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ABSTRACT: Ability to work and live independently is of particular concern for patients with Parkinson's disease (PD). We studied a series of PD patients able to work or live independently at baseline, and evaluated potential risk factors for two separate outcomes: loss of ability to work and loss of ability to live independently.
The series comprised 495 PD patients followed prospectively. Ability to work and ability to live independently were based on clinical interview and examination. Cox regression models adjusted for age and disease duration were used to evaluate associations of baseline characteristics with loss of ability to work and loss of ability to live independently.
Higher UPDRS dyskinesia score, UPDRS instability score, UPDRS total score, Hoehn and Yahr stage, and presence of intellectual impairment at baseline were all associated with increased risk of future loss of ability to work and loss of ability to live independently (P ≤ 0.0033). Five years after initial visit, for patients ≤70 years of age with a disease duration ≤4 years at initial visit, 88% were still able to work and 90% to live independently. These estimates worsened as age and disease duration at initial visit increased; for patients >70 years of age with a disease duration >4 years, estimates at 5 years were 43% able to work and 57% able to live independently.
The information provided in this study can offer useful information for PD patients in preparing for future ability to perform activities of daily living.
Parkinsonism & Related Disorders 02/2012; 18(2):130-5. · 3.80 Impact Factor
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ABSTRACT: To examine predictive factors associated with onset of depression among individuals diagnosed with Parkinson's disease (PD).
Depression may precede or follow symptomatic parkinsonism in PD. It is frequently treatable but often overlooked.
The clinical series comprised 685 individuals who were diagnosed with PD and followed by one neurologist (RJU) from 1994 to 2007. The primary outcome was time to depression following the onset of PD. Diagnosis of depression was based on clinical assessment of depressive symptoms from patients (and spouse/family/caregiver) and antidepressant usage. A number of demographic, historical and clinical predictive factors were examined, including gender, age at symptomatic onset, disease duration, onset characteristics, clinical ratings, antiparkinsonian medications, cognitive status, depression history, and familial history of PD and other neurodegenerative disorders.
Seventy-two percent of patients developed depression within ten years of symptomatic PD onset, and the mean time to depression was 7.9 years (median: 5.7 years). Factors associated with depression included longer PD duration, greater impairment in activities of daily living, and positive family history of motor neuron disease (MND).
A high rate of individuals with PD develop depressive symptoms during the course of the disease. Based on first clinic visit characteristics, most factors examined were not helpful in identifying individuals with an increased risk of depression. However, disease duration, functional limitations and family history of MND should lead clinicians to an increased vigilance for identifying depression.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 01/2010; 37(1):61-6. · 0.97 Impact Factor
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ABSTRACT: Examine the characteristics of an essential tremor (ET) clinical cohort including base-rate variability of several commonly accepted diagnostic criteria.
A clinical series of 487 consecutive individuals diagnosed with ET were included for study.
The sample was 53% male, had a mean age of onset of 52, and a mean age of 71. Half of the sample had a family history of ET. Half presented with asymmetrical disease and tremor affected the arms (97%), voice (62%), and head or neck (48%). There was considerable variability in the base rate of individuals fulfilling various commonly used diagnostic criteria of ET.
The sample was deemed representative of ET clinical cohorts. Asymmetric disease was common, and there was considerable base-rate variation across traditional ET diagnostic criteria.
Parkinsonism & Related Disorders 09/2007; 13(6):333-9. · 3.80 Impact Factor
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ABSTRACT: The object of this study was to assess the results of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for management of advanced Parkinson disease (PD).
A clinical series of 24 patients (mean age 71 years, range 56-80 years) with medically intractable PD, who were undergoing unilateral magnetic resonance imaging-targeted, electrophysiologically guided STN DBS, completed a battery of qualitative and quantitative outcome measures preoperatively (baseline) and postoperatively, using a modified Core Assessment Program for Intracerebral Transplantations protocol. The mean follow-up period was 9 months. Statistically significant improvement was observed in the Unified Parkinson's Disease Rating Scale (UPDRS) Part II score (18%), the total UPDRS PART III score (31%), the contralateral UPDRS Part III score (63%), and scores for axial motor features (19%), contralateral tremor (88%), rigidity (60%), bradykinesia (54%), and dyskinesia (69%), as well as the Parkinson's Disease Quality of Life questionnaire score (15%) in the on-stimulation state compared with baseline. Ipsilateral symptoms improved by approximately 15% or less. Performance on the Purdue pegboard test improved in the contralateral hand in the on-stimulation state compared with the off-stimulation state (38%, p < 0.05). The daily levodopa-equivalent dose was reduced by 21% (p = 0.018). Neuropsychological tests revealed an improvement in mental flexibility and a trend toward reduced letter fluency. There were no permanent surgical complications. Of the 16 participants with symmetrical disease, five required implantation of the DBS unit on the second side.
