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Clinical Management of Parkinson's Symptoms

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (10 March 2024) | Viewed by 16678

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Special Issue Editors

Dr. Alejandro Rodríguez-Molinero

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Guest Editor

Consorci Sanitari de l'Alt Penedès i Garraf (CSAPG), Sant Pere de Ribes, Barcelona, Spain
Interests: hypokinesia; tremors; finger tapping gait; Parkinson's disease; accidental falls; azithromycin; tocilizumab; COVID-19

Dr. Jorge Hernández-Vara

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Neurology Department, Neurodegenerative Diseases Research Group (Vall D'Hebron Research Institute), Vall D'Hebron University Campus, Passeig Vall D'Hebron 119-129, 08035 Barcelona, Spain
Interests: Parkinson's disease; movement disorders; biomarkers; neuroimaging; genetics

Special Issue Information

Dear Colleagues,

Parkinson disease (PD) is the second most frequent neurodegenerative disease after Alzheimer´s disease, with an age-standardized annual incidence rate of 160 per 100,000 subjects aged 65 years or older. People living with PD present a wide variety of symptoms, including motor symptoms (bradykinesia, rigidity, freezing of gait, etc.), and non-motor symptoms (depression, anxiety, disautonomic features, etc.). As the disease progresses, the effect of the medication decreases over time (wearing off), leading to fluctuating and difficult-to-control symptoms and thus greatly worsening patients’ quality of life. That patients often do not perceive the manifestations of the disease, and therefore cannot accurately report their time course, further complicates therapeutic adjustment.

This Special Issue will include research on the early identification of the various symptoms of Parkinson's disease or their fluctuation via different means, such as new questionnaires or wearables. Research on progression markers aiming to enhance the understanding of these symptoms is also welcome. We welcome papers aimed at improving the clinical control of patients by any means, including innovations in the care process and non-pharmacological therapies.

Dr. Alejandro Rodríguez-Molinero
Dr. Jorge Hernández-Vara
Guest Editors

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Keywords

idiopathic Parkinson's disease
symptom assessment
dyskinesias
hypokinesia
rigidity
extrapyramidal
wearing off
freezing of gait
non-motor symptoms
wearable electronic devices
drug therapy
electric stimulation therapy
early medical intervention
non-pharmacological treatments

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Published Papers (7 papers)

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Research

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15 pages, 1395 KiB

Open AccessArticle

Parkinson’s Disease Non-Motor Subtypes Classification in a Group of Slovenian Patients: Actuarial vs. Data-Driven Approach

by Timotej Petrijan, Jan Zmazek and Marija Menih

J. Clin. Med. 2023, 12(23), 7434; https://doi.org/10.3390/jcm12237434 - 30 Nov 2023

Cited by 2 | Viewed by 1266

Abstract

Background and purpose: The aim of this study was to examine the risk factors, prodromal symptoms, non-motor symptoms (NMS), and motor symptoms (MS) in different Parkinson’s disease (PD) non-motor subtypes, classified using newly established criteria and a data-driven approach. Methods: A total of 168 patients with idiopathic PD underwent comprehensive NMS and MS examinations. NMS were assessed by the Non-Motor Symptom Scale (NMSS), Montreal Cognitive Assessment (MoCA), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), Epworth Sleepiness Scale (ESS), Starkstein Apathy Scale (SAS) and Fatigue Severity Scale (FSS). Motor subtypes were classified based on Stebbins’ method. Patients were classified into groups of three NMS subtypes (cortical, limbic, and brainstem) based on the newly designed inclusion criteria. Further, data-driven clustering was performed as an alternative, statistical learning-based classification approach. The two classification approaches were compared for consistency. Results: We identified 38 (22.6%) patients with the cortical subtype, 48 (28.6%) with the limbic, and 82 (48.8%) patients with the brainstem NMS PD subtype. Using a data-driven approach, we identified five different clusters. Three corresponded to the cortical, limbic, and brainstem subtypes, while the two additional clusters may have represented patients with early and advanced PD. Pearson chi-square test of independence revealed that a priori classification and cluster membership were significantly related to one another with a large effect size (χ²(8) = 175.001, p < 0.001, Cramer’s V = 0.722). The demographic and clinical profiles differed between NMS subtypes and clusters. Conclusion: Using the actuarial and clustering approach, marked differences between individual NMS subtypes were found. The newly established criteria have potential as a simplified tool for future clinical research of NMS subtypes of Parkinson’s disease. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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11 pages, 2392 KiB

