson's Disease Rating Scale and of the Short Parkinson's Evaluation Scale. 1459 81

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a popular treatment option for patients suffering from severe Parkinson's disease (PD). Yet the long-term outcome of subthalamic DBS is unknown. A total of 27 patients suffering from severe PD underwent bilateral stereotactic implantation of high-frequency stimulators in the STN. Before surgery and at least annually after surgery they were examined with the Unified Parkinson's Disease Rating Scale (UPDRS). This study presents the results of a mean 30 months (range 23 to 55) follow-up of these patients. We found stable and significant off medication improvement of motor function by DBS (between 40% and 44% in the UPDRS part III). While on medication there was no significant change in the motor function by DBS. UPDRS part III worsened gradually during the follow-up period, suggesting disease progression. Thirty months postsurgery the UPDRS part II (ADL) was still improved by 17%. There was a lasting decrease in fluctuations by more than 50%, and dyskinesias were reduced by about 70%. Freezing was reduced significantly from 2.2 in the UPDRS part II to 1.2 at the endpoint. The daily levodopa-equivalent dose was reduced by 39% at 12 months and by 30% at 30 months after STN stimulator implantation. Subthalamic DBS improves sustainable motor function in patients with severe Parkinson's disease and leads to a lasting reduction of medication. Limitations of this procedure were found for disturbances of speech and swallowing.
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PMID:Chronic inhibition of the subthalamic nucleus in Parkinson's disease. 1505 Apr 47

There is little information on the efficacy of various surgical interventions in terms of health-related quality of life in Parkinson's disease (PD) patients. Most studies evaluated only motor symptoms of PD after surgical treatment avoiding subjective patient's assessment. The goal of this study is the assessment of surgical treatment of PD on quality of life using Parkinson's Disease Questionnaire (PDQ-39). To 134 patients PDQ-39 questionnaires were send, 91 of them responded. Among 91 patients 32 underwent unilateral thalamotomy, 38 unilateral pallidotomy and 21 bilateral staged pallidotomy. The patients were assessed at baseline and 3 to 6 months after surgery. The PDQ-39 recorded significant improvement in mobility, activity of daily living and stigma in thalamotomy and pallidotomy group. The most striking improvement was noticed in bilateral pallidotomy group. After bilateral pallidotomy improvement was noticed in mobility, ADL, emotional well being, stigma and bodily discomfort. Our results indicate that quality of life in PD patients after surgical treatment is measurable according to PDQ-39 and the most benefit is noted in patients who underwent bilateral staged pallidotomy.
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PMID:[Evaluation of quality of life in Parkinson disease treatment]. 1509 50

In intractable neurological diseases, there are often no appropriate treatment methods even after admission and the course is frequently chronic. Therefore treatment at home is a major choice. In particular, in Parkinson's disease and amyotrophic lateral sclerosis, care at home while symptoms are stable is appropriate in terms of extension of ADL and the QOL of the patient and family. We have performed continuous treatment at home according to our plan for the previous 9 years. This treatment was favorably accepted by the patient and family without major problems. It is important to organize network to support patient with intractable neurological diseases. By virtue of the care insurance system established in 2000, services of medical care, health and welfare are being collectively provided at present. But, there still remain many issues awaiting solution on the support to advanced intractable neurological diseases. A pending problem about suction of sputa for the ALS patients serving at home are being allowed to non-medical profession like home helper.
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PMID:[Intractable neurological diseases and neurology]. 1515 64

The aim of this study was to evaluate the effects of prolonged physical therapy on disability in patients with Parkinson's disease. The study was designed as an open long-term trial over 20 weeks. Twenty slightly to moderately affected parkinsonian patients were included (Hoehn & Yahr stages: 1.5-3). A comprehensive rehabilitation program was applied three times a week in all patients. Pharmacological treatment was kept stable. Evaluations were performed at baseline, at the end of treatment and after 3 months. Following physical rehabilitation, there was a significant improvement in UPDRS (ADL and motor sections) scores, Self-assessment Parkinson's disease Disability Scale, Ten-Meter Walk test and Zung scale for depression. At 3-month follow-up clinical improvements were largely maintained. A sustained improvement of motor skills in PD patients can be achieved with a long-term comprehensive rehabilitation program.
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PMID:Physical therapy in Parkinson's disease: an open long-term rehabilitation trial. 1516 94

