Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown.To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD.We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms.A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness.Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.
Objective To postulate a new possible cause of a unilaterally reduced arm swing in addition to the known medical conditions such as shoulder pathology, Erb’s palsy, stroke, and Parkinson’s disease. Methods Analysis of YouTube videos depicting the gait of highly ranked Russian officials. Results We found a similar walking pattern in President Vladimir Putin, Prime Minister Dmitry Medvedev and three other highly ranked Russian officials, all presenting with a consistently reduced right arm swing in the absence of other overt neurological abnormalities. Conclusions We propose that this new gait pattern, which we term “gunslinger’s gait,” may result from a behavioural adaptation, possibly triggered by KGB or other forms of weapons training where trainees are taught to keep their right hand close to the chest while walking, allowing them to quickly draw a gun when faced with a foe. This should be included in the differential diagnosis of a unilaterally reduced arm swing.
The present study sought to make a cross-cultural adaptation of the Dysarthria Impact Profile (DIP) for European Portuguese (EP) and validate it for use in Parkinson's disease (PD) patients.The cross-cultural adaptation was carried out in accordance with the guidelines. The EP version of the DIP was administered to 80 people with PD, and 30 sex- and age-matched control participants. Psychometric properties, acceptability, feasibility reliability (internal consistency and intrarater agreement) and validity (construct, convergent and known-groups validity) were assessed using other assessment tools (motor disability and impairment, and voice impact).Overall, the EP-DIP final version has the same conceptual meaning, semantics, idiomatic and score equivalences as the original version. Statistical analyses showed adequate feasibility (missing data <5%), good acceptability (ceiling or floor effects <15%; high requests of assistance to complete the questionnaire), satisfactory internal consistency (Cronbach's α = 0.9), weak-to-moderate intrarater reliability, good construct validity, strong convergent validity (with the Voice Handicap Index; Spearman's P = -0.8) and good known-groups validity (between those with PD and control participants).The EP-DIP version displays the salient features of a valid patient-based assessment tool used to measure the psychosocial impact of slight-to-mild dysarthria in people with PD. Geriatr Gerontol Int 2018; 18: 767-774.
While sleep disturbances are among the most frequent non-motor symptoms of Parkinson's disease (PD), there is a lack of evidence to support its treatment. To evaluate the efficacy of opicapone 50 mg in treating sleep disturbances in patients with PD and end-of-dose motor fluctuations. OASIS was an exploratory, open-label, single-arm clinical trial in PD patients with end-of-dose motor fluctuations and associated sleep disturbances. The primary endpoint was change from baseline to week 6 in Parkinson's Disease Sleep Scale 2 (PDSS-2). Secondary endpoints included functional motor and non-motor assessments (Movement Disorder Society [MDS]-Unified Parkinson's Disease Rating Scale [UPDRS], MDS-Non-motor Scale [NMS], 8-item PD Questionnaire [PDQ-8], 16-item PD Fatigue Scale [PFS-16], ON/OFF home diary), Clinical and Patient Global Impression of Change (CGI-C; PGI-C) and adverse events. At week 6, there was a significant reduction of -7.9 points (95%CI -13.6, -2.2; p = 0.0099) in PDSS-2 total score, with a significant mean change of -4.7 in the PDSS-2 domain of disturbed sleep (95%CI: -7.2, -2.3; p = 0.0009). Significant reductions were also observed in PFS-16 (-9.6; p = 0.0211), MDS-NMS total score (-28.9; p = 0.0015), MDS-UPDRS-III (-6.3; p = 0.0253), MDS-UPDRS-IV (-1.2; p = 0.0044) and PDQ-8 (-14.2; p = 0.0051). Absolute OFF-time was reduced (-142.1 min). Most patients (93.3%) and most clinicians (80.0%) reported improvements on PGI-C and CGI-C, respectively. Opicapone was well tolerated. Adding opicapone 50 mg to levodopa/DDCI therapy in patients with PD and motor fluctuations and sleep disturbances improved both sleep disturbances and OFF time in these patients.
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