Personality and quality-of-life improvement after apomorphine infusion in Parkinson's disease

International audiencePeople with Parkinson’s disease with motor fluctuations can be treated by Continuous Subcutaneous Apomorphine Infusion (CSAI) to reduce their symptoms. Nonetheless, factors are lacking to predict patients’ quality-of-life amelioration after CSAI. This pilot study aimed to evaluate associations between personality dimensions and quality-of-life improvement after six months of CSAI. Thirty-nine people with Parkinson’s disease awaiting CSAI were included. Linear regression models between “Temperament and Character Inventory” personality dimensions at baseline and percentage of change in PDQ-39 (Parkinson’s Disease Questionnaire-39) scores after six months of CSAI were realized (n = 35). Temperament and Character Inventory was also compared between patients awaiting CSAI and patients awaiting deep brain stimulation of the sub-thalamic nucleus (n = 39 from the PREDI-STIM study). Higher Reward Dependence scores were associated with a better quality-of-life outcome after six months of CSAI, while Self-Directedness scores were associated with a better quality of life before CSAI (as opposed to Harm Avoidance, Reward Dependence, and Self-Transcendence scores associated with a worse quality of life). Moreover, people with Parkinson’s disease awaiting deep brain stimulation of the sub-thalamic nucleus had similar Temperament and Character Inventory dimensions compared to patients awaiting CSAI. People with Parkinson’s disease with higher Reward Dependence scores at baseline had the best quality-of-life improvement after six months of CSAI. This finding could be used to better prepare and accompany people with Parkinson’s disease during CSAI establishment. Moreover, this result could serve as an orientation factor to second-line treatments

Could personality predict Non-Motor Fluctuations improvement after Deep Brain Stimulation in Parkinson's disease patients?

Objective: to investigate associations between personality dimensions and NMFs and the improvement of NMFs following two types of treatments

Dopaminergic denervation using [123I]-FPCIT and pain in Parkinson’s disease: a correlation study

International audienceIn patients with Parkinson's disease (PD), abnormal activations of nociceptive brain areas and lowered pain thresholds were reported, probably reflecting a central modification of pain processing. The aim of this study was to investigate the possible correlation between the striatal and extrastriatal dopaminergic system and pain threshold in PD patients. We included 25 PD patients with various intensities of central pain (visual analog scale). Subjective pain threshold (thermotest) and a motor examination (UPDRS III) were performed. Patients underwent SPECT imaging with [123I]-FP-CIT. We analyzed the correlation between [123I]-FP-CIT binding and subjective pain threshold, using a simple linear regression model for striatal uptake and a voxel-based approach for extrastriatal uptake. The covariables were age, sex, duration of PD, and UPDRS motor score. A pain matrix mask was also used to identify clusters in relation with pain matrix. Striatal analysis revealed that [123I]-FP-CIT binding was negatively correlated with age (p = 0.02), duration of PD (p = 0.0002) and UPDRS motor score (p = 0.006), but no correlation with pain threshold was observed. The extrastriatal analysis showed a positive correlation between [123I]-FP-CIT binding and subjective heat pain threshold for the left posterior cingulate cortex (PCC) (p < 0.001) and negative correlations for the right secondary visual cortex (p < 0.001) and left insula (p < 0.001). When applying the pain matrix mask, correlations remained significant only in the left PCC and the left insula. We suggest that pain perception abnormalities in PD are not directly related to striatal dopaminergic dysfunction. Painful sensations may be related to extrastriatal monoaminergic systems

La personnalité impacte l’amélioration de la qualité de vie des patients parkinsoniens après stimulation cérébrale profonde

