scholarly journals Pathophysiology of Motor Dysfunction in Parkinson’s Disease as the Rationale for Drug Treatment and Rehabilitation

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Francesca Magrinelli ◽  
Alessandro Picelli ◽  
Pierluigi Tocco ◽  
Angela Federico ◽  
Laura Roncari ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disturbances ◽  
Signs And Symptoms ◽  
Motor Fluctuations ◽  
Motor Dysfunction ◽  
Nonmotor Symptoms ◽  
Motor Problems ◽  
Gait Disturbances ◽  
Symptoms And Signs

Cardinal motor features of Parkinson’s disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation. Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways. Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment. The present review will focus on classical notions and recent insights into the neuropathology, neuropharmacology, and neurophysiology of motor dysfunction of PD. These pieces of information represent the basis for the pharmacological, neurosurgical, and rehabilitative approaches to PD.

scholarly journals Parkinson's Disease and Sleep/Wake Disturbances

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Todd J. Swick
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Treatment Options ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Clinical Aspects ◽  
Nonmotor Symptoms ◽  
Sleep Behavior

Parkinson's disease (PD) has traditionally been characterized by its cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability. However, PD is increasingly being recognized as a multidimensional disease associated with myriad nonmotor symptoms including autonomic dysfunction, mood disorders, cognitive impairment, pain, gastrointestinal disturbance, impaired olfaction, psychosis, and sleep disorders. Sleep disturbances, which include sleep fragmentation, daytime somnolence, sleep-disordered breathing, restless legs syndrome (RLS), nightmares, and rapid eye movement (REM) sleep behavior disorder (RBD), are estimated to occur in 60% to 98% of patients with PD. For years nonmotor symptoms received little attention from clinicians and researchers, but now these symptoms are known to be significant predictors of morbidity in determining quality of life, costs of disease, and rates of institutionalization. A discussion of the clinical aspects, pathophysiology, evaluation techniques, and treatment options for the sleep disorders that are encountered with PD is presented.

Changes in Nonmotor Symptoms Following an 8-Week Yoga Intervention for People with Parkinson's Disease

2019 ◽  
Vol 29 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Alysha A. Walter ◽  
Em V. Adams ◽  
Marieke Van Puymbroeck ◽  
Brandi M. Crowe ◽  
Enrique Urrea-Mendoza ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disturbances ◽  
Neurodegenerative Disorder ◽  
Nonmotor Symptoms ◽  
Yoga Intervention ◽  
Balance Confidence ◽  
Related Quality

Abstract Parkinson's disease (PD) is a neurodegenerative disorder marked by progressive degenerative motor symptoms (e.g., tremors, impaired balance and gait) and nonmotor symptoms (e.g., fatigue, sleep disturbances, pain) that can negatively influence health-related quality of life (HRQoL). Previous studies have shown that yoga for individuals with PD improves balance, strength, and mobility. However, little research has been conducted to determine the effect of yoga on nonmotor symptoms of PD. The purpose of this study was to examine changes in nonmotor symptoms among individuals with PD following an 8-week yoga intervention. Data used for analyses were part of a larger study that researched improvements in motor function for individuals with PD. Participants (N = 27) were randomly assigned to experimental (n = 15) and control (n = 12) groups and completed pre- and postintervention quantitative measures. Within-group improvements were statistically significant for fatigue measured by the Parkinson's Fatigue Scale, balance confidence measured by the Activities Balance Confidence Scale, the belief in one's ability to manage falls measured by the Falls Management Scale, activity constraints measured by the Activities Constraint Questionnaire, and PD-specific quality of life measured by the Parkinson's Disease Questionnaire-8. Across-group changes were statistically significant for activity constraints. Findings indicate yoga may be an efficacious intervention for improving nonmotor symptoms as well as HRQoL for individuals with PD.

scholarly journals Quantitative Analysis of Motor Status in Parkinson’s Disease Using Wearable Devices: From Methodological Considerations to Problems in Clinical Applications

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Masahiko Suzuki ◽  
Hiroshi Mitoma ◽  
Mitsuru Yoneyama
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disturbances ◽  
Freezing Of Gait ◽  
Wearable Devices ◽  
Mean Values ◽  
Methodological Problems ◽  
Methodological Considerations ◽  
Motor Abnormalities ◽  
Gait Disturbances