Open AccessArticle

The Effect of Personalized Shoe Insoles on Parkinson’s Disease Subjects: A Triple-Blind Randomized Controlled Trial

by Joel Pollet, Riccardo Buraschi, Giorgia Ranica, Simone Pancera, Denise Anastasi, Rossella Fazio, Serena Monteleone, Eleonora Lena, Valeria Floridi, Franco Zucchini and Maurizio Vincenzo Falso

J. Clin. Med. 2023, 12(23), 7204; https://doi.org/10.3390/jcm12237204 - 21 Nov 2023

Cited by 1 | Viewed by 1178

Abstract

Subjects with Parkinson’s Disease (PD) display different motor and non-motor symptoms. Different therapies have been shown to be effective, such as plantar foot stimulation, which has proved to be effective for motor symptoms. Different stimulation methods were proposed and tested through specific devices, or insoles. Our aim was to assess the effect of a newly designed custom-made insole called PRO-STEP compared with a flat sham insole on subjects with PD. Subjects were randomized 1:1 into two arms and were asked to wear PRO-STEP or sham insoles for at least 6 h per day for 10 weeks. Participants were evaluated at four timepoints. Forty-two subjects were randomly assigned to the PRO-STEP (EG) or sham group (SG). The comparison of the EG and SG without and with insoles (T0–T1) did not show significant differences in the TUG time and in the 10MWT gait parameters. At T1, T2, and T3 TUG time, BBS, SF12-MC, and SF12-PC did not show significant differences. The satisfaction level with the PRO-STEP or sham insoles was high in both groups. PD patients were satisfied with PRO-STEP insoles; however, plantar foot stimulation is not effective from a functional perspective. Future studies should consider possible modifications to the proposed stimulation to improve its effectiveness in patients with PD. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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13 pages, 1667 KiB

Open AccessArticle

Depressive Symptoms and Their Impact on Quality of Life in Parkinson’s Disease: An Exploratory Network Analysis Approach

by Konstantin G. Heimrich, Sarah Mendorf, Aline Schönenberg, Diego Santos-García, Pablo Mir, COPPADIS Study Group and Tino Prell

J. Clin. Med. 2023, 12(14), 4616; https://doi.org/10.3390/jcm12144616 - 11 Jul 2023

Cited by 1 | Viewed by 1570

Abstract

The clinical presentation of Parkinson’s disease (PD) is often dominated by depressive symptoms, which can significantly impact the patients’ quality of life (QoL). However, it is not clear how these depressive symptoms are interconnected, or if some symptoms are more influential in affecting QoL. In the Cohort of Patients with Parkinson’s Disease in Spain (COPPADIS) study, 686 patients with PD were analyzed using network analyses. The patients completed the Beck Depression Inventory II (BDI-II) and provided their overall QoL (EUROHIS-QOL) at the beginning of the study. The study used centrality measures such as Expected Influence and Bridge Expected Influence to identify depressive symptoms that had the greatest impact on overall QoL. The results of exploratory network analyses indicate that the BDI-II items related to loss of energy, past failure, and tiredness or fatigue have the greatest impact on overall QoL as measured by the EUROHIS-QOL 8-item index. The loss of energy and tiredness or fatigue BDI-II items are also strongly associated with a number of different EUROHIS-QOL items, according to Bridge Expected Influences. For individuals suffering from PD, network analysis can aid in identifying significant non-motor symptoms that impact their QoL, thus paving the way for potential improvements. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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11 pages, 600 KiB

