Non-motor symptoms of Parkinson's disease: diagnosis and management.
ABSTRACT The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy. By contrast with the dopaminergic symptoms of the disease, for which treatment is available, non-motor symptoms are often poorly recognised and inadequately treated. However, attention is now being focused on the recognition and quantitation of non-motor symptoms, which will form the basis of improved treatments. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with available treatments. Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs. Inevitably, the development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration provides the best hope of curing non-motor symptoms.
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ABSTRACT: In order to understand how dopamine modulates the effect of anxiety on gait, the goal of this study was to use virtual reality to provoke anxiety in PD (in both ON and OFF states) and quantify its effect on gait. Seventeen PD and 20 HC were instructed to walk in a virtual environment in two anxiety-provoking conditions: (i) across a plank that was located on the GROUND; (ii) across an ELEVATED plank. All PD participants completed this in both the ON and OFF states, and then were striated into groups based on baseline trait anxiety scores for further analyses. Anxiety (skin conductance and self-report) and spatiotemporal aspects of gait were measured. Overall, the ELEVATED condition resulted in greater skin conductance levels and self-reported anxiety levels. Additionally, all participants demonstrated slower gait with increased step-to-step variability when crossing the ELEVATED plank compared to the plank on the GROUND. Results showed that dopaminergic treatment selectively improved gait in only the highly anxious PD group, by significantly improving velocity, step length, step time and step-to-step variability specifically when walking across the ELEVATED plank (ON versus OFF comparison). In conclusion, only highly trait anxious PD benefitted from dopaminergic treatment, specifically when walking in the anxiety-provoking environment. Improvements to gait during anxious walking might be a result of dopaminergic medication acting in two ways: 1) improving the basal ganglia's capacity to process information and 2) by reducing the load from anxiety and subsequently making more resources available to effectively process other competing inputs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.European Journal of Neuroscience 04/2015; DOI:10.1111/ejn.12928 · 3.67 Impact Factor
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ABSTRACT: Abstract Parkinson's disease (PD) involves impairments of voice and speech (hypokinetic dysarthria). Dysprosody is one of the most common features of PD speech that includes alterations of rhythm and velocity of articulation. The aim of this study is the evaluation of dysprosody patterns in Parkinsonian patients during a sentence repetition task by means of a fully automated tool. Twenty PD patients (14 male and 6 female) and 19 healthy controls (9 male and 10 female) were tested. Results show significant differences between the two groups as far as the time interval between each sentence repetition (Tinter), the percent of speech time with respect to sentence duration (D%) and the Net Speech Rate (NSR – defined as the number of syllables of the sentence divided by the effective speech time) are concerned. In particular, Tinter is larger in PD patients while D% is higher in the control group. These results show that PD patients may exhibit longer pauses between each sentence repetition and a lower percentage of “speech time” during a whole repetition period. Thus, the decrease of D% leads to an increase of NSR. Other acoustic parameters (noise and F0 variability) did not show any significant difference. This study confirms that speech in PD patients is characterized by short rushes followed by unorthodox pauses. These results may lead to the development of a system for the automatic acoustic analysis which could significantly reduce the processing time in particular during pre-processing, that to date is a time-consuming and operator-dependent step especially in case of recordings of long duration.Biomedical Signal Processing and Control 03/2015; 17:47 - 54. DOI:10.1016/j.bspc.2014.07.006 · 1.53 Impact Factor
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ABSTRACT: The use of progressive resistance training (PRT) to improve gait and balance in people with Parkinson’s disease (PD) is an emerging area of interest. However, the main effects of PRT on lower limb function such as gait, balance and leg strength in people with PD remain unclear. Therefore the aim of the meta-analysis is to evaluate the evidence surrounding the use of PRT to improve gait and balance in people with PD. Five electronic databases, from inception to December 2014, were searched to identify the relevant studies. Data extraction was performed by two independent reviewers and methodological quality assessed using the PEDro scale. Standardized mean differences (SMD) and 95% confidence intervals (CIs) of fixed and random effects models were used to calculate the effect sizes between experimental and control groups and I2 33 statistics were used to determine levels of heterogeneity. In total, 7 studies were identified consisting of 172 participants (Experimental n=84; Control n=88). The pooled results showed a moderate but significant effect of PRT on leg strength (SMD 1.42, 95% CI 0.464 to 2.376), however no significant effects were observed for gait speed (SMD 0.418, 95% CI -0.219 to 1.055). No significant effects were observed for balance measures included in this review. In conclusion, our results showed no discernable effect of PRT on gait and balance measures, although this is likely due to the lack of studies available. It may be suggested that PRT be performed in conjunction with balance or task-specific functional training to elicit greater lower limb functional benefits in people with PD.Frontiers in aging series 03/2015; DOI:10.3389/fnagi.2015.00040