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

Flow chart of selection of PD patients.

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

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

Medication of non-retention patients between 6 and 12 months after starting treatment.

<p>Chi-squared test for p-values;</p><p>*p<0.05 compared to initial medication - LD only group;</p>#<p>p<0.05 compared to initial medication - DA only group;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to initial medication – LD+DA group; N: case number, %: percentage.</p><p>Medication of non-retention patients between 6 and 12 months after starting treatment.</p

Trends of initial pharmacotherapies in different age groups between 2000–2005 and 2006–2010.

<p>(Compared by chi-squared test) (<b>A1</b>) ≤40 years-old, 2000–2005, (<b>A2</b>) ≤40 years-old, 2006–2010 (p = 0.643), (<b>B1</b>) 41–64 years-old, 2000–2005, (<b>B2</b>) 41–64 years-old, 2006–2010 (p = 0.042), (<b>C1</b>) ≥65 years-old, 2000–2005, (<b>C2</b>) ≥65 years-old, 2006–2010 (p = 0.099).</p

Initial medication choice in patients with newly diagnosed Parkinson’s disease according to prescribing doctor, 2000–2010.

<p>Chi-squared test for p-values;</p><p>*p<0.05 compared to LD only group;</p>#<p>p<0.05 compared to neurologist of medical center group.</p><p>N: case number, %: percentage.</p><p>Initial medication choice in patients with newly diagnosed Parkinson’s disease according to prescribing doctor, 2000–2010.</p

Initial medication choice in patients with newly diagnosed Parkinson’s disease according to age, 2000–2010.

<p>Chi-squared test for p-values.</p><p>* p<0.05 compared to LD only group;</p>#<p>p<0.05 compared to age≤40 years old;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to 41–64 years old group.</p><p>N: case number, %: percentage.</p><p>Initial medication choice in patients with newly diagnosed Parkinson’s disease according to age, 2000–2010.</p

Table_1_Altered Functional Connectivity and Sensory Processing in Blepharospasm and Hemifacial Spasm: Coexistence and Difference.DOCX

Background: Blepharospasm (BSP) and hemifacial spasm (HFS) are both facial hyperkinesia however BSP is thought to be caused by maladaptation in multiple brain regions in contrast to the peripherally induced cause in HFS. Plausible coexisting pathophysiologies between these two distinct diseases have been proposed.Objectives: In this study, we compared brain resting state functional connectivity (rsFC) and quantitative thermal test (QTT) results between patients with BSP, HFS and heathy controls (HCs).Methods: This study enrolled 12 patients with BSP, 11 patients with HFS, and 15 HCs. All subjects received serial neuropsychiatric evaluations, questionnaires determining disease severity and functional impairment, QTT, and resting state functional MRI. Image data were acquired using seed-based analyses using the CONN toolbox.Results: A higher cold detection threshold was found in the BSP and HFS patients compared to the HCs. The BSP and HFS patients had higher rsFC between the anterior cerebellum network and left occipital regions compared to the HCs. In all subjects, impaired cold detection threshold in the QTT of lower extremities had a correlation with higher rsFC between the anterior cerebellar network and left lingual gyrus. Compared to the HCs, increased rsFC in right postcentral gyrus in the BSP patients and decreased rsFC in the right amygdala and frontal orbital cortex in the HFS subjects were revealed when the anterior cerebellar network was used as seed.Conclusions: Dysfunction of sensory processing detected by the QTT is found in the BSP and HSP patients. Altered functional connectivity between the anterior cerebellar network and left occipital region, especially the Brodmann area 19, may indicate the possibility of shared pathophysiology among BSP, HFS, and impaired cold detection threshold. Further large-scale longitudinal study is needed for testing this theory in the future.</p

Table_1_The greatest loss of unpleasant smells may be related to the risk of more severe PD symptoms.docx

BackgroundLimited research has explored the relationship between the valence of olfactory dysfunction and PD clinical symptoms. This study aimed to investigate correlations between the emotional valence of olfactory impairment and different domains of PD symptoms.MethodsPD patients who fulfilled the clinically probable PD diagnostic criteria of the International Parkinson and Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s Disease were recruited from the Center for Parkinson and Movement Disorders at Taichung Veterans General Hospital between October 2016 and April 2022. Demographic data and serial clinical assessments were collected, including the traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC) and Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Thirty-five odors from the UPSIT-TC were classified into neutral, pleasant or unpleasant groups. Group comparisons, correlation analyses, and linear regression analyses were conducted to examine the relationship between olfactory impairment of UPSIT-TC odors, considering emotional valence, and MDS-UPDRS subscores across various domains.ResultsA total of 176 PD patients were recruited for analysis. Patients in the predominantly neutral/unpleasant odor impairment groups had higher MDS-UPDRS part III scores compared to those in the predominantly pleasant odor impairment group (pleasant vs. neutral vs. unpleasant odor impairment groups: 26.79 ± 13.59 vs. 35.33 ± 16.36 vs. 31.57 ± 12.37, p = 0.009). This trend was also noted in MDS-UPDRS rigidity, bradykinesia, and akinetic-rigid subscores (p = 0.003, p = 0.012, and p = 0.001, respectively). Correlation analysis revealed a weak but significant correlation between rigidity/akinetic-rigid subscores and misidentification numbers for neutral/unpleasant odors (all p ConclusionOur results emphasize the link between olfactory impairment of specific emotional valence, neutral/unpleasant odors, and PD severity, particularly with respect to akinetic-rigid symptoms. A concise olfactory test that focuses on both neutral and unpleasant odors may offer deeper insights into PD symptoms.</p