Open AccessArticle

Assessing the Feasibility of Using Electrochemical Skin Conductance as a Substitute for the Quantitative Sudomotor Axon Reflex Test in the Composite Autonomic Scoring Scale and Its Correlation with Composite Autonomic Symptom Scale 31 in Parkinson’s Disease

by Yu-Chuan Huang, Chih-Cheng Huang, Yun-Ru Lai, Chia-Yi Lien, Ben-Chung Cheng, Chia-Te Kung, Yi-Fang Chiang and Cheng-Hsien Lu

J. Clin. Med. 2023, 12(4), 1517; https://doi.org/10.3390/jcm12041517 - 14 Feb 2023

Cited by 4 | Viewed by 1591

Abstract

The Composite Autonomic Scoring Scale (CASS) is a quantitative scoring system that integrates the sudomotor, the cardiovagal, and the adrenergic subscores, and the Composite Autonomic Symptom Scale 31 (COMPASS 31) is based on a well-established comprehensive questionnaire designed to assess the autonomic symptoms across multiple domains. We tested the hypothesis that electrochemical skin conductance (Sudoscan) can be a substitute for the quantitative sudomotor axon reflex test (QSART) in the sudomotor domain and assessed its correlation with COMPASS 31 in patients with Parkinson’s disease (PD). Fifty-five patients with PD underwent clinical assessment and cardiovascular autonomic function tests and completed the COMPASS 31 questionnaire. We compared the modified CASS (integrating the Sudoscan-based sudomotor, adrenergic, and cardiovagal subscores) and CASS subscores (the sum of the adrenergic and cardiovagal subscores). The total weighted score of COMPASS 31 was significantly correlated with both the modified CASS and the CASS subscore (p = 0.007 and p = 0.019). The correlation of the total weighted score of COMPASS 31 increased from 0.316 (CASS subscores) to 0.361 (modified CASS). When we added the Sudoscan-based sudomotor subscore, the case numbers for autonomic neuropathy (AN) increased from 22 (40%, CASS subscores) to 40 (72.7%, modified CASS). The modified CASS not only better reflects the exact autonomic function, but also improves the characterization and quantification of AN in patients with PD. In areas in which a QSART facility is not easily available, Sudoscan could be a time-saving substitution. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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16 pages, 922 KiB

Open AccessArticle

Sex Differences in Motor and Non-Motor Symptoms among Spanish Patients with Parkinson’s Disease

by Diego Santos-García, Ariadna Laguna, Jorge Hernández-Vara, Teresa de Deus Fonticoba, Carlos Cores Bartolomé, Maria J. Feal Painceiras, Maria Cristina Íñiguez-Alvarado, Iago García Díaz, Silvia Jesús, Maria Teresa Boungiorno, Lluís Planellas, Marina Cosgaya, Juan García Caldentey, Nuria Caballol, Ines Legarda, Iria Cabo, Lydia López Manzanares, Isabel González Aramburu, Maria A. Ávila Rivera, Víctor Gómez Mayordomo, Víctor Nogueira, Víctor Puente, Julio Dotor García-Soto, Carmen Borrué, Berta Solano Vila, María Álvarez Sauco, Lydia Vela, Sonia Escalante, Esther Cubo, Francisco Carrillo Padilla, Juan C. Martínez Castrillo, Pilar Sánchez Alonso, Maria G. Alonso Losada, Nuria López Ariztegui, Itziar Gastón, Jaime Kulisevsky, Manuel Menéndez González, Manuel Seijo, Javier Rúiz Martínez, Caridad Valero, Mónica Kurtis, Jessica González Ardura, Ruben Alonso Redondo, Carlos Ordás, Luis M. López Díaz, Darrian McAfee, Pablo Martinez-Martin, Pablo Mir and on behalf of the COPPADIS Study Group Show full author list Hide full author list

