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Non-motor symptoms in parkinson’s disease  [PDF]
Torgan T.I.,Baidina T.V.
Saratov Journal of Medical Scientific Research , 2012,
Abstract: The goal of the research was to investigate some non-motor disorders at patients with Parkinson disease (PD) and to determine their relations to the main manifestations of the disease. 68 patients with PD without dementia were studied. Duration of disease was 4 (2-6) years. The following scales were used: Modifed Fatigue Impact Scale (MFIS), Unifed Parkinson Disease Rating Scale (UPDRS, part 3), Hospital Anxiety and Depression Scale (HADS), A. M. Veyn Questionnaire for autonomic disturbances and the Epworth Sleepiness Scale (ESS). The results of this study have revealed the presence of emotional disorders, fatigue, autonomic dysfunction and dyssomnia at patients with PD. Non-motor symptom severity does not depend on age and sex of the patients, as well as the main motor symptoms of the disease. The relationships of the examined non-motor symptoms were revealed.
Pre-Fibrillar α-Synuclein Mutants Cause Parkinson's Disease-Like Non-Motor Symptoms in Drosophila  [PDF]
Madhu Babu Gajula Balija, Christian Griesinger, Alf Herzig, Markus Zweckstetter, Herbert J?ckle
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024701
Abstract: Parkinson's disease (PD) is linked to the formation of insoluble fibrillar aggregates of the presynaptic protein α-Synuclein (αS) in neurons. The appearance of such aggregates coincides with severe motor deficits in human patients. These deficits are often preceded by non-motor symptoms such as sleep-related problems in the patients. PD-like motor deficits can be recapitulated in model organisms such as Drosophila melanogaster when αS is pan-neurally expressed. Interestingly, both these deficits are more severe when αS mutants with reduced aggregation properties are expressed in flies. This indicates that that αS aggregation is not the primary cause of the PD-like motor symptoms. Here we describe a model for PD in Drosophila which utilizes the targeted expression of αS mutants in a subset of dopadecarboxylase expressing serotonergic and dopaminergic (DA) neurons. Our results show that targeted expression of pre-fibrillar αS mutants not only recapitulates PD-like motor symptoms but also the preceding non-motor symptoms such as an abnormal sleep-like behavior, altered locomotor activity and abnormal circadian periodicity. Further, the results suggest that the observed non-motor symptoms in flies are caused by an early impairment of neuronal functions rather than by the loss of neurons due to cell death.
Non-Motor Symptoms in Patients with Parkinson’s Disease – Correlations with Inflammatory Cytokines in Serum  [PDF]
Daniel Lindqvist, Eli Kaufman, Lena Brundin, Sara Hall, Yulia Surova, Oskar Hansson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0047387
Abstract: Background Parkinson’s Disease (PD) is the second most common neurodegenerative disorder of the central nervous system. Motor symptoms are the focus of pharmacotherapy, yet non-motor features of the disease (e.g. fatigue, mood disturbances, sleep disturbances and symptoms of anxiety) are both common and disabling for the patient. The pathophysiological mechanisms behind the non-motor symptoms in PD are yet to be untangled. The main objective of this study was to investigate associations between pro-inflammatory substances and non-motor symptoms in patients with PD. Methods and Materials We measured C-reactive protein, interleukin (IL)-6, soluble IL-2 receptor (sIL-2R) and tumor necrosis factor-α (TNF-α) in blood samples from PD patients (n = 86) and healthy controls (n = 40). Symptoms of fatigue, depression, anxiety and sleeping difficulties were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT), the Hospital Anxiety and Depression Scale (HAD), and the Scales for Outcome in PD-Sleep Scale respectively. Results IL-6 was significantly higher in PD patients than in healthy controls. Compared to healthy controls, PD patients displayed significantly higher mean scores on HAD and lower scores on FACIT, thus indicating more severe symptoms as measured with these scales. Within the PD sample, high levels of both sIL-2R and TNF-α were significantly associated with more severe symptoms assessed by means of FACIT and HAD (depression and anxiety subscales). SIL-2-R levels were able to significantly predict FACIT and HAD scores after the effects of age, gender, anti-parkinsonian medications, and severity of motor symptoms were controlled for. Discussion We suggest that non-motor symptoms in PD patients, such as fatigue and depressive symptoms, might be generated via inflammatory mechanisms. This knowledge might contribute to the development of novel treatment options in PD, specifically targeting non-motor symptoms.
