Diagnostic accuracy of glabellar tap sign for Parkinson's disease

Glabellar tap or reflex (GR) is an old bedside clinical test used in the diagnostics of Parkinson's disease (PD), but its diagnostic value is unclear. This study examines the diagnostic validity and reliability of GR in PD in relation to brain dopaminergic activity. GR was performed on 161 patients with PD, 47 patients with essential tremor (ET) and 40 healthy controls immediately prior to dopamine transporter (DAT) [I-123]FP-CIT SPECT scanning. The binding ratios were investigated with consideration of the GR result (normal/abnormal). In addition, the consistency of the GR was investigated with 89 patients after a mean follow-up of 2.2 years. PD and ET patients had higher GR scores than healthy controls (p 0.36). Over follow-up, the GR changed from abnormal to normal in 20% of PD patients despite the presence of clinically typical disease. The sensitivity and specificity of GR for differentiating PD from ET were 78.3% and 36.2%, respectively. Although GR has been used by clinicians in the diagnostics of PD, it does not separate PD from ET. It also shows considerable inconsistency over time, and abnormal GR has no relationship with dopamine loss. Its usefulness should be tested for other clinical diagnostic purposes.Peer reviewe

Gastrointestinal Symptoms and Dopamine Transporter Asymmetry in Early Parkinson's Disease

Background The neurophysiological correlates of gastrointestinal symptoms (GISs) in Parkinson's disease (PD) are not well understood. It has been proposed that in patients with a gastrointestinal origin of PD dopaminergic neurodegeneration would be more symmetric. Objectives The aim is to assess the associations between GISs and asymmetry of nigrostriatal dopaminergic neurodegeneration in PD. Methods Ninety PD patients were assessed using motor and GIS scales and I-123-FP-CIT SPECT. We calculated the asymmetry index and the predominant side of motor symptoms and dopamine transporter (DAT) imaging defect and assessed their association with GISs. Results There were no significant differences in GISs between symmetric and asymmetric dopaminergic defect. Left predominant defect was related to more GIS and higher constipation scores. Conclusions GISs were associated with left predominant reduction in putaminal DAT binding but not asymmetry per se. It remains open whether left-sided DAT deficit is related to more pronounced GI involvement or symptom perception in PD. (c) 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.Peer reviewe

Diagnostic value of micrographia in Parkinson's disease : a study with [I-123]FP-CIT SPECT

Micrographia is a common symptom of Parkinson's disease (PD), and it may precede other motor symptoms. Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [I-123]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET, p = 0.002, and 27.2% smaller area of handwriting compared to healthy controls, p = 0.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median b = - 0.14 in PD, b = - 0.06 in ET, p = 0.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [I-123]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD. ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).Peer reviewe

Fecal microbiome alterations in treatment-naive de novo Parkinson's disease

Gut microbiota alterations in Parkinson's disease (PD) have been found in several studies and are suggested to contribute to the pathogenesis of PD. However, previous results could not be adequately adjusted for a potential confounding effect of PD medication and disease duration, as almost all PD participants were already using dopaminergic medication and were included several years after diagnosis. Here, the gut microbiome composition of treatment-naive de novo PD subjects was assessed compared to healthy controls (HC) in two large independent case-control cohorts (n = 136 and 56 PD, n = 85 and 87 HC), using 16S-sequencing of fecal samples. Relevant variables such as technical batches, diet and constipation were assessed for their potential effects. Overall gut microbiome composition differed between PD and HC in both cohorts, suggesting gut microbiome alterations are already present in de novo PD subjects at the time of diagnosis, without the possible confounding effect of dopaminergic medication. Although no differentially abundant taxon could be replicated in both cohorts, multiple short chain fatty acids (SCFA) producing taxa were decreased in PD in both cohorts. In particular, several taxa belonging to the family Lachnospiraceae were decreased in abundance. Fewer taxonomic differences were found compared to previous studies, indicating smaller effect sizes in de novo PD.Peer reviewe

Gastrointestinal Symptoms and Dopamine Transporter Asymmetry in Early Parkinson's Disease

Background: The neurophysiological correlates of gastrointestinal symptoms (GISs) in Parkinson's disease (PD) are not well understood. It has been proposed that in patients with a gastrointestinal origin of PD dopaminergic neurodegeneration would be more symmetric.Objectives: The aim is to assess the associations between GISs and asymmetry of nigrostriatal dopaminergic neurodegeneration in PD.Methods: Ninety PD patients were assessed using motor and GIS scales and 123 I-FP-CIT SPECT. We calculated the asymmetry index and the predominant side of motor symptoms and dopamine transporter (DAT) imaging defect and assessed their association with GISs.Results: There were no significant differences in GISs between symmetric and asymmetric dopaminergic defect. Left predominant defect was related to more GIS and higher constipation scores.Conclusions: GISs were associated with left predominant reduction in putaminal DAT binding but not asymmetry per se. It remains open whether left-sided DAT deficit is related to more pronounced GI involvement or symptom perception in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.</p

Diagnostic accuracy of glabellar tap sign for Parkinson's disease

Glabellar tap or reflex (GR) is an old bedside clinical test used in the diagnostics of Parkinson's disease (PD), but its diagnostic value is unclear. This study examines the diagnostic validity and reliability of GR in PD in relation to brain dopaminergic activity. GR was performed on 161 patients with PD, 47 patients with essential tremor (ET) and 40 healthy controls immediately prior to dopamine transporter (DAT) [123I]FP-CIT SPECT scanning. The binding ratios were investigated with consideration of the GR result (normal/abnormal). In addition, the consistency of the GR was investigated with 89 patients after a mean follow-up of 2.2 years. PD and ET patients had higher GR scores than healthy controls (p p = 0.09). There were no differences in the ratio of abnormal to normal GRs between the PD and ET groups (73% vs. 64% abnormal, respectively, p = 0.13) or in DAT binding between PD patients with abnormal and normal GRs (p > 0.36). Over follow-up, the GR changed from abnormal to normal in 20% of PD patients despite the presence of clinically typical disease. The sensitivity and specificity of GR for differentiating PD from ET were 78.3% and 36.2%, respectively. Although GR has been used by clinicians in the diagnostics of PD, it does not separate PD from ET. It also shows considerable inconsistency over time, and abnormal GR has no relationship with dopamine loss. Its usefulness should be tested for other clinical diagnostic purposes.</p

Diagnostic value of micrographia in Parkinson's disease: a study with [I-123]FP-CIT SPECT

Micrographia is a common symptom of Parkinson's disease (PD), and it may precede other motor symptoms. Despite the high prevalence of micrographia in PD, its neurobiological mechanisms are not known. Given that levodopa may alleviate consistent micrographia and that nondopaminergic essential tremor (ET) is not associated with micrographia, micrographia could possibly be used as an ancillary diagnostic method that reflects nigrostriatal dopamine function. We evaluated the usefulness of micrographia as a simple one-sentence writing test in differentiating PD from ET. A total of 146 PD patients, 42 ET patients and 38 healthy controls provided writing samples and were scanned with brain [123I]FP-CIT dopamine transporter (DAT) SPECT imaging with ROI-based and voxelwise analyses. The diagnostic accuracy of micrographia was evaluated and