International audienceContexte : La maladie de Parkinson altère fortement la Qualité de Vie (QdV) des patientsparticulièrement au stade des fluctuations motrices1 où un traitement chirurgical parStimulation Cérébrale Profonde des Noyaux Sous-Thalamiques (SCP-NST) peut être proposé.Face à l’incomplète satisfaction de certains patients3, l’objectif de notre étude est d’évaluerl’association entre les dimensions de personnalité et l’amélioration de la QdV de patientsparkinsoniens après un an de SCP-NST.Méthode : Les données proviennent de la cohorte française PREDI-STIM incluant des patientsparkinsoniens traités par SCP-NST. Tous les participants (n=303) ont répondu auxquestionnaires suivants : le Temperament and Character Inventory (TCI)4 uniquement avant lastimulation, et le PDQ- 39 (Parkinson Disease Questionnaire-39) avant et un an après la SCP.Les analyses ont été faites en utilisant des modèles de régression linéaire univariés ajustéspour évaluer une potentielle association entre les dimensions de personnalité du TCI et lespourcentages d’évolution des scores de QdV duPDQ-39.Résultats attendus : Les dimensions de Recherche de la Nouveauté, de Fatigabilité (une sousdimension de l’Evitement du Danger) et de Coopérativité étaient associés à une meilleureévolution de la QdV des patients après la SCP-NST (p&lt;0.01).Discussion : La Recherche de la Nouveauté, la Fatigabilité et la Coopérativité sont associéesà une plus forte amélioration de QdV chez les patients parkinsoniens après un an de SCPNST. Desprogrammes spécifiques d’éducation thérapeutique travaillant sur ces dimensionsde personnalité (acceptation de la nouveauté, écoute de l’entourage etc.) pourraient alorsêtre proposés aux patientsen amont de la SCP pour améliorer leur satisfaction postopératoire

Could personality predict Non-Motor Fluctuations improvement after Deep Brain Stimulation in Parkinson's disease patients?

Objective: to investigate associations between personality dimensions and NMFs and the improvement of NMFs following two types of treatments

Atelier d’éducation thérapeutique centré sur le médicament dans la maladie de Parkinson : quel impact sur la représentation du médicament ?

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Parkinsonian central pain is linked to the connectivity of the nucleus accumbens and the anterior insula

International audiencePain is a frequent and disabling non-motor symptom of Parkinson’s Disease (PD). Yet, no treatment to date can efficiently reduce this pain. This article investigates the brain functional connectivity of PD patients with central pain and the effects of levodopa and oxycodone on this connectivity.Thirty-eight PD patients received either levodopa, oxycodone, or a placebo during an eight-week period. Pain intensity was evaluated using the Visual Analogue Scale and resting-state functional connectivity was measured before and after treatments. PD patients were also separated into two groups: responders and non-responders.At baseline, the intensity of pain was correlated with the connectivity between the anterior insula and the posterior cingulate cortex and between the nucleus accumbens, the brainstem, and the hippocampus. Levodopa and oxycodone had no specific effects on functional connectivity. Responders had a decrease in connectivity between the anterior insula and the posterior cingulate cortex, while non-responders showed an increase in connectivity.The correlation between pain intensity and specific brain connectivity may represent a “hyper-awareness” of pain and a distortion of learning and memory systems in PD patients with central pain, leading to a state of chronic pain. The placebo effect could explain the changes in connectivity that are associated with a potential reduction in pain awareness

Oxycodone or Higher Dose of Levodopa for the Treatment of Parkinsonian Central Pain: OXYDOPA Trial