Unilateral STN DBS is an effective and safe treatment for selected patients with advanced PD. Unilateral STN DBS provides improvement of contralateral motor symptoms of PD as well as quality of life, reduces requirements for medication, and possibly enhances mental flexibility. This method of surgical treatment may be associated with a reduced risk and may provide an alternative to bilateral STN DBS for PD, especially in older patients or patients with asymmetry of parkinsonism.
Journal of Neurosurgery 04/2007; 106(4):626-32. · 2.96 Impact Factor
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Journal of Neurosurgery 02/2007; 106(1):192-3; author reply 193-4. · 2.96 Impact Factor
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ABSTRACT: To assess genetic influence on the clinical presentation of progressive supranuclear palsy (PSP), the genetic effect on disease course was examined for variants in the tau gene (MAPT) and the gene for apolipoprotein E (APOE) in 58 cases of pathologically confirmed PSP. Clinical indicators of disease course included age at symptomatic onset (AAO), age at death (AAD), and disease duration (DD) and the genetic effects examined included MAPT haplotypes and APOE genotypes. From linear regression analysis, the MAPT H1/H1 genotype was associated with significantly earlier AAO (P=0.038). The MAPT genotype did not significantly influence DD or AAD. The APOE epsilon4 allele did not significantly influence AAO, AAD, or DD. Male sex was a predictor for earlier AAO (P=0.015). The interaction between MAPT and APOE was not significant for AAD and DD, but a significant negative coefficient was found for AAO suggesting their combination does not have an additive effect. These results support the assertion that the H1/H1 genotype may contribute to the earlier occurrence of clinical symptoms.
Neuroscience Letters 10/2006; 405(1-2):116-9. · 2.11 Impact Factor
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ABSTRACT: We examined sex-based differences in phenotypic expression among a consecutive clinical series of 121 individuals diagnosed with probable progressive supranuclear palsy (PSP). For both men (44%) and women (56%), the age at symptomatic onset (66.2 and 68.5 years, respectively) and disease duration (4.6 and 4.3 years, respectively) were similar. The overwhelming majority of sex-based comparisons showed no significant difference on a variety of demographic, historical, and clinical characteristics, as well as measures of disease progression. The only differences observed were that men had significantly worse tremor as measured by the Unified Parkinson's Disease Rating Scale tremor subscore (0.9 for men and 0.3 for women, P<0.01) and men had a significantly higher mean body mass index (BMI; 28.2 for men and 25.1 for women, P=0.01), although these differences were not significant after Bonferroni correction. In general, the disease phenotype was similar between men and women, suggesting that sex may have little or no influence on the development, expression, or progression of the PSP phenotype.
Movement Disorders 06/2006; 21(5):689-92. · 4.51 Impact Factor
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ABSTRACT: Parkinson disease (PD) is a clinically well-documented neurodegenerative disorder. However, the mechanism or mechanisms of its phenotypic expressions are still unknown.
To compare phenotypes by examining demographic and clinical features of patients with familial PD and sporadic PD and with or without a family history of PD.
Historical review of patients with sporadic PD in clinic-based samples and individual patients diagnosed with PD from families whose linkage to mutations or loci has been identified.
Movement disorder clinic in a referral center.
A total of 1277 patients with sporadic PD and 40 patients with familial PD.
Clinical features, including distribution by sex, initial motor symptom, location of initial motor symptom, and frequency of asymmetric motor symptoms.
Despite different etiologic backgrounds, both familial and sporadic PD exhibited several interesting commonalities, including a higher incidence in men, tremor as the initial motor symptom (predominantly involving the upper extremities), and asymmetric parkinsonism during disease course.
The increased incidence of parkinsonism in men with familial PD suggests that the sex disparity is more likely the result of a protective effect against development of PD in women than of an increased risk in men that is associated with environmental factors. Phenotypic similarity among familial and sporadic PD indicates that a similar topographic distribution of the nigrostriatal lesion exists in patients with either form of PD regardless of apparent genetic influence.
Archives of Neurology 05/2006; 63(4):579-83. · 7.58 Impact Factor
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ABSTRACT: To determine whether there are gender differences in the Parkinson's disease (PD) phenotype using a large clinic-based cohort.