Three years after the implantation of electrodes in the subthalamic nucleus (STN) and the start of deep brain stimulation (DBS) for advanced Parkinson's disease, a 62-year-old man was admitted because of a stimulation-related manic state that did not respond to treatment with a mood stabiliser and that led to chaotic behaviour, megalomania, serious financial debts and mental incompetence. Although adjustment of the stimulation parameters resulted in a normophoric state with a return of insight and capacity to judge, this was only at the cost of a serious exacerbation of his motor symptoms that left the patient bedridden. There was no therapeutic margin between the two states. Ultimately, there seemed to be only two alternatives: to admit the patient to a nursing home because of serious invalidity, but mentally in good condition, or to admit the patient to a chronic psychiatric ward because of a manic state, but with acceptable motor capacity and ADL functions. Thorough ethical evaluation followed. When not being stimulated, the patient was considered competent to decide about his own treatment; in this condition the patient chose for the second option. In accordance with his own wishes he was therefore legally committed to a chronic ward in the regional psychiatric hospital. The current ethical views on mental competence do not consider the potential influence of modern methods of treatment such as STN-DBS on this capacity.
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PMID:[Manipulation of mental competence: an ethical problem in case of electrical stimulation of the subthalamic nucleus for severe Parkinson's disease]. 1552 38

The aim of this study was to analyse and compare published data during the last decade on the different approaches to Parkinson's disease surgery. Eighty-eight papers published between 1990 and 2001 fulfilled the inclusion criteria. Full-text and prospective papers on lesion and stimulation of GPi or STN were assessed. Descriptive analysis of surgery procedure and population under study was performed, as well as a meta-analysis of the most consistently reported variables. A total of 1702 patients underwent surgery with a mean age of 58.75 years (range 46.5 - 72.5), mean duration of illness 13.6 years (8.1 - 18.1) and a male:female ratio 1.5:1. Mean postoperative follow-up was 9 months (1 - 52). Single blind assessment was performed in two papers, while double blind evaluation was used in 6. In the GPi group, no difference was found between the pre- and postoperative levodopa equivalent daily dose (960.39 v. 943.13; p > 0.05), while the STN group showed a marked reduction (1104.8 v. 483.04; p < 0.05) of this dosage. Meta-analysis of the most consistently reported variables (UPDRS total score, UPDRS motor score, UPDRS ADL score and Schwab & England score showed that Nucleus, Bilaterality of Approach and Surgical Procedure were the best moderators for defining outcome. Bilateral DBS STN procedures proved to be associated with better outcome. Microelectrode recording was not found to be a moderator that influenced outcome. Although there was a significant improvement of dyskinesias among the different approaches described in the papers, the heterogeneity of data makes it impossible to perform a structured analysis on this item.
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PMID:Functional surgery for Parkinson's disease treatment: a structured analysis of a decade of published literature. 1532 20

There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions, but this usefulness has not been studied in multiple system atrophy (MSA) to date. The aim of this small pilot study was to identify the feasibility of a larger randomized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability, mood, and health-related quality of life in patients with MSA. Patient groups were comparable for age, gender distribution, type of MSA, and severity. The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson's Disease Rating Scale (total score and Activities of Daily Living [ADL] section), and PDQ-39 scores (total scores and ADL subsection). An occupational therapy program may improve functional abilities in patients with mild to moderate MSA. A larger multicenter study is needed.
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PMID:Occupational therapy in multiple system atrophy: a pilot randomized controlled trial. 1538 83

In this study we aimed to investigate the effects of bilateral STN HFS in patients with advanced Parkinson disease (PD) at long-term, with a minimum follow-up of 4 years. Twenty patients (15 men, five women) were included, with a mean age of 60.9+/-8.1 years. Surgery was performed under local anesthesia. The target was defined on computerized tomography (CT). At 3 months, significant improvements were found on the total Unified Parkinson disease rating scale (UPDRS) III (motor) score, in the medication. off (from 42.3+/-9.3 to 19.5+/-6.4), as well as the medication on (from 18.6+/-12.1 to 10.1+/-5.9) phase. The UPDRS IVa (dyskinesias) and IVb (motor fluctuations) scores decreased significantly. At long-term follow-up, there were still significant improvements on the total UPDRS III motor score (from 42.3+/-9.3 to 24.2+/-13.2), as well as in all motor subscores, in the off phase, during stimulation. In the on phase, the only significant improvement was seen for rigidity. Complications included hypomania to mania in four patients. Our results indicate that HFS STN results in long-lasting improvement of the motor symptoms, ADL activities and functional performance in patients suffering from advanced PD. The stimulation induced behavioural changes need special consideration.
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PMID:Long-term effects of bilateral subthalamic nucleus stimulation in advanced Parkinson disease: a four year follow-up study. 1582 80


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