J. Clin. Med. 2023, 12(4), 1329; https://doi.org/10.3390/jcm12041329 - 7 Feb 2023

Cited by 8 | Viewed by 5265

Abstract

Background and objective: Sex plays a role in Parkinson’s disease (PD) mechanisms. We analyzed sex difference manifestations among Spanish patients with PD. Patients and Methods: PD patients who were recruited from the Spanish cohort COPPADIS from January 2016 to November 2017 were included. A cross-sectional and a two-year follow-up analysis were conducted. Univariate analyses and general linear model repeated measure were used. Results: At baseline, data from 681 PD patients (mean age 62.54 ± 8.93) fit the criteria for analysis. Of them, 410 (60.2%) were males and 271 (39.8%) females. There were no differences between the groups in mean age (62.36 ± 8.73 vs. 62.8 ± 9.24; p = 0.297) or in the time from symptoms onset (5.66 ± 4.65 vs. 5.21 ± 4.11; p = 0.259). Symptoms such as depression (p < 0.0001), fatigue (p < 0.0001), and pain (p < 0.00001) were more frequent and/or severe in females, whereas other symptoms such as hypomimia (p < 0.0001), speech problems (p < 0.0001), rigidity (p < 0.0001), and hypersexuality (p < 0.0001) were more noted in males. Women received a lower levodopa equivalent daily dose (p = 0.002). Perception of quality of life was generally worse in females (PDQ-39, p = 0.002; EUROHIS-QOL8, p = 0.009). After the two-year follow-up, the NMS burden (Non-Motor Symptoms Scale total score) increased more significantly in males (p = 0.012) but the functional capacity (Schwab and England Activities of Daily Living Scale) was more impaired in females (p = 0.001). Conclusion: The present study demonstrates that there are important sex differences in PD. Long-term prospective comparative studies are needed. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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Review

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14 pages, 297 KiB

Open AccessReview

Treatment of Apathy in Parkinson’s Disease and Implications for Underlying Pathophysiology

by Senan Maher, Eoghan Donlon, Gerard Mullane, Richard Walsh, Tim Lynch and Conor Fearon

J. Clin. Med. 2024, 13(8), 2216; https://doi.org/10.3390/jcm13082216 - 11 Apr 2024

Cited by 1 | Viewed by 2381

Abstract

Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson’s disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

16 pages, 756 KiB

Open AccessReview

Effect of Transcranial Direct Current Stimulation (tDCS) on Depression in Parkinson’s Disease—A Narrative Review

by James Chmiel, Filip Rybakowski and Jerzy Leszek

J. Clin. Med. 2024, 13(3), 699; https://doi.org/10.3390/jcm13030699 - 25 Jan 2024

Cited by 1 | Viewed by 2409

Abstract

Introduction: Depression is the most prevalent comorbid neuropsychiatric condition in individuals with Parkinson’s disease (PD), and its underlying mechanisms are not yet fully understood. Current treatment methods are characterised by moderate effectiveness and possible side effects, prompting the search for new non-invasive and safe treatment methods. Methods: This narrative review explores the use of transcranial direct current stimulation (tDCS) in the treatment of depression in PD, based on neuropsychological measures. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. Results: Nine relevant studies were identified, where depression scores served as either primary or secondary outcomes. Stimulation protocols displayed heterogeneity, especially concerning choice of stimulation site. Patient samples were also heterogeneous. The majority of the studies incorporated anodal stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). The results revealed a reduction in depression scores among PD patients following tDCS. Potential mechanisms through which tDCS may alleviate depression in PD were discussed and recommendations for future research were made. Conclusions: Preliminary evidence suggests that tDCS applied anodally to the left DLPFC reduces depression scores in people with PD; however, due to the heterogeneity of the studies analysed, the use of tDCS in this field should be approached with caution and warrants further validation and confirmation. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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