We examined gender differences in demographic, historical and clinical characteristics in a consecutive clinical series of 1,264 individuals diagnosed with PD.
The majority of individuals in the sample were male (67 %). Comparative analyses showed males and females were not significantly different on most demographic and historical characteristics. For both genders, the mean age and the mean age at symptomatic onset were about 70 and 63 years, respectively and, thus, disease duration was not significantly different between genders. The proportion of individuals with a positive family history of PD (15 %) was similar for both genders. A positive history of depression was significantly higher in females (35 % vs. 24 %). The UPDRS instability score was significantly worse among females, whereas the rigidity score was significantly worse for males. Females showed significantly worse ADL capacity and a more advanced H&Y stage. The proportion of individuals receiving antiparkinsonian medication (about 66 %) and time between the last dose and the clinical evaluation (about 4 hours) was similar for both genders. There was a trend for lower daily levodopa equivalence dosage and more severe dyskinesia score among females but these differences did not reach statistical significance after Bonferroni correction.
The majority of comparisons tended to highlight the commonalities in the PD phenotype between genders, particularly in reference to historical and early disease stage characteristics. However, gender may be an important factor related to the expression of PD features during the symptomatic disease course.
Journal of Neurology 11/2005; 252(10):1201-5. · 3.47 Impact Factor
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ABSTRACT: To determine the extent of lead movement based on the type of burr hole fixation device used to secure the lead (Image-Guided Neurologics [IGN], Navigus versus Medtronic [Model 7495-51]). A randomized, blinded design of lead movement measurement was used.
A clinical series of 58 individuals undergoing placement of a deep brain stimulation (DBS) system with a total of 71 operative sides were examined. Lead position was compared between 71 paired, sagital, digitized X-rays of lead position immediately before and after the lead was secured to the basecap. Lead movement was measured in a randomized, blinded fashion using the Siemens measurement tool at an 8x magnification rate. The presurgical planned target centered at the cross hatch of the reticules on a lateral X-ray served as the reference point to determine lead movement.
The overall mean lead movement was significantly less using the IGN (1.9 mm), as compared to the Medtronic (3.3 mm), fixation device. Moreover, the pattern of lead movement was significantly different between the two devices. That is, the majority of measured movements using IGN device was in the superior direction (74%), whereas the opposite was true for the Medtronic device (i.e., 62% with inferior movement).
The IGN burr hole fixation device is associated with significantly less movement when securing the lead. Probable mechanisms of movement are discussed.
Clinical Neurology and Neurosurgery 09/2005; 107(5):393-5. · 1.58 Impact Factor
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Yasuhiko Baba,
Yoshio Tsuboi,
Matthew C Baker,
Ryan J Uitti,
Michael L Hutton,
Dennis W Dickson,
Matthew Farrer, John D Putzke,
Bryan K Woodruff,
Bernardino Ghetti, [......],
Nobuhiko Sunohara,
Osamu Komure,
Sadako Kuno,
Anne D Sperfeld,
Gabriela Stoppe,
Jürgen Kohlhase,
Stuart Pickering-Brown,
David Neary,
Orso Bugiani,
Zbigniew K Wszolek
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ABSTRACT: The clinical phenotype of frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17) varies. This variability is seen not only between kindreds with different mutations but also in families sharing the same mutation. Inheritance of tau haplotype (H1) and genotype (H1/H1) has been established as a risk factor for some neurodegenerative disorders with parkinsonism. We assessed the effect of tau polymorphism on the clinical features of FTDP-17 in 61 cases from 30 separately ascertained families with four different tau mutations, including P301L, +16, N279K, and P301S. There were no significant differences of age at symptomatic onset and disease duration between H1/H1 and H1/H2 genotypes. The comparison between tau genotype and type of initial clinical sign showed an association between the H1/H1 genotype and parkinsonian phenotype and between the H1/H2 genotype and frontotemporal dementia phenotype (OR=11.7; 95% confidence interval, 1.4-98.7; P=0.008). Our results suggest that tau genotype does not influence the disease course. However, it may predispose to a specific clinical sign in the early stage of FTDP-17.
Parkinsonism & Related Disorders 07/2005; 11(4):205-8. · 3.80 Impact Factor
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ABSTRACT: Organ transplant recipients are at risk for vertebral compression fractures (VCFs). The goal of this study was to determine whether kyphoplasty is an effective treatment for VCFs that develop in this patient population.
