Article

AHV; National Institute for Clinical Excellence. Non-motor symptoms of Parkinson's disease: diagnosis and management

Movement Disorders Unit, Kings College Hospital, Guy's King's and St Thomas' School of Medicine, London, UK.
The Lancet Neurology (Impact Factor: 21.9). 04/2006; 5(3):235-45. DOI: 10.1016/S1474-4422(06)70373-8
Source: PubMed

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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    • "Importantly, stress may cause imbalance of neurotransmitters that can worsen muscular movements related to other activities such as writing, speaking, blinking etc.[9]. Furthermore, PD causes issues with the (4) Autonomous System, that acts to control the body's involuntary muscle movements such as heart beating, pupillary dilation, urination, digestion and respiratory tract functions; symptoms including postural hypotension, slowness or absence of movement due to muscle stiffness and constipation may be present during later stage of disease[4,10,11]. Another debilitating symptom of PD is (5) GI dysfunction. "

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    • "seminal study by Braak et al. [2] introduced a time-dependent evolution of PD, consisting in six successive stages starting with initial olfactory symptoms evolving to cognitive and emotional symptoms , until the emergence of motor impairments [3]. Indeed, it is increasingly recognized that the deterioration of executive functions and deficits of working memory are present at the prodrome and at early phases of PD in around 25% of patients [4] [5] [6] and constitute a major burden for patients [7] [8]. "
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    ABSTRACT: Parkinson's disease (PD) is characterized by motor dysfunction associated with dopaminergic degeneration in the dorsolateral striatum (DLS). However, motor symptoms in PD are often preceded by short-term memory deficits, which have been argued to involve deregulation of medial prefrontal cortex (mPFC). We now used a 6-hydroxydopamine (6-OHDA) rat PD model to explore if alterations of synaptic plasticity in DLS and mPFC synapses underlie short-term memory impairments in PD prodrome. The bilateral injection of 6-OHDA (20μg/hemisphere) in the DLS caused a marked loss of dopaminergic neurons in the substantia nigra (>80%) and decreased monoamine levels in the striatum and PFC, accompanied by motor deficits evaluated after 21 days in the open field and accelerated rotarod. A lower dose of 6-OHDA (10μg/hemisphere) only induced a partial degeneration (about 60%) of dopaminergic neurons in the substantia nigra with no gross motor impairments, thus mimicking an early premotor stage of PD. Notably, 6-OHDA (10μg)-lesioned rats displayed decreased monoamine levels in the PFC as well as short-term memory deficits evaluated in the novel object discrimination and in the modified Y-maze tasks; this was accompanied by a selective decrease in the amplitude of long-term potentiation in the mPFC, but not in DLS, without changes of synaptic transmission in either brain regions. These results indicate that the short-term memory dysfunction predating the motor alterations in the 6-OHDA model of PD is associated with selective changes of information processing in PFC circuits, typified by persistent changes of synaptic plasticity.
    Full-text · Article · Dec 2015 · Behavioural brain research
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    • "Symptoms progress slowly but irreversibly, so that late stages are more abundant in the elderly (>60 year old) population, with only approximately 10% of PD patients under the age of 50. In early stages, PD commonly affects motor function, while cognitive, behavioral and mental-related symptoms are usually met in more advanced stages [2]. Non motor-related symptoms of the disease include sleep disturbance, depression, anxiety, psychosis, visual hallucinations, cognitive impairment, pain and fatigue. "
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    ABSTRACT: Parkinson's Disease (PD) is a progressive neurodegenerative movement disorder that affects more that 6 million people worldwide. Motor dysfunction gradually increases as the disease progress. It is usually mild in the early stages of the disease but it relentlessly progresses to a severe or very severe disability that is characterized by increasing degrees of bradykinesia, hypokinesia, muscle rigidity, loss of postural reflexes and balance control as well as freezing of gait. In addition to a line of treatment based on dopaminergic PD-specific drugs, attending neurologists strongly recommend regular exercise combined with physiotherapy. However, the routine of traditional rehabilitation often create boredom and loss of interest. Opportunities to liven up a daily exercise schedule may well take the form of character-based virtual reality games which engage the player to physically train in a non-linear and looser fashion, providing an experience that varies from one game loop the next. Such "exergames", a word that results from the amalgamation of the words "exercise" and "game" challenge patients into performing movements of varying complexity in a playful and immersive virtual environment. In fact, today's game consoles using controllers like Nintendo's Wii, Sony PlayStation Eye and the Microsoft Kinect sensor present new opportunities to infuse motivation and variety to an otherwise mundane physiotherapy routine. But are these controllers and the games built for them appropriate for PD patients? In this paper we present some of these approaches and discuss their suitability for these patients mainly on the basis of demands made on balance, agility and gesture precision.
    Full-text · Article · Nov 2015
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