Oral mucosa symptoms, signs and lesions, in end stage renal disease and non-end stage renal disease diabetic patients
de la Rosa García,Estela; Mondragón Padilla,Arnoldo; Aranda Romo,Saray; Bustamante Ramírez,Martha Alicia;
Medicina Oral, Patología Oral y Cirugía Bucal (Internet) , 2006,
Abstract: aim: to assess oral signs, symptoms and oral lesions (ol) type and prevalence, in diabetic patients with end stage renal disease (esrd dm), and compare them with analogous findings in a non-esrd dm group; analyze the possible association between oral manifestations, as well as with relevant laboratory findings. research design. two adult groups were studied: group a: esrd dm on dialysis, and group b: non-esrd dm (serum creatinine <2.0 mg/dl). known dm evolution time, dialysis treatment type and duration, and laboratory results were recorded. an oral exam was performed, searching for signs, symptoms and esrd-associated ol. associations were analyzed using chi square, fisher?s exact test, and odds ratios (or) with 95% confidence intervals. ages, time on dialysis, and laboratory results were compared with student?s t test. results: 229 individuals were examined, group a 99, and group b 130 pts. signs and symptoms prevalence was higher in group a: 77.8% vs. 57.6%, (p<0.001), uremic breath (48.5%), unpleasant taste (45.5%) and xerostomia (44.4%) being the most frequent ones. ol were also more prevalent in group a; 65.6% vs. 36.9% (p<0.001). the most frequent ol were dry, fissured lips (28.3%), saburral tongue (18.2%) and candidiasis (17.2%). no difference was found in candidiasis prevalence between groups. candidiasis was found associated to xerostomia (p<0.05) and smooth tongue (p<0.05) only in group a. conclusions. esrd dm patients had a significantly higher prevalence of signs, symptoms and ols, as compared to non-esrd dm pts. the high prevalence of uremic fetor, xerostomia, saburral tongue and candidiasis in group a, could be tried as warning signs on the possibility of non diagnosed advanced renal disease in other diabetic patients.
Psychometric validation of the revised SCOPA-Diary Card: expanding the measurement of non-motor symptoms in parkinson's disease
Regina Rendas-Baum, Philip O Buck, Michelle K White, Jane Castelli-Haley
Health and Quality of Life Outcomes , 2011, DOI: 10.1186/1477-7525-9-69
Abstract: A convenience sample was used to recruit four focus groups of PD patients. Based on findings from focus groups, the SCOPA-DC was revised and administered to a sample of 101 PD patients. Confirmatory factor analysis was conducted to test the domain structure of the Revised SCOPA-DC. The reliability, convergent and discriminant validity, and ability to predict off-time of the Revised SCOPA-DC were then assessed.Based on input from PD patients, the Revised SCOPA-DC included several format changes and the addition of non-motor symptoms. The Revised SCOPA-DC was best represented by a three-factor structure: Mobility, Physical Functioning and Psychological Functioning. Correlations between the Revised SCOPA-DC and other Health-Related Quality of Life scores were supportive of convergent validity. Known-groups validity analyses indicated that scores on the Revised SCOPA-DC were lower among patients who reported experiencing off-time when compared to those without off-time. The three subscales had satisfactory predictive utility, correctly predicting off-time slightly over two-thirds of the time.These findings provide evidence of content validity of the Revised SCOPA-DC and suggest that a three-factor structure is an appropriate model that provides reliable and valid scores to assess symptom severity among PD patients with symptom fluctuations in the U.S.Parkinson's disease (PD) is the second most prevalent neurodegenerative disease in the U.S., afflicting about one million Americans over age 60 [1]. Motor symptoms associated with PD include bradykinesia (slowness of movement), tremor of resting muscles, postural instability or impaired balance, and gait disturbances [2]. In addition to motor symptoms, a wide range of non-motor symptoms are also associated with PD. The most common include neuropsychiatric symptoms (depression, anxiety, cognitive impairment, etc.), sleep dysfunction, autonomic dysfunction (bladder dysfunction, excessive sweating, etc.), gastrointestinal dysf
Differentiating Non-Motor Symptoms in Parkinson's Disease from Controls and Hemifacial Spasm  [PDF]
Ming-Hui Yong, John C. Allen, Kumar M. Prakash, Eng-King Tan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0049596