Six consecutive patients who had undergone an organ transplant (five liver and one kidney transplant) had a total of 13 symptomatic VCFs that were treated with balloon kyphoplasty. Postprocedure follow-up duration ranged from 6 to 12 months. The mean visual analog scale pain score was 9.3 before treatment and declined to 1.8 after treatment. This improvement was highly significant (p < 0.001). Intake of narcotic drugs decreased or was eliminated in all patients, and there were no complications related to the procedure. There was one instance of clinically insignificant extraosseous cement extravasation. Sagittal alignment was improved by 5 degrees in one patient and was unchanged in the remaining five. During the follow-up period, a new fracture developed adjacent to a treated level in one patient. This was successfully treated with an additional kyphoplasty procedure.
Kyphoplasty can be performed safely in organ transplant recipients with VCF, in whom results are just as favorable as those seen in patients with no history of organ transplantation.
Neurosurgical FOCUS 04/2005; 18(3):e6. · 2.87 Impact Factor
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ABSTRACT: To determine the course of self-reported life satisfaction in a spinal cord injury (SCI) cohort.
Prospective study using longitudinal data from the Injury Control Research Center.
Adult persons with traumatic-onset SCI (n = 207) evaluated at 1, 2, 4, and 5 years postinjury using the Life Satisfaction Index-A.
A nonsignificant (P > 0.05) main effect of time was found using a repeated-measures analysis controlling for education and employment status. Several methods were used that provided a range of liberal to conservative estimates for missing data (ie, 38% retention rate at year 5). Subsequent missing data analyses tended to corroborate the finding of a nonsignificant effect of time, although the most conservative methods showed a significant decrease in life satisfaction between year 1 and year 5 postinjury (P < 0.05). Examination of numerous demographic, injury, and treatment-related characteristics at each follow-up time point suggested that the main findings of the study were not merely the result of differential dropout rates.
Life satisfaction after the first year of injury remains largely the same over the next 4 years. Methodologic and analytic recommendations are discussed.
The journal of spinal cord medicine 01/2004; 27(2):106-10. · 2.11 Impact Factor
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ABSTRACT: To determine the interrater reliability of the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes.
A total of 64 pain sites reported by 29 individuals were classified using International Association for the Study of Pain and Tunks' classification schemes. Three raters independently categorized each pain site.
In general, disagreement in pain classification between the three raters was found for about 50-70% of the pain sites. Disagreement between rater pairs (two raters at a time) was somewhat better, ranging from about 20% to 50%. The kappa statistic for interrater agreement was in the marginally acceptable range (i.e., 0.3 to 0.65). Although disagreement tended to be somewhat higher using the Tunks scheme, both classification schemes showed low interrater agreement.
Consistent with our previous research using the Donovan spinal cord injury pain classification scheme, considerable variability between raters was demonstrated using the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes.
American Journal of Physical Medicine & Rehabilitation 07/2003; 82(6):437-40. · 1.58 Impact Factor
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ABSTRACT: To determine whether cranial magnetic resonance imaging (MRI) is associated with deep brain stimulation (DBS) lead displacement or program interference.
In vitro and in vivo studies were performed with the Itrel II implantable pulse generator (IPG) (Model 7424; Medtronic, Minneapolis, MN), Medtronic 3387 and 3389 leads, and a 1.5-T GE Horizon LX scanner (General Electric, Milwaukee, WI). In the in vivo study, two MRI volumetric data sets were compared for each of five patients undergoing staged, bilateral, DBS electrode placement in the thalamic or subthalamic nucleus. The data sets were acquired shortly after the initial implantation and during stereotactic planning for the second implantation (1-8 mo between acquisitions). An additional thalamotomy-treated patient was included as a control patient. Volumetric data were analyzed in a blinded manner, using AnalyzeAVW 3.0 software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN), to determine lead movement. In the in vitro study, the IPG and leads were positioned in the magnetic field in various configurations and were systematically assessed for movement.
In vivo, the majority of measured deviations (88%) were within the standard error of measurement (1.4 mm). The maximal measured deviation was 3 mm (2% occurrence). Excellent tremor control with stimulation was demonstrated, which did not change after MRI. In vitro, the DBS leads demonstrated no deflection when introduced into the magnetic field. Similarly, no changes in IPG battery strength, lead impedance, or program settings were observed.
MRI was not associated with significant DBS electrode movement or changes in clinical responses. Other IPG models and components and MRI scanners should be evaluated, to develop specific guidelines for MRI among individuals with implanted DBS systems.
Neurosurgery 01/2003; 51(6):1423-28; discussion 1428-31. · 2.79 Impact Factor
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ABSTRACT: To determine the interrater reliability of the Donovan system for classification of pain in spinal cord injury (SCI) as well as the clinician-based usefulness of each of the classification criteria used in the Donovan system.
