304 research outputs found
Neuroepidemiology of Parkinsonâs disease in an urban area of Iran : from screening and prevalence to nutritional, clinical and psychiatric features and quality of life
Background. Parkinsonâs disease (PD) is the second most common neurodegenerative
disorder with complex presentations consisting of different motor and non-motor symptoms.
The multisystem and progressive nature of PD has made it a complicated entity with broad
variation in manifestations and reciprocal effects on several aspects of daily life.
Aims. This doctoral thesis investigated different neuroepidemiologic aspects of PD and
parkinsonism including its screening and prevalence in the urban area of Tehran, Iran,
nutritional status and risk factors for malnutrition, clinical and psychiatric features, healthrelated quality of life (HRQoL) and its determinants in Iranian PD patients. For this purpose,
we also aimed to validate several questionnaires and make a new screening instrument.
Study I. Psychometric properties of the Persian-translated version of the short-form
Parkinsonâs disease questionnaire (PDQ-8) were assessed in 114 Iranian patients with PD
consecutively recruited from an outpatient Movement Disorder Clinic. The Cronbachâs alpha
coefficient of the entire PDQ-8 was 0.740 (95% CI: 0.661-0.806). Replacement of PDQ-8
items with other questions with the highest internal consistency within each dimension of the
long-form PDQ (PDQ-39) did not further improve reliability. The Persian version of the
PDQ-8 was shown to be a valid and reliable instrument to assess HRQoL in Iranian PD
population especially in mental and behavioral aspects. PDQ-8 is a practical and informative
instrument in daily clinical practice where clinicians are in shortage of time and need a
validated self-reported brief questionnaire.
Study II. To develop a new instrument for screening of parkinsonism in community-based
surveys, a comprehensive questionnaire consisting of 25 items on different PD symptoms
was filled in 157 patients with parkinsonism and 110 controls. Using the concept of clinical
utility index (CUI), six items on âstiffness & rigidityâ, âtremor & shakingâ, âtroublesome
buttoningâ, âtroublesome arm swingâ, âfeet stuck to floorâ and âslower daily activityâ
demonstrated good validity (CUIâ„0.64) to be included in the new screening tool . We
introduced a new set of six items to screen parkinsonism, which showed higher diagnostic
values [area under curve (AUC)=0.977] compared to the previously developed
questionnaires. This new instrument could be used in population-based surveys to screen
parkinsonism in poor-resource settings.
Study III. Following a random multistage sampling of the households within the network of
âHealth Centersâ with 374 subunits in all 22 urban districts of Tehran, 20,621 individuals
answered the baseline checklist and the screening questionnaire developed in study II. Data
from 19,500 persons aged â„30 years were entered in the final analysis. A total number of 157
cases were positively screened for parkinsonism that resulted in age- and sex-adjustment
prevalence rates of 222.9/100,000 (95% CI: 160-300) and 285/100,000 (95% CI: 240-329)
based on the real Tehran population and âWHO World Standard Populationâ, respectively.
The male/female ratio of probable parkinsonism was 1.62 and there was a steady increase by
advancing age. The calculated rates for the prevalence of parkinsonism in our study are closer
to the reports from some European and Middle-East countries, higher than reports from the
Eastern Asian and African populations, and lower than Australia. The prevalence rate of
>200/100,000 for parkinsonism in Tehran, Iran is considered as a medium-to-high rate.
Study IV. Nutritional status was evaluated in 143 Iranian PD patients and 145 age- and sexmatched controls by means of the validated Persian version of the mini-nutritional assessment
(MNA). The mean of total MNA score was not significantly different between the two groups
[24.4 (SD=3.8) in controls vs. 25.1 (SD=3.4) in PD patients, p=0.094]. Three (2.1%) PD
patients were suffering from malnutrition and another 37 (25.9%) were at risk of
malnutrition; while in control group similar feature was observed (2.0% malnourished and
35.2% at risk of malnutrition, p=0.228). Our findings indicated similar nutritional status
among mild-to-moderate PD patients and matched controls from the same community.
However, nearly one third of PD population were either malnourished or at risk of
malnutrition necessitating more attention towards nutritional assessment in PD.
Study V. Factors affecting nutritional status were investigated in 150 PD patients including a
comprehensive list of motor and non-motor scales. The total score of the Unified Parkinson's
disease rating scale (UPDRS) scale (r=-0.613, p<0.001) and PD duration (r=-0.284, p=0.002)
had a significant inverse correlation with the total MNA score. A higher Hoehn and Yahr
stage [2.5 vs. 2.0, p<0.001], more severe anxiety [8.8 vs. 5.9, p=0.002], depression [9.0 vs.
3.6, p<0.001] and fatigue [5.4 vs. 4.2, p<0.001] were observed in PD patients with nutritional
insufficiency. Except for stigma, all other domains of the HRQoL significantly correlated
with the total MNA score. We showed that disease duration, severity of motor and psychiatric
symptoms (depression, anxiety) and fatigue associated with nutritional status in PD, which
itself affected different aspects of HRQoL especially the emotional well-being and mobility.