Abstract: Background and Aims Non-motor symptoms (NMS) are important manifestations of Parkinson's disease (PD) that reduce patients' health-related quality of life. Some NMS may also be caused by age-related changes, or manifested as a psychological reaction to a chronic neurological condition. This case-control study compared the NMS burden among PD patients, healthy controls and hemifacial spasm (HFS) patients. In addition, we determined the NMS that discriminated between PD and non-PD subjects. Methods 425 subjects were recruited from a tertiary hospital in Singapore (200 PD patients, 150 healthy controls and 75 HFS patients). NMS burden in subjects was measured using the Non-Motor Symptoms Scale (NMSS). Results NMSS total score was significantly higher in PD patients (37.9±2.6) compared to healthy controls (11.2±0.9) (p<0.0001) and HFS patients (18.0±2.1) (p<0.0001). In addition, NMSS total score was significantly higher in HFS patients compared to healthy controls (p = 0.003). PD patients experienced a higher NMS burden than healthy controls in all domains, and a higher NMS burden than HFS patients in all but attention/memory and urinary domains. NMS burden for HFS and healthy controls differed only in the sleep/fatigue and urinary domains. Using stepwise logistic regression, problems of ‘constipation’, ‘restless legs’, ‘dribbling saliva’, ‘altered interest in sex’ and ‘change in taste or smell’ were found to have significant discriminative power in differentiating between PD patients and healthy controls and between PD patients and HFS patients. Conclusion PD patients experienced a greater overall NMS burden compared to both healthy controls and HFS patients. HFS patients demonstrated a higher NMS burden than controls, and some NMS may be common to chronic neurological conditions while others are more specific to PD. Differentiating patients using NMS domains may help refine the clinical management of NMS in PD patients.
Detección y manejo de síntomas no motores en la enfermedad de Parkinson: impacto en su prevalencia Detection and management of non-motor symptoms in Parkinson's disease: impact on their prevalence  [cached]
Mayela Rodríguez-Violante,Amin Cervantes-Arriaga
Revista médica de Chile , 2011,
Abstract: Background: Non-motor symptoms are common among patients with Parkinson disease and include cognitive, psychiatric, sleep and autonomic dysfunctions. Aim: To determine if the detection of non-motor symptoms along with the appropriate referral to an specialist has an impact on their prevalence after one year follow-up. Material and Methods: We included 60 patients diagnosed with Parkinson′ s disease attending to the Movement Disorder Clinic. The presence of non-motor symptoms was determined by the non-motor symptom questionnaire (NMSQuest). Results: The mean NMSQuest scores at baseline and at one year follow up were 12.6 ± 6.2 and 9.9 ± 5.6, respectively (p < 0.01). The non-motor symptoms that showed a statistically significant differences in frequency between baseline and the final assessment, were constipation (p = 0.04), urinary urgency (p = 0.02), hallucinations (p = 0.04), dizziness (p = 0.02) and vivid dreams (p = 0.04). Conclusions: Intentional search for non-motor symptoms in patients with Parkinson′ s disease along with a multidisciplinary approach has an impact on their prevalence. The change in specific symptoms is probably related to adjustments in dopaminergic management.
Executive dysfunction and motor symptoms in Parkinson's disease
Campos-Sousa, Indira Silveira;Campos-Sousa, Raimundo Nonato;Ataíde Jr, Luiz;Soares, Marta Maria de Brito;Almeida, Kelson James;
Arquivos de Neuro-Psiquiatria , 2010, DOI: 10.1590/S0004-282X2010000200018
Abstract: the aim of this study is to analyze executive function and motor symptoms in patients with idiopathic parkinson's disease (pd). the sample consisted of 44 subjects with pd between the ages of 45 to 75, who were examined consecutively. the subjects were divided into two groups according to the duration of the disease. the control group was composed of spouses, family and accompanying members. patients included were submitted to motor dysfunction evaluation using the updrs. the executive functions modalities analyzed included: operational memory, inhibitory control, planning, cognitive flexibility and inductive reasoning. significant differences between the experimental and control groups were found in all the executive domains studied. evidence of tremor, rigidity and bradykinesia correlation with executive dysfunction were not observed. patients with pd, even in the initial phase of the disease, presented executive dysfunction. the cardinal motor signs of the disease were not correlated with the cognitive dysfunction found.
An Evaluation of Signs and Symptoms of Crohns Disease
M Najafi Sani
Iranian Journal of Pediatrics , 2000,
Abstract: Crohn's disease is an inflammatory bowel lesion that may involve any part of the gastrointestinal tract. This retrospective study of 6 pediatric patients, 3 girls and 3 boys, 6 to 14 years (Mean age 6.7 years) old, observed in the last 15 years showed weight loss and abdominal pain as major symptoms in all of them, fever and diarrhea occurring in 82%. 4 patients had ileocolitis, one ileitis and one colitis. The most remarkable and important points was delay in diagnosis of 1 to 8 years.