Long-term and objective monitoring is necessary for full assessment of the condition of patients with Parkinson’s disease (PD). Recent advances in biotechnology have seen the development of various types of wearable (body-worn) sensor systems. By using accelerometers and gyroscopes, these devices can quantify motor abnormalities, including decreased activity and gait disturbances, as well as nonmotor signs, such as sleep disturbances and autonomic dysfunctions in PD. This review discusses methodological problems inherent in wearable devices. Until now, analysis of the mean values of motion-induced signals on a particular day has been widely applied in the clinical management of PD patients. On the other hand, the reliability of these devices to detect various events, such as freezing of gait and dyskinesia, has been less than satisfactory. Quantification of disease-specific changes rather than nonspecific changes is necessary.

scholarly journals Nonmotor Symptoms Groups in Parkinson's Disease Patients: Results of a Pilot, Exploratory Study

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Santiago Perez Lloret ◽  
Malco Rossi ◽  
Marcelo Merello ◽  
Olivier Rascol ◽  
Daniel P. Cardinali
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disturbances ◽  
Tricyclic Antidepressants ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Depression Scale ◽  
Nonmotor Symptoms ◽  
Wearing Off ◽  
Urogenital Symptoms

Nonmotor symptoms (NMS) like neuropsychiatric symptoms, sleep disturbances or autonomic symptoms are a common feature of Parkinson's disease (PD). To explore the existence of groups of NMS and to relate them to PD characteristics, 71 idiopathic non-demented PD out-patients were recruited. Sleep was evaluated by the PD Sleep Scale (PDSS). Several neuropsychiatric, gastrointestinal and urogenital symptoms were obtained from the NMSQuest. Sialorrhea or dysphagia severity was obtained from the Unified PD Rating Scale activities of daily living section. MADRS depression scale was also administered. Exploratory factor analysis revealed the presence of 5 factors, explaining 70% of variance. The first factor included PDSS measurement of sleep quality, nocturnal restlessness, off-related problems and daytime somnolence; the second factor included nocturia (PDSS) and nocturnal activity; the third one included gastrointestinal and genitourinary symptoms; the forth one included nocturnal psychosis (PDSS), sialorrhea and dysphagia (UPDRS); and the last one included the MADRS score as well as neuropsychiatric symptoms. Sleep disorders correlated with presence of wearing-off, nocturia with age >69 years, and nocturnal psychosis with levodopa equivalent dose or UPDRS II score. Neuropsychiatric symptoms correlated with UPDRS II+III score and non-tricyclic antidepressants. These results support the occurrence of significant NMS grouping in PD patients.

scholarly journals Hypomania, Depression, Euthymia: New Evidence in Parkinson’s Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Margherita Canesi ◽  
Sara Lavolpe ◽  
Viviana Cereda ◽  
Alessandra Ranghetti ◽  
Roberto Maestri ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Depressive Symptoms ◽  
Mood State ◽  
Internal State ◽  
Motor Fluctuations ◽  
Nonmotor Symptoms ◽  
State Distribution ◽  
Group A ◽  
Disease Stages

The field related to mood disorders in Parkinson’s disease (PD) is fragmented. The aim of this cohort observational study was to evaluate whether the episodes of mood alteration could appear in different disease stages and to verify how nonmotor symptoms were led off into different stages. We enrolled 93 PD outpatients (three groups: drug naive—DN; not exhibiting motor fluctuations—n-MF; and exhibiting motor fluctuations—MF) and 50 healthy controls. Mood state was assessed through the Internal State Scale (ISS) while depressive symptoms were evaluated through the Beck Depression Inventory-II (BDI-II), nonmotor symptoms by means of the Non-Motor Symptoms Scale (NMSS), and the presence of impulse control disorders (ICDs) with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP). Clinical and pharmacological data have also been recorded. No significant differences in mood state distribution between groups were observed. Nevertheless, as regards the mood state distribution within groups, in n-MF (47.6%) and MF patients (50%), (hypo)mania presence was significantly higher than other symptoms. In DN patients, hypomania showed a prevalence of 38.1% although it was not significant. At least one ICD was reported in 29.3% of n-MF and 50% of MF patients. In the MF group, a moderate positive correlation between ISS ACTivation subscale scores and the presence of ICDs and compulsive medication use emerged. Finally, MF patients reported higher BDI-II total scores than DN. Our results show that mood alterations in PD, considering both depressive symptoms and mood elevation, are related to the advanced stages of the disease as well as the presence of ICDs, and dopaminergic therapy would not always be able to restore a normal mood condition.