Study VI. A broad spectrum of demographic, motor and non-motor characteristics were
evaluated in 157 PD patients consisting of comorbidity profile, nutritional status, UPDRS
(total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial
functioning through physical examination, validated questionnaires and scales. Structural
equation model (SEM) and multivariate regressions were applied to find determinants of
Parkinsonâs disease severity index (PDSI) and different domains of HRQoL (PDQ-39).
Female sex, anxiety, depression and UPDRS-part II scores were the significant independent
determinants of PDSI. A structural model consisting of global motor, global non-motor and
co-morbidity indicator as three main components was able to predict 89% of the variance in
HRQoL. However, outstanding heterogeneities in the pattern and determinants of HRQoL
were found among different PD phenotypes.
Conclusions. We showed a medium-to-high prevalence rate for suspicious parkinsonism in
Iranian population living in the urban area of Tehran by means of a novel 6-item screening
instrument. Similar nutritional status was found in mild-to-moderate PD patients and matched
controls from the same community. Yet, approximately one third of people with mild-tomoderate PD were either malnourished or at risk of malnutrition. Duration of PD, severity of
motor symptoms, depression, anxiety and fatigue associated with nutritional status in PD
patients. Motor symptoms affecting activities of daily living (ADL), depression, anxiety and
female sex were found to be the strongest independent determinants of HRQoL in Iranian PD
population. Clear heterogeneities were found in the pattern and determinants of HRQoL in
different PD phenotypes, which should be considered during the assessments and developing
personalized interventions to improve life quality in PD patients with different prominent
features
Active Aging for Individuals with Parkinsonâs Disease: Definitions, Literature Review, and Models
Active aging has been emerged to optimize different aspects of health opportunities during the aging process in order to enhance quality of life. Yet, most of the efforts are on normal aging and less attention has been paid for the elderly suffering from a chronic illness such as Parkinsonâs disease (PD). The aim of this review was to investigate how the concept of âactive agingâ fit for the elderly with PD and to propose a new model for them using the recent improvements in caring models and management approaches. For this purpose, biomedical databases have been assessed using relevant keywords to find out appropriate articles. Movement problems of PD affect physical activity, psychiatric symptoms lessen social communication, and cognitive impairment could worsen mental well-being in elderly with PD, all of which could lead to earlier retirement and poorer quality of life compared with healthy elderly. Based on the multisystematic nature of PD, a new âActive Aging Model for Parkinsonâs Diseaseâ is proposed consisting of self-care, multidisciplinary and interdisciplinary care, palliative care, patient-centered care, and personalized care. These strategies could potentially help the individuals with PD to have a better management approach for their condition towards the concept of active aging
PhD Education Challenges - Doctoral Candidatesâ Perspectives
Doctoral training was included in the Bologna system as the third cycle. The important consequence of this change is that the doctoral studies became more structured, and most universities now train doctors in a shorter time period than in the past, mostly in 3 to 4 years. The National Association of PhD students from Serbia (Doktoranti Srbije) conducted the same survey in the form of a questionnaire three years in a row (2010-2012). In 2010 the survey received 335 responses, in 2011 there were 557 responses and in 2012 there were 625. The survey results showed that doctoral candidates recognise supervision as a key issue that need to be improved. Surveyed individuals emphasised the impact of the supervisorâs engagement on the quality of their PhD projects. Supportiveness is the quality that PhD students value the most. This involves supervisors being encouraging, and aware that students' lives extend beyond the PhD. Other key areas for improvement, according to Serbian PhD candidates, are financing and mobility, especially international mobility
Evolution of Orofacial Symptoms and Disease Progression in Idiopathic Parkinsonâs Disease: Longitudinal Data from the Jönköping Parkinson Registry
Background. Orofacial symptoms are common in Parkinsonâs disease (PD) both as initial manifestations and late markers of disease complications. We aimed to investigate the evolution of orofacial manifestations and their prognostic value throughout PD progression. Methods. Data was obtained from âJönköping Parkinson Registryâ database on routine care visits of 314 people with idiopathic PD in southern Sweden. Information on baseline symptomatology, orofacial features, UPDRS, and medications was recorded at baseline and during each follow-up visit within an average of 4.2 (range: 1â12) years. Results. Hypomimia, affected speech, drooling, and impaired swallowing were present in 37.3%/91.6%, 14.1%/65.5%, 11.7%/55.3%, and 10.2%/34.5% at baseline/follow-up, respectively. Male sex [OR = 2.4 (95% CI: 1.0â5.9)], UPDRS motor scores [OR = 1.2 (95% CI: 1.1â1.3)], dominant rigidity [OR = 5.2 (95% CI: 1.4â19.1)], and autonomic disturbance [OR = 3.4 (95% CI: 1.1â10.9)] were risk factors for drooling. Individuals with more severe orofacial burden at baseline had shorter median time to develop UPDRS-Part III > 28 [3rd tertile = 4.7âyr, 2nd tertile = 6.2âyr, and 1st tertile = 7.8âyr; p = 0.014]. Conclusions. Majority of people with PD manifest orofacial manifestations at either early or late stages of the disease. PD severity, symmetry of motor disturbances, and autonomic disorders correlate with orofacial symptoms. Individuals with more severe orofacial burden at baseline progressed faster to more advanced stages
