Data_Sheet_1_Impact of olfactory function on the trajectory of cognition, motor function, and quality of life in Parkinson’s disease.PDF

BackgroundOlfactory dysfunction in Parkinson’s disease (PD) is associated with more severe phenotypes, but trajectories of cognitive function, disease severity, and subdomains of quality-of-life measurements in patients with distinct olfactory profiles remain underexplored.ObjectiveTo analyze the influence of olfaction on trajectories of clinical parameters in patients with PD.DesignRetrospective cohort study.SubjectsFrom October 2016 to May 2021, the study tracked 58 participants over 3 years. Participants completed follow-up assessments using tools including the Chinese version of the University of Pennsylvania’s Smell Identification Test (UPSIT), Montreal Cognitive Assessment (MoCA), Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, and the Chinese translation of the 39-item Parkinson’s Disease Questionnaire (PDQ-39).MethodsParticipants were divided into anosmia (UPSIT ResultsDivergent cognitive trajectories were observed between groups. The anosmia group exhibited a faster cognitive decline (adjusted B [beta coefficient] = −1.8, p = 0.012) according to the interaction effect of olfaction and time on the MoCA score. The anosmia group exhibited no longitudinal correlation between cognition and olfactory function but showed correlations with age (rrm [coefficient of repeated measures correlation] = −0.464, p = 0.004) and disease duration (rrm = −0.457, p = 0.005). The non-anosmia group’s UPSIT scores decreased over time (B = −2.3, p = 0.005) alongside a significant correlation with motor function (rrm = −0.479, p = 0.006).ConclusionThe anosmia group’s accelerated cognitive decline correlated with age and disease duration, but not olfactory function, suggesting a poor cognitive outcome in this population despite the lack of longitudinal correlation between cognition and olfaction. The non-anosmia group exhibited progressive olfactory degradation and notable correlations between motor function and UPSIT scores, implying pathological accumulation in the olfactory structure and basal ganglia.</p

Initial Medication in Patients of Newly Diagnosed Parkinson’s Disease in Taiwan

<div><p>Introduction</p><p>Several treatment guidelines for Parkinson’s disease (PD) had been proposed in recent decades. The aim of current study was to investigate the initial medication utilized in newly diagnosed PD subjects in Taiwan during an eleven-year period.</p><p>Methods</p><p>A total of 7,550 patients with newly diagnosed Parkinsonism were retrospectively enrolled from the National Health Insurance Research Database of Taiwan from 2000 to 2010. After excluding patients at risk of secondary or atypical Parkinsonism, those never receiving medication or having incomplete data, 1,645 subjects were included. The participants were then divided into four treating regimen groups, namely levodopa (LD) only group, dopamine agonist (DA) only group, LD+DA group, and No-LD, No-DA group. The demographic data and medication retention rate were compared across the four treatment groups.</p><p>Results</p><p>LD only and No-LD, No-DA regimens were the main initial choice of PD treatment in Taiwan. LD containing drugs were more often prescribed to the elderly population than the other two treatment regimens, while No-LD, No-DA medication was the major initial choice for younger patients. DA only regimen occupied only 3–4% of the initial PD prescriptions and was given predominantly by neurologists. Over the eleven-year period, there is a trend for the middle-aged population to receive medication containing LD as initial treatment. The one year retention rate of anti-Parkinsonism medication was around 30–50% in our population. Age, polypharmacy, change of one-year daily levodopa equivalent dosage and newly onset of dementia, stroke and psychiatric diseases all affect drug compliance in PD patients.</p><p>Conclusions</p><p>This is the first long-term study to explore initial pharmacotherapies in an Asian PD population. We hope to provide evidence for adjusting government policies and public education of physicians and PD patients in the future.</p></div

Clinical characteristics of retention and non-retention groups of patients with newly diagnosed Parkinson’s disease.

<p>N: case number, %: percentage, MPR: medical possession rate, No medication: receive no anti-PD medication during the 7^th to 12^th month after starting medication, CNS: central nervous system.</p>a<p>ANOVA test; chi-squared test for all other p-values.</p><p>Post hoc test (Scheffe’s test) with statistical significance (p<0.05):</p>b<p>Retention (MPR≥80%) group differs from Retention (MPR<80%) group;</p>c<p>Retention (MPR≥80%) group differs from Non-retention (Keep medication) group;</p>d<p>Retention (MPR<80%) group differs from Non-retention (No-medication) group;</p>e<p>Non-retention (Keep medication) group differs from Non-retention (No-medication) group.</p><p>*p<0.05 compared to MPR≥80% group;</p>#<p>p<0.05 compared to medical center group;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to regional hospital group;</p>$<p>p<0.05 compared to clinics group.</p>f<p>The medical institution from where patients received ≥50% medication during the first year. Subjects would be classified into multiple hospitals group if they received medication <50% from each level of medical institution.</p>g<p>Only patients with medication from outpatient services were analyzed.</p>h<p>The last prescription of patients with medication from outpatient services during one-year follow-up were analyzed.</p>i<p>Definition of comorbidities: patients with diseases of the following ICD codes for more than three times during the outpatient services or once during hospitalization within one year after the diagnosis of Parkinson’s disease. Stroke: 430–438/A290-A294, A299; Dementia: 290, 331.0, 331.2/A210; CNS trauma: 344, 800, 801, 803, 804, 805, 806, 850, 851, 852, 853, 854, 959.01/A470, A490, A491, 952; Sepsis: 038, 020.0, 790.7, 117.9, 112.5, 112.81; Congestive heart failure: 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425.4–425.9, 428; Liver decompensation: 570, 571.2, 571.5, 571.6, 572.2, 572.4, 567.0, 567.2, 567.8, 567.9, 789.5, 456.0, 456.1, 456.2; Renal decompensation (renal failure): 584, 585, 586, V451, V56; Respiratory failure: 5188; Neoplasm: 140–208 (excluding 195–199); Psychiatric disorders: 290–313.</p><p>Clinical characteristics of retention and non-retention groups of patients with newly diagnosed Parkinson’s disease.</p

S1 Dataset -

AimsPrevious studies showed conflicting relationship between hyperlipidemia, lipid-lowering therapy and diabetic peripheral neuropathy (DPN). As most of these works emerges from the Western and Australian countries, our study aims to investigate whether hyperlipidemia or lipid-lowering therapy (LLT) is associated with DPN in Taiwanese patients with type 2 diabetes (T2D).MethodsA cross-sectional, hospital-based observation study in adults with T2D was conducted from January to October 2013. DPN was screened using the Michigan Neuropathy Screening Instrument. Data were obtained at the time of enrollment, including medication usage, anthropometric measurements and laboratory examinations.Results2,448 participants were enrolled, 524 (21.4%) of whom had DPN. Patients with DPN had significantly lower plasma total cholesterol (185.6 ± 38.6 vs 193.4 ± 42.3 mg/dL) and low-density lipoprotein cholesterol levels (114.6 ± 32.7 vs 119 ± 30.8 mg/dL). Multivariate analysis demonstrated that neither hyperlipidemia (adjusted OR (aOR), 0.81; 95% confidence interval (CI), 0.49–1.34) nor LLT (aOR, 1.10; 95% CI, 0.58–2.09) was associated with DPN. Subgroup analysis revealed that neither total cholesterol (aOR, 0.72; 95% CI, 0.2–2.62), low-density lipoprotein cholesterol levels (aOR, 0.75; 95% CI, 0.2–2.79), statin (aOR, 1.09; 95% CI, 0.59–2.03) nor fibrate (aOR, 1.73; 95% CI, 0.33–1.61) was associated with DPN.ConclusionOur results suggest that neither hyperlipidemia nor lipid-lowering medication was associated with DPN in adults with T2D. DPN is a multifactorial disease, and our findings indicate that lipid metabolism may play a minor role in its pathogenesis.</div

Demographic characteristics of newly diagnosed PD patients, 2000–2010.

a<p>ANOVA test; chi-squared test for all other p-values.</p>b<p>Only patients with medication from outpatient services were analyzed.</p><p>Post hoc test (Scheffe’s test) with statistical significance (p<0.05):</p>c<p>LD only group differs from DA only group;</p>d<p>LD+DA group differs from DA only group;</p>e<p>LD+DA group differs from No-LD, No-DA group;</p>f<p>LD only group differs from No-LD, No-DA group;</p>g<p>DA only group differs from No-LD, No-DA group;</p>h<p>LD+DA group differs from LD only group.</p><p>*p<0.05 compared to LD only group;</p>#<p>p<0.05 compared to medical center group;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to day 0 group.</p><p>PD: Parkinson’s disease, N: case number, %: percentage, SD: standard deviation, NTD: New Taiwan Dollar.</p><p>Demographic characteristics of newly diagnosed PD patients, 2000–2010.</p

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to different classes of lipid-lowering drugs use.

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to different classes of lipid-lowering drugs use.</p

Table_1_Age-Stratified Risk of Dementia in Parkinson's Disease: A Nationwide, Population-Based, Retrospective Cohort Study in Taiwan.DOC

Introduction: Parkinson's disease (PD) manifests with dominant motor symptoms and a wide range of non-motor symptoms (NMS). Dementia is one of the most disabling and exhausting NMS throughout the clinical course. We conducted a population-based, age-stratified, retrospective cohort study to investigate the incidence rate and risk of dementia of patients with newly diagnosed PD, and linked to the clinicopathological PD subtypes.Methods: Patients with newly diagnosed PD (PD group, n = 760) and control subjects (non-PD group, n = 3,034) were selected from the Taiwan's National Health Insurance Research Database from January 2001 to December 2005. The dementia incidence rate and dementia-free survival rate were calculated.Results: The overall dementia incidence rate was 17.5 and 5.7 per 1,000 person-years in PD and non-PD groups, respectively. The PD group had a significantly higher overall risk of dementia than controls (p Conclusion: In our study, the older age of onset in PD patients resulted in a higher incidence rate of dementia. In the young age of PD patients, the incidence rate of dementia was lower than the older PD patients, but the dementia risk was higher than controls of the same age. These findings possibly implied that there were different pathogenesis and pathologies causing dementia in younger and older PD patients.</p

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to lipidemic status and lipid-lowering drug use condition.

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to lipidemic status and lipid-lowering drug use condition.</p

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to classification of lipid profiles.

Adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for DPN, according to classification of lipid profiles.</p

Flow chart of selection of PD patients.

<p>Flow chart of selection of PD patients.</p