scholarly journals Potential Application of Yokukansan as a Remedy for Parkinson’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-19
Author(s):  
Jung-Hee Jang ◽  
Kyungsook Jung ◽  
Joong-Sun Kim ◽  
Inchul Jung ◽  
Horyong Yoo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Efficacy ◽  
Sleep Disturbances ◽  
Clinical Symptoms ◽  
Neurodegenerative Disorder ◽  
Psychological Symptoms ◽  
Nonmotor Symptoms ◽  
Neuroprotective Effects ◽  
Complementary And Alternative

Parkinson’s disease (PD), the second most common progressive neurodegenerative disorder, is characterized by complex motor and nonmotor symptoms. The clinical diagnosis of PD is defined by bradykinesia and other cardinal motor features, although several nonmotor symptoms are also related to disability, an impaired quality of life, and shortened life expectancy. Levodopa, which is used as a standard pharmacotherapy for PD, has limitations including a short half-life, fluctuations in efficacy, and dyskinesias with long-term use. There have been efforts to develop complementary and alternative therapies for incurable PD. Yokukansan (YKS) is a traditional herbal medicine that is widely used for treating neurosis, insomnia, and night crying in children. The clinical efficacy of YKS for treating behavioral and psychological symptoms, such as delusions, hallucinations, and impaired agitation/aggression subscale and activities of daily living scores, has mainly been investigated in the context of neurological disorders such as PD, Alzheimer’s disease, and other psychiatric disorders. Furthermore, YKS has previously been found to improve clinical symptoms, such as sleep disturbances, neuropsychiatric and cognitive impairments, pain, and tardive dyskinesia. Preclinical studies have reported that the broad efficacy of YKS for various symptoms involves its regulation of neurotransmitters including GABA, serotonin, glutamate, and dopamine, as well as the expression of dynamin and glutamate transporters, and changes in glucocorticoid hormones and enzymes such as choline acetyltransferase and acetylcholinesterase. Moreover, YKS has neuroprotective effects at various cellular levels via diverse mechanisms. In this review, we focus on the clinical efficacy and neuropharmacological effects of YKS. We discuss the possible mechanisms underpinning the effects of YKS on neuropathology and suggest that the multiple actions of YKS may be beneficial as a treatment for PD. We highlight the potential that YKS may serve as a complementary and alternative strategy for the treatment of PD.

scholarly journals Dopamine-Induced Nonmotor Symptoms of Parkinson's Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Ariane Park ◽  
Mark Stacy
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Side Effects ◽  
Sleep Disturbances ◽  
Complex Disease ◽  
Sleep Problems ◽  
Motor Symptoms ◽  
Nonmotor Symptoms ◽  
Neuropsychiatric Complications ◽  
Non Motor Symptoms

Nonmotor symptoms of Parkinson's disease (PD) may emerge secondary to the underlying pathogenesis of the disease, while others are recognized side effects of treatment. Inevitably, there is an overlap as the disease advances and patients require higher dosages and more complex medical regimens. The non-motor symptoms that emerge secondary to dopaminergic therapy encompass several domains, including neuropsychiatric, autonomic, and sleep. These are detailed in the paper. Neuropsychiatric complications include hallucinations and psychosis. In addition, compulsive behaviors, such as pathological gambling, hypersexuality, shopping, binge eating, and punding, have been shown to have a clear association with dopaminergic medications. Dopamine dysregulation syndrome (DDS) is a compulsive behavior that is typically viewed through the lens of addiction, with patients needing escalating dosages of dopamine replacement therapy. Treatment side effects on the autonomic system include nausea, orthostatic hypotension, and constipation. Sleep disturbances include fragmented sleep, nighttime sleep problems, daytime sleepiness, and sleep attacks. Recognizing the non-motor symptoms that can arise specifically from dopamine therapy is useful to help optimize treatment regimens for this complex disease.

scholarly journals Degraded Impairment of Emotion Recognition in Parkinson’s Disease Extends from Negative to Positive Emotions

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Chia-Yao Lin ◽  
Yi-Min Tien ◽  
Jong-Tsun Huang ◽  
Chon-Haw Tsai ◽  
Li-Chuan Hsu
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Emotion Recognition ◽  
Facial Expressions ◽  
Positive Emotions ◽  
Motor Dysfunction ◽  
Control Group ◽  
Emotional Facial Expressions ◽  
Dopaminergic Neurodegeneration ◽  
Motor Problems