Information pertinent to the Donovan system was provided incrementally by videotape for each pain site. After each additional piece of information, the 3 raters classified the pain site into 1 of 5 types and gave a confidence rating (5-point Likert scale) regarding the accuracy of their classifications. Thus, each pain site was classified 6 separate times, each with an associated confidence rating.
Academic rehabilitation hospital.
Twenty-eight persons with traumatic onset SCI reported 60 pain sites.
Not applicable.
The short-form McGill Pain Questionnaire.
Interrater agreement ranged from 50% to 70%. Interrater agreement did not change as additional information was provided. In contrast, confidence ratings significantly increased as additional information was provided.
There was considerable variability between raters using the Donovan system for classifying SCI pain. Additional clinical information increased the rater's confidence in the accuracy of their ratings but did not improve interrater agreement.
Archives of Physical Medicine and Rehabilitation 10/2002; 83(9):1290-4. · 2.28 Impact Factor
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ABSTRACT: The current study employed a case-control design to examine the impact of marital status on adjustment among individuals with spinal cord injury (SCI) 1 year post-injury. Two groups of 53 individuals (i.e., single versus married individuals) were matched case-for-case on age (i.e., within 10 years), education, gender, race, and lesion level. Although not specifically matched, etiology of SCI, and number of rehospitalizations and days rehospitalized during the past year were not significantly different between groups. Outcome measures included the Satisfaction With Life Scale, the Craig Handicap Assessment and Reporting Technique (CHART), and the SF-12. Results indicated that overall self-reported QOL was significantly lower among single individuals as compared to their matched married counterparts. Similarly, self-reported handicap was significantly higher among single individuals, particularly in the areas of social integration and economic self-sufficiency. In contrast, overall physical and mental health were not different across groups.
Journal of Clinical Psychology in Medical Settings 05/2001; 8(2):101-107. · 1.49 Impact Factor
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ABSTRACT: Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs.
To explore whether balloon kyphoplasty is an effective treatment for VCF that develop in solid organ transplant recipients. A secondary goal was to determine whether there are any differences between VCF in transplant patients and VCF in patients with primary osteoporosis, with respect to disease severity and new fracture development.
Prospective, longitudinal clinical series.
The transplant group included 10 consecutive transplant patients (9 liver and 1 kidney), with a total of 29 symptomatic VCFs. The comparison group included 10 consecutive patients with primary osteoporosis and no history of organ transplantation, with a total of 15 VCFs.
The primary clinical end point was back pain, measured using the Visual Analog Scale (VAS), which was recorded at baseline, and 1 and 12 months postprocedure. Radiographic evaluation included measurement of Cobb angles for each treated vertebral segment on preprocedure and 1-month postprocedure lateral radiographs. An improvement of >5 degrees was considered significant. The number of fractures seen at the time of diagnosis and the number of new fractures occurring during the follow-up period were recorded.
Balloon kyphoplasty was performed at all symptomatic levels. All fractures were treated within 3 months of onset. Patient follow-up was 12 months.
The transplant group had significantly higher levels of pain at baseline, (mean VAS 9.3 and 7.7 for the transplant group and primary osteoporosis group, respectively: p=.013). After treatment, the VAS decreased to 3.2 in the transplant group and 1.5 in the comparison group. Improvement was highly significant in both groups (p<.001), and was maintained at 12-month follow-up. Sagittal alignment was improved by >5 degrees in three patients in each group (30%). There were no procedural complications in either group. Compared with the primary osteoporosis group, the transplant group was more likely to have multiple fractures at the time of diagnosis (2.9 vs. 1.5, p=.03), had a twofold greater incidence of new fractures during the follow-up period (40% vs. 20%), was more than a decade younger (64 vs. 75 years, p<.01), was much more likely to have received chronic immunosuppressive therapy with glucocorticoids and calcineurin phosphate inhibitors (100% vs. 0%, p<.001), and had a higher percentage of males (70% vs. 10%, p=.02),
These data suggest that balloon kyphoplasty can be performed safely in organ transplant recipients with VCFs. The degree of pain relief is equivalent to that seen in patients with primary osteoporosis. Results are durable at 12-month follow-up. Transplant patients developed earlier and more severe bony disease, with more severe baseline pain, a higher incidence of multiple fractures at the time of diagnosis, and a greater risk of new fracture development posttreatment, as compared with the primary osteoporosis group.
The Spine Journal 6(5):494-9. · 3.29 Impact Factor
