[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to determine self-awareness of dyskinesias and other core motor symptoms in Parkinson's disease (PD) through the use of movie presentations. A scale based on 10 movies (five depicting dyskinesias and five showing core symptoms) and the Self-Assessment Parkinson's Disease Disability Scale were administered to 21 patients (all with a Mini-Mental State Examination - MMSE score ≥ 25). Neurological assessment included the Unified Parkinson's Disease Rating Scale and the Hoehn-Yahr and Schwab-England scales. In addition, the MMSE, Beck Depression Inventory and Stroop task were administered. Overall, patient and caregiver ratings of dyskinesias and core PD symptoms were consistent. Two patients (9%) completely denied dyskinesias, while four patients (19%) significantly underestimated their dyskinesias. Our results confirm that poor self-awareness of symptoms in PD may be selective and that denial of dyskinesias affects only a minority of patients with normal cognitive status (MMSE ≥ 25). Most patients are aware of the presence of dyskinesias. Poor self-awareness of dyskinesias is associated with longer disease duration.
No preview · Article · Jul 2011 · Functional neurology
[Show abstract][Hide abstract] ABSTRACT: Background Involuntary movements are one of the features of Huntington's disease (HD), Parkinson's disease (PD) and cervical dystonia (CD). Self-awareness of symptoms is overally deficient in HD, while in PD poor self-awareness of symptoms is related to dementia. Self-awareness of symptoms in CD is supposed to be preserved. Previous studies assessing self-awareness of chorea used questionnaire format, which may be prone to misunderstandings.
Aims The study aimed at assessing self-awareness of motor and daily disability in HD, PD with (PDdys) and without dyskinesias (PDndys) and in cervical dystonia (CD). Self-awareness was assessed by comparing patient's and caregiver's ratings and by correlating them with objective results. Film materials were used to depict specific motor symptoms.
Methods/techniques Eighty-nine patients scoring at least 20 in Mini-Mental State Examination (MMSE) participated in the study (23 with HD, 25 PD with PDdys, 21 with PDndys and 20 with CD). Neurological examination comprised of Unified Huntington's Disease Rating Scale (UHDRS) for HD, Unified Parkinson's Disease Rating Scale (UPDRS) part II-IV for PD and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) for CD. Questionnaires filled in by the patient and his/her caregiver included: Self-Assessment Parkinson's Disease Disability Scale and a scale based on a series of 15 films demonstrating different motor symptoms (5 UHDRS, 5 UPDRS and 5 from TWSTRS).
Results/outcome HD patients overall underestimated their dysfunctions. PDdys patients both underestimated and overestimated certain aspects of motor symptoms and dysfunction in daily activities. PDndys and CD patients demonstrated better self-awareness of symptoms.
Conclusions Deficits in the self-awareness of symptoms are more generalised in HD than in PD, regardless of the cognitive status.
No preview · Article · Sep 2010 · Journal of Neurology Neurosurgery & Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Background: Latrepirdine is an orally administered experimental small molecule that was initially developed as an antihistamine and subsequently was shown to stabilize mitochondrial membranes and function, which might be impaired in Huntington disease. Objective: To determine the effect of latrepirdine on cognition and global function in patients with mild to moderate Huntington disease. Design: Randomized, double-blind, placebo-controlled study. Setting: Sixty-four research centers in Australia, Europe, and North America. Patients: Four hundred three patients with mild to moderate Huntington disease and baseline cognitive impairment (Mini-Mental State Examination score, 10-26). Intervention: Latrepirdine (20 mg) vs matching placebo administered orally 3 times daily for 26 weeks. Main Outcome Measures: The co-primary outcome measures were cognition as measured by the change in Mini-Mental State Examination score from baseline to week 26 and global function at week 26 as measured by the Clinician Interview-Based Impression of Change, plus carer interview, which ranges from 1 (marked improvement) to 7 (marked worsening). Secondary efficacy outcome measures included behavior, daily function, motor function, and safety. Results: The mean change in Mini-Mental State Examination score among participants randomized to latrepirdine (1.5-point improvement) did not differ significantly from that among participants randomized to placebo (1.3-point improvement) (P=.39). Similarly, the distribution of the Clinician Interview-Based Impression of Change, plus carer interview did not differ significantly among those randomized to latrepirdine compared with placebo (P=.84). No significant treatment effects were detected on the secondary efficacy outcome measures. The incidence of adverse events was similar between those randomized to latrepirdine (68.5%) and placebo (68.0%). Conclusion: In patients with mild to moderate Huntington disease and cognitive impairment, treatment with latrepirdine for 6 months was safe and well tolerated but did not improve cognition or global function relative to placebo. Trial Registration: clinicaltrials.gov Identifier: NCT00920946 JAMA Neurol. 2013;70(1):25-33. Published online October 29, 2012. doi:10.1001/2013.jamaneurol.382