Because of dopaminergic neurodegeneration, patients with Parkinson’s disease (PD) show impairment in the recognition of negative facial expressions. In the present study, we aimed to determine whether PD patients with more advanced motor problems would show a much greater deficit in recognition of emotional facial expressions than a control group and whether impairment of emotion recognition would extend to positive emotions. Twenty-nine PD patients and 29 age-matched healthy controls were recruited. Participants were asked to discriminate emotions in Experiment  1 and identify gender in Experiment  2. In Experiment  1, PD patients demonstrated a recognition deficit for negative (sadness and anger) and positive faces. Further analysis showed that only PD patients with high motor dysfunction performed poorly in recognition of happy faces. In Experiment  2, PD patients showed an intact ability for gender identification, and the results eliminated possible abilities in the functions measured in Experiment  2 as alternative explanations for the results of Experiment  1. We concluded that patients’ ability to recognize emotions deteriorated as the disease progressed. Recognition of negative emotions was impaired first, and then the impairment extended to positive emotions.

scholarly journals Effect and Potential Mechanism of Electroacupuncture Add-On Treatment in Patients with Parkinson’s Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Fang Wang ◽  
Li Sun ◽  
Xiao-zhe Zhang ◽  
Jun Jia ◽  
Zhuo Liu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disturbances ◽  
Rating Scale ◽  
Early Stage ◽  
Life Quality ◽  
Motor Symptoms ◽  
Nonmotor Symptoms ◽  
Nitric Oxide Level ◽  
Disease Rating

Objectives. To explore effectiveness and mechanisms of electroacupuncture (EA) add-on treatment in Parkinson’s disease (PD) patients.Methods. Fifty PD patients were randomly assigned to drug plus EA (D + EA) group and drug alone (D) group. Subjects in D + EA group received stimulation in points of bilateral fengfu, fengchi, hegu, and central dazhui. Participants were evaluated by scales for motor and nonmotor symptoms. Levels of neuroinflammatory factors and neurotransmitters in serum were detected.Results. EA add-on treatment remarkably reduced scores of Unified Parkinson’s Disease Rating Scale (UPDRS) III and its subitems of tremor, rigidity, and bradykinesia and conspicuously decreased UPDRS III scores in patients with bradykinesia-rigidity and mixed types and mild severity. Depression and sleep disturbances were eased, which were reflected by decreased scores of Hamilton Depression Rating Scale, Pittsburgh Sleep Quality Index, and elevated noradrenaline level. Effects of EA add-on treatment on motor symptoms and sleep disturbances were superior to drug alone treatment, markedly improving life quality of PD patients. EA add-on treatment decreased nitric oxide level in serum.Conclusions. EA add-on treatment is effective on most motor symptoms and some nonmotor symptoms and is particularly efficacious in PD patients at early stage. Antineuroinflammation may be a mechanism of EA add-on treatment.

scholarly journals Importance of the Brain Angiotensin System in Parkinson’s Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
John W. Wright ◽  
Joseph W. Harding
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Growth Factor ◽  
Oral Delivery ◽  
Sleep Disturbances ◽  
Treatment Strategies ◽  
Disease Process ◽  
Motor Dysfunction ◽  
Receptor System ◽  
Major Health Problem

Parkinson’s disease (PD) has become a major health problem affecting 1.5% of the world’s population over 65 years of age. As life expectancy has increased so has the occurrence of PD. The primary direct consequence of this disease is the loss of dopaminergic (DA) neurons in the substantia nigra and striatum. As the intensity of motor dysfunction increases, the symptomatic triad of bradykinesia, tremors-at-rest, and rigidity occur. Progressive neurodegeneration may also impact non-DA neurotransmitter systems including cholinergic, noradrenergic, and serotonergic, often leading to the development of depression, sleep disturbances, dementia, and autonomic nervous system failure. L-DOPA is the most efficacious oral delivery treatment for controlling motor symptoms; however, this approach is ineffective regarding nonmotor symptoms. New treatment strategies are needed designed to provide neuroprotection and encourage neurogenesis and synaptogenesis to slow or reverse this disease process. The hepatocyte growth factor (HGF)/c-Met receptor system is a member of the growth factor family and has been shown to protect against degeneration of DA neurons in animal models. Recently, small angiotensin-based blood-brain barrier penetrant mimetics have been developed that activate this HGF/c-Met system. These compounds may offer a new and novel approach to the treatment of Parkinson’s disease.

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