非运动症状对于帕金森病鉴别诊断的价值
The value of non-motor symptoms in the differential diagnosis of Parkinson’s disease
 [PDF]

张娟利,商苏杭,党君亮,,,邓永宁,屈秋民
- , 2018, DOI: 10.7652/jdyxb201805024
Abstract: 摘要:目的 比较帕金森病(PD)、特发性震颤(ET)、非典型帕金森症(PD-plus)患者非运动症状(NMS)的差异,探讨NMS对于PD鉴别诊断的价值。方法 2015年3月―2016年6月对本院神经内科门诊和住院的PD、ET、PD-plus患者进行面对面问卷调查,详细了解NMS发生的时间、频率、严重程度及与运动症状的关系,分析NMS对于PD鉴别诊断的价值。结果 ①共入组PD 226例(男109例,48.2%),ET 71例(男30例,42.3%),PD-plus 56例(男32例,57.1%)。②PD组有NMS 209例(92.3%),前3位依次为便秘106例(46.9%)、多梦100例(44.2%)、夜尿增多95例(42.0%);ET组有NMS 54例(76.1%),前3位依次为夜尿增多22例(31.0%)、多梦20例(28.2%)、焦虑18例(25.4%);PD-plus组有NMS 56例(100%),前3位依次为多梦32例(64.3%)、睡眠行为紊乱(RBD)29例(51.8%)、便秘33例(58.9%)。PD组和PD-plus组的NMS显著高于ET组(P<0.05)。③PD组嗅觉减退、便秘、流涎、吞咽困难、近记忆障碍、性欲改变、容易摔倒、睡眠障碍及不安腿均显著高于ET组(P<0.05);PD-plus组流涎、吞咽困难、抑郁焦虑、体位性低血压、容易摔倒及睡眠障碍显著高于PD组(P<0.05)。④逐步多因素Logistics回归显示,PD组与ET组有统计学差异的NMS为嗅觉减退、排便异常、RBD、不安腿,其并联诊断灵敏度为70.8%,特异度69.0%。PD组与PD-plus组有统计学差异的NMS为吞咽困难、体位性低血压、容易摔倒、RBD,其并联诊断灵敏度为100%,特异度为53.5%。结论 PD和PD-plus NMS显著高于ET,嗅觉减退、便秘、RBD和不宁腿对于PD与ET鉴别具有一定的价值;吞咽困难、体位性低血压、容易摔倒、RBD对于PD和PD-plus鉴别有一定的价值。
ABSTRACT: Objective To compare Parkinson’s disease (PD), essential tremor (ET) and atypical Parkinson disease (PD-plus) in patients with non-motor symptoms (NMSs) so as to explore the value of NMSs in differential diagnosis of PD. Methods A face-to-face questionnaire survey was conducted among PD, ET, and PD-plus inpatients and outpatients of Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, during March 2015 and June 2016. We tried to understand the relationship of NMS occurrence time, frequency and severity with motor symptoms, and analyze the value of NMSs in differential diagnosis of PD. Results We recruited 226 PD patients (109 males, 48.2%), 71 ET ones (30 males, 42.3%), and 56 PD-plus ones (32 males, 57.1%). In PD group, there were 209 cases (92.3%) of NMSs, followed by 106 cases (46.9%) of constipation, 100 cases (44.2%) of frequent dreams, and 95 cases (42%) of nocturia. In ET group, there were 54 cases (76.1%) of NMSs, followed by nocturia in 22 cases (31%), frequent dreams in 20 cases (28.2%) and anxiety in 18 cases (25.4%). In PD-plus group, there were 56 cases (100%) of NMSs, followed by frequent dreams in 32 cases (64.3%), sleep behavior disorders in 29 cases (51.8%), and constipation in 33 cases (58.9%). NMSs were significantly higher in PD and PD-plus groups than in ET group (P<0.05). In PD group, hyposmia, constipation, salivation, dysphagia, recent memory disorders, altered sexual desire, inclination to fall, sleep disorder and restless legs were significantly higher than those in ET group (P<0.05). Salivation, dysphagia, depression, anxiety, postural hypotension, inclination to fall and sleep disorder were more frequent in PD-plus group
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