Anticholinergic Medication Burden in Parkinson’s Disease Outpatients

2021 ◽  
pp. 1-8
Author(s):  
Huma Nawaz ◽  
Lana Sargent ◽  
Helengrace Quilon ◽  
Leslie J. Cloud ◽  
Claudia M. Testa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cholinesterase Inhibitors ◽  
Anticholinergic Drug ◽  
Weighted Kappa ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Drug Classes ◽  
Highly Correlated ◽  
Anticholinergic Burden

Background: Individuals with Parkinson’s disease (PD) may be especially vulnerable to future cognitive decline from anticholinergic medications. Objective: To characterize anticholinergic medication burden, determine the co-occurrence of anticholinergic and cholinesterase inhibitors, and to assess the correlations among anticholinergic burden scales in PD outpatients. Methods: We studied 670 PD outpatients enrolled in a clinic registry between 2012 and 2020. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Drug Burden Index-Anticholinergic component (DBI-Ach). Correlations between scales were assessed with weighted kappa coefficients. Results: Between 31.5 to 46.3% of PD patients were taking medications with anticholinergic properties. Among the scales applied, the ACB produced the highest prevalence of medications with anticholinergic properties (46.3%). Considering only medications with definite anticholinergic activity (scores of 2 or 3 on ACB, ADS, or ARS), the most common anticholinergic drug classes were antiparkinsonian (8.2%), antipsychotic (6.4%), and urological (3.3%) medications. Cholinesterase inhibitors and medications with anticholinergic properties were co-prescribed to 5.4% of the total cohort. The most highly correlated scales were ACB and ADS (κ= 0.71), ACB and ARS (κ= 0.67), and ADS and ARS (κ= 0.55). Conclusion: A high proportion of PD patients (20%) were either taking antiparkinsonian, urological, or antipsychotic anticholinergic medications or were co-prescribed anticholinergic medications and cholinesterase inhibitors. By virtue of its detection of a high prevalence of anticholinergic medication usage and its high correlation with other scales, our data support use of the ACB scale to assess anticholinergic burden in PD patients.

Influence of Drugs on Mild Cognitive Impairment in Parkinson’s Disease: Evidence from the PACOS Study

2021 ◽  
Vol 20 ◽  
Author(s):  
Calogero Edoardo Cicero ◽  
Roberto Monastero ◽  
Claudio Terravecchia ◽  
Giulia Donzuso ◽  
Antonina Luca ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Anticholinergic Drug ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Drug Classes ◽  
Pharmacological Data

Background: Polytherapy and the anticholinergic activity of several drugs negatively influence cognition in the elderly. However, little is known on the effect on Mild Cognitive Impairment (MCI) in Parkinson’s Disease (PD). Methods: Patients with PD belonging to the baseline PACOS cohort with full pharmacological data, have been included in this study. MCI diagnosis was made according to the MDS level II criteria. Polytherapy was defined as patients assuming ≥6 drugs. Anticholinergic burden has been calculated using the Anticholinergic Drug Scale (ADS). Molecules have been classified according to the ATC classification. Association with MCI has been assessed with a multivariate logistic regression analysis with MCI as the dependent variable. Results: Pharmacological data was available for 238 patients (mean age 64.7±9.7). One hundred (42.0%) were diagnosed as MCI. In the full multivariate model (correcting for age, sex, disease duration, education, UPDRS-ME, LEDD-DAs) no association was found with either polytherapy or the ADS. Concerning drug classes, anti-hypertensive medications increased the risk of PD-MCI (OR 2.02;95%CI 1.04-3.89; p=0.035) while gastroprotective agents had a protective effect (OR 0.51; 95%CI 0.27-0.99; p=0.047). Conclusion: The magnitude of polytherapy and anticholinergic drugs burden does not appear to modulate MCI risk in PD, probably due to cautious prescription patterns. The effect of anti-hypertensive and gastroprotective agents on PD-MCI risk, while needing further confirmations, could be relevant for clinical practice.

scholarly journals Listener Perception of Monopitch, Naturalness, and Intelligibility for Speakers With Parkinson's Disease

2015 ◽  
Vol 58 (4) ◽  
pp. 1134-1144 ◽  
Author(s):  
Supraja Anand ◽  
Cara E. Stepp
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Speech Intelligibility ◽  
Potential Significance ◽  
Rehabilitation Outcomes ◽  
Rate Method ◽  
Highly Correlated ◽  
Short Utterances ◽  
Speech Naturalness