Sexual dimorphism in Parkinson’s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females
Medium-to-high prevalence of screening-detected parkinsonism in the urban area of Tehran, Iran: data from a community-based door-to-door study
Clinimetrics of the Freezing of Gait Questionnaire for Parkinson Disease During the "off" State
Introduction: Freezing of gait, a common PD motor symptom, could increase the risk of falling. This study aimed to investigate the clinimetric attributes of the Freezing of Gait Questionnaire (FOGQ) for people with Parkinson disease in the "off" state. Methods: A total of 115 patients with Parkinson disease (PD; mean age, 60.25 years) were included. Acceptability, internal consistency (by the Cronbach alpha, and test-retest by Intraclass Correlation [ICC]), and reliability of the Persian-translated version of the FOGQ were examined. Dimensionality was estimated by Exploratory Factor Analysis (EFA). Fall efficacy scale-international, unified Parkinson disease rating scale-II, Berg balance scale, functional reach test, and Parkinson disease questionnaire-39 were applied to determine the convergent validity. Diagnostic accuracy for obtaining optimal cutoff point, separating faller and non-faller groups, was analyzed by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). All tests were carried out in an "off" state. Results: The Cronbach alpha was high (α=0.92). The test-retest showed high reliability (ICC=0.89). The FOGQ was unidimensional according to the EFA and had acceptable convergent validity with moderate to high correlation with other clinical scales. The optimal cutoff point to discriminate fallers from non-fallers during the "off" state was 9/10, with an AUC of 0.92. Conclusion: Our results suggest that the FOGQ has appropriate reliability, validity, and discriminative ability for measuring FOG in patients with PD during the "off" state.S
Comparison of the Psychological Symptoms and Disease-Specific Quality of Life between Early- and Typical-Onset Parkinsonâs Disease Patients
The impact of Parkinsonâs disease (PD) on psychological status and quality of life (QoL) may vary depending on age of disease onset. The aim of this study was to compare psychological symptoms and disease-specific QoL between early onset versus the rest of the PD patients. A total number of 140 PD patients with the mean current age of 61.3 (SD=10.4)âyr were recruited in this study. PD patients with the onset age of â€50âyr were defined as âearly-onsetâ (EOPD) group (n=45), while the ones with >50âyr at the time of diagnosis were categorized as the âtypical-onsetâ (TOPD) patients (n=95). Different questionnaires and scales were used for between-group comparisons including PDQ39, HADS (hospital anxiety and depression scale), FSS (fatigue severity scale), MNA (mininutritional assessment), and the UPDRS. Depression score was significantly higher in EOPD group (6.3 (SD=4.5) versus 4.5 (SD=4.2), P=0.02). Among different domains of QoL, emotion score was also significantly higher in the EOPD group (32.3 (SD=21.6) versus 24.4 (SD=22.7), P=0.05). Our findings showed more severe depression and more impaired emotional domain of QoL in early-onset PD patients. Depression and anxiety play an important role to worsen QoL among both EOPD and TOPD patients, while no interaction was observed in the efficacy of these two psychiatric symptoms and the onset age of PD patients
Insulin-Independent and Dependent Glucose Transporters in Brain Mural Cells in CADASIL
Typical cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the human NOTCH3 gene. Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is characterized by subcortical ischemic strokes due to severe arteriopathy and fibrotic thickening of small vessels. Blood regulating vascular smooth muscle cells (VSMCs) appear as the key target in CADASIL but the pathogenic mechanisms remain unclear. With the hypothesis that brain glucose metabolism is disrupted in VSMCs in CADASIL, we investigated post-mortem tissues and VSMCs derived from CADASIL patients to explore gene expression and protein immunoreactivity of glucose transporters (GLUTs), particularly GLUT4 and GLUT2 using quantitative RT-PCR and immunohistochemical techniques.In vitrocell model analysis indicated that both GLUT4 and -2 gene expression levels were down-regulated in VSMCs derived from CADASIL patients, compared to controls.In vitrostudies further indicated that the down regulation of GLUT4 coincided with impaired glucose uptake in VSMCs, which could be partially rescued by insulin treatment. Our observations on reduction in GLUTs in VSMCs are consistent with previous findings of decreased cerebral blood flow and glucose uptake in CADASIL patients. That impaired ability of glucose uptake is rescued by insulin is also consistent with previously reported lower proliferation rates of VSMCs derived from CADASIL subjects. Overall, these observations are consistent with the development of severe cerebral arteriopathy in CADASIL, in which VSMCs are replaced by widespread fibrosis
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