International audienceBackground: Among the different types of pain related to Parkinson's disease (PD), parkinsonian central pain (PCP) is the most disabling. Objectives We investigated the analgesic efficacy of two therapeutic strategies (opioid with oxycodone‐ prolonged‐release (PR) and higher dose of levodopa/benserazide) compared with placebo in patients with PCP.Methods: OXYDOPA was a randomized, double‐blind, double‐dummy, placebo‐controlled, multicenter parallel‐group trial run at 15 centers within the French NS‐Park network. PD patients with PCP (≥30 on the Visual Analogue Scale [VAS]) were randomly assigned to receive oxycodone‐PR (up to 40 mg/day), levodopa/benserazide (up to 200 mg/day) or matching placebo three times a day (tid) for 8 weeks at a stable dose, in add‐on to their current dopaminergic therapy. The primary endpoint was the change in average pain intensity over the previous week rated on VAS from baseline to week‐10 based on modified intention‐to‐treat analyses.Results: Between May 2016 and August 2020, 66 patients were randomized to oxycodone‐PR (n = 23), levodopa/benserazide (n = 20) or placebo (n = 23). The mean change in pain intensity was −17 ± 18.5 on oxycodone‐PR, −8.3 ± 11.1 on levodopa/benserazide, and −14.3 ± 18.9 in the placebo groups. The absolute difference versus placebo was −1.54 (97.5% confidence interval [CI], −17.0 to 13.90; P = 0.8) on oxycodone‐PR and +7.79 (97.5% CI, −4.99 to 20.58; P = 0.2) on levodopa/benserazide. Similar proportions of patients in each group experienced all‐cause adverse events. Those leading to study discontinuation were most frequently observed with oxycodone‐PR (39%) than levodopa/benserazide (5%) or placebo (15%).Conclusions: The present trial failed to demonstrate the superiority of oxycodone‐PR or a higher dose of levodopa in patients with PCP, while oxycodone‐PR was poorly tolerated. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Personality dimensions are associated with quality of life in fluctuating Parkinson's disease patients (PSYCHO-STIM)

International audienceBackground:Parkinson’s disease (PD) negatively affects patients’ Quality of Life (QoL) which depends on both objective criteria such as physical health and subjective ones such as worries and norms according to personal believes. Therefore, QoL could be also associated to personality dimensions in chronic neurological diseases such as PD. Objective:Our objective was thus to study the potential association between personality dimensions and QoL in PD patients with motor fluctuations before Deep Brain Stimulation of the Sub-Thalamic Nucleus (DBS-STN). Methods:Data were obtained from the French multicentric cohort study Predi-Stim. All PD patients awaiting DBS-STN and responding to the inclusion criteria at the time of the study were included. All participants answered the “Temperament and Character Inventory” (TCI) and the PDQ-39 before surgery. Analyses were made using adjusted univariate generalized linear regression models to evaluate a potential association between TCI dimensions and PDQ-39 scores. Results:Three hundred thirty-three consecutive patients were included. The temperament Harm Avoidance was negatively associated with QoL (p = 1e-4, R2= 0.33), whereas the character Self-Directedness was positively associated with mental component of QoL (p = 2e-4, R2= 0.33) in PD patients with motor fluctuations awaiting DBS-STN. Conclusions:PD patients with motor fluctuations, with lower Harm Avoidance and higher Self-Directedness scores have the best QoL mainly at an emotional and social level. Therapeutic education of these PD patients focusing on their personal resources may thus be important to improve their well-being

Personality Assessment with Temperament and Character Inventory in Parkinson's Disease.

International audienceINTRODUCTION: There is a growing interest in personality evaluation in Parkinson's disease (PD), following observations of specific temperaments in PD patients. Therefore, our objective was to evaluate personality dimensions from the Temperament and Character Inventory (TCI) in a cohort of fluctuating PD patients considered for deep brain stimulation. METHODS: Fluctuating PD patients from the PREDISTIM cohort were included. Description of TCI dimensions and comparison with a French normative cohort were performed. Pearson correlations between TCI dimensions and motor, behavioral and cognitive variables were investigated. Structural and internal consistency analysis of the TCI were further assessed. RESULTS: The 570 PD patients presented significant higher scores in Harm Avoidance, Reward Dependence, Persistence, Self-Directedness and Cooperativeness and significant lower scores in Self-Transcendence compared to the French normative cohort; only Novelty Seeking scores were not different. Harm Avoidance and Self-directedness scores were correlated with PDQ-39 total, HAMD, HAMA scores, and anxiolytic/antidepressant treatment. Novelty Seeking scores were correlated with impulsivity. Pearson correlations between TCI dimensions, principal component analysis of TCI sub-dimensions and Cronbach's alpha coefficients showed adequate psychometric proprieties. CONCLUSION: The TCI seems to be an adequate tool to evaluate personality dimensions in PD with good structural and internal consistencies. These fluctuating PD patients also have specific personality dimensions compared to normative French population. Moreover, Harm Avoidance and Self-Directedness scores are associated with anxio-depressive state or quality of life and, and Novelty Seeking scores with impulsivity