PurposeGiven the potential significance of speech naturalness to functional and social rehabilitation outcomes, the objective of this study was to examine the effect of listener perceptions of monopitch on speech naturalness and intelligibility in individuals with Parkinson's disease (PD).MethodTwo short utterances were extracted from monologue samples of 16 speakers with PD and 5 age-matched adults without PD. Sixteen listeners evaluated these stimuli for monopitch, speech naturalness and intelligibility using the visual sort and rate method.ResultsNaïve listeners can reliably judge monopitch, speech naturalness, and intelligibility with minimal familiarization. While monopitch and speech intelligibility were only moderately correlated, monopitch and speech naturalness were highly correlated.ConclusionsA great deal of attention is currently being paid to improvement of vocal loudness and thus speech intelligibility in PD. Our findings suggest that prosodic characteristics such as monopitch should be explored as adjuncts to this treatment of dysarthria in PD. Development of such prosodic treatments may enhance speech naturalness and thus improve quality of life.

scholarly journals Mitochondria interaction networks show altered topological patterns in Parkinson’s disease

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Massimiliano Zanin ◽  
Bruno F. R. Santos ◽  
Paul M. A. Antony ◽  
Clara Berenguer-Escuder ◽  
Simone B. Larsen ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Point Mutations ◽  
Interaction Network ◽  
Critical Dimension ◽  
Alpha Synuclein ◽  
Interaction Networks ◽  
Scale Free ◽  
Midbrain Dopaminergic Neurons ◽  
Highly Correlated

Abstract Mitochondrial dysfunction is linked to pathogenesis of Parkinson’s disease (PD). However, individual mitochondria-based analyses do not show a uniform feature in PD patients. Since mitochondria interact with each other, we hypothesize that PD-related features might exist in topological patterns of mitochondria interaction networks (MINs). Here we show that MINs formed nonclassical scale-free supernetworks in colonic ganglia both from healthy controls and PD patients; however, altered network topological patterns were observed in PD patients. These patterns were highly correlated with PD clinical scores and a machine-learning approach based on the MIN features alone accurately distinguished between patients and controls with an area-under-curve value of 0.989. The MINs of midbrain dopaminergic neurons (mDANs) derived from several genetic PD patients also displayed specific changes. CRISPR/CAS9-based genome correction of alpha-synuclein point mutations reversed the changes in MINs of mDANs. Our organelle-interaction network analysis opens another critical dimension for a deeper characterization of various complex diseases with mitochondrial dysregulation.

Gene Co-Expression Network Analysis Implicates microRNA Processing in Parkinson’s Disease Pathogenesis

2018 ◽  
Vol 18 (4) ◽  
pp. 191-199 ◽  
Author(s):  
Jason A. Chen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Network Analysis ◽  
Statistical Power ◽  
Association Studies ◽  
Model Systems ◽  
Specific Cell ◽  
Genome Wide Association Studies ◽  
Microrna Processing ◽  
Highly Correlated

Background: Recent advances in genetics have provided insights into important inherited causes of Parkinson’s disease (PD), but the underlying biological mechanisms are still incompletely understood. Gene expression studies have pointed toward the dysregulation of neuroinflammation, mitochondrial function, and protein degradation pathways. Objective: We aimed to identify groups of dysregulated genes in PD. Methods: In order to increase statistical power and control for potential confounders, we re-analyzed transcriptomic data from PD patients and model systems, integrating additional genomic data using a systems biology approach. Using weighted gene co-expression network analysis, we partitioned genes into co-expressed modules. Results: One co-expression module, M13, had an expression trajectory that was highly correlated with PD, was not characterized by any specific cell type markers, and was enriched in PD genes identified by genome-wide association studies. Genes within M13 seemed to be related to global microRNA biogenesis, and DICER1 and AGO3 were highly connected within the module. The NUCKS1 gene, previously identified as part of the PARK16 locus, was also a hub gene within M13. Conclusion: These results suggest that microRNA processing and function may play a role in the pathogenesis of PD, and thus may represent a useful target for future drug development.

Brain perfusion effects of cholinesterase inhibitors in Parkinson’s disease with dementia

2006 ◽  
Vol 113 (11) ◽  
pp. 1787-1790 ◽  
Author(s):  
R. Ceravolo ◽  
D. Volterrani ◽  
D. Frosini ◽  
S. Bernardini ◽  
C. Rossi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cholinesterase Inhibitors ◽  
Brain Perfusion ◽  
Parkinson’S Disease With Dementia

scholarly journals The accuracy of diagnosis of major depression in patients with Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory

2008 ◽  
Vol 66 (2a) ◽  
pp. 152-156 ◽  
Author(s):  
Vitor Tumas ◽  
Guilherme Gustavo Ricioppo Rodrigues ◽  
Tarsis Leonardo Almeida Farias ◽  
José Alexandre S. Crippa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Major Depression ◽  
Beck Depression Inventory ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Diagnostic Value ◽  
Geriatric Depression ◽  
Operating Characteristics ◽  
Highly Correlated

OBJECTIVE: Evaluate the accuracy of diagnosis of major depression in patients with Parkinson's disease (PD) using the UPDRS, the 15-item Geriatric Depression Scale (GDS15) and the Beck Depression Inventory (BDI). METHOD: 50 consecutive patients with PD were evaluated. The diagnosis of major depression was made according to the DSM-IV criteria. RESULTS: We found a 24% prevalence of major depression. All depression scales were highly correlated but UPDRS depression item had the lowest diagnostic value. The GDS15 had the more appropriate "receiver operating characteristics" curve. The best cut-off scores for screening depression were 17/18 for BDI and 8/9 for GDS15. We did not find any correlation between the level of depression and intensity of motor symptoms, functional capacity and duration of the disease. CONCLUSION: GDS15 is better than the BDI and the UPDRS for screening depression in PD and depression is not related to the degree of parkinsonian symptoms.

scholarly journals Test-retest reliability of physical activity questionnaires in Parkinson’s disease

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Ånfors ◽  
Ann-Sofi Kammerlind ◽  
Maria H. Nilsson
Keyword(s):  
Physical Activity ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Weighted Kappa ◽  
Activity Level ◽  
Single Item ◽  
Retest Reliability ◽  
Activity Questionnaires ◽  
Test Retest Reliability

Abstract Background People with Parkinson’s disease are less physically active than controls. It is important to promote physical activity, which can be assessed using different methods. Subjective measures include physical activity questionnaires, which are easy and cheap to administer in clinical practice. Knowledge of the psychometric properties of physical activity questionnaires for people with Parkinson’s disease is limited. The aim of this study was to evaluate the test-retest reliability of physical activity questionnaires in individuals with Parkinson’s disease without cognitive impairment. Methods Forty-nine individuals with Parkinson’s disease without cognitive impairment participated in a test-retest reliability study. At two outpatient visits 8 days apart, the participants completed comprehensive questionnaires and single-item questions: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Physical Activity Scale for the Elderly (PASE), Saltin-Grimby Physical Activity Level Scale (SGPALS) and Health on Equal Terms (HOET). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), limits of agreement, weighted kappa or the Svensson method. Results Several of the physical activity questionnaires had relatively low test-retest reliability, including the comprehensive questionnaires (IPAQ-SF and PASE). Total physical activity according to IPAQ-SF had an ICC value of 0.46 (95% confidence interval [CI], 0.21–0.66) and SEM was 2891 MET-min/week. The PASE total score had an ICC value of 0.66 (95% CI, 0.46–0.79), whereas the SEM was 30 points. The single-item scales of SGPALS-past six months (SGPALS-6 m) and HOET question 1 (HOET-q1) with longer time frames (6 or 12 months, respectively) showed better results. Weighted kappa values were 0.64 (95% CI, 0.45–0.83) for SGPALS-6 m and 0.60 (95% CI, 0.39–0.80) for HOET-q1, whereas the single-item questions with a shorter recall period had kappa values < 0.40. Conclusions Single-item questions with a longer time frame (6 or 12 months) for physical activity were shown to be more reliable than multi-item questionnaires such as the IPAQ-SF and PASE in individuals with Parkinson’s disease without cognitive impairments. There is a need to develop a core outcome set to measure physical activity in people with Parkinson’s disease, and there might be a need to develop new physical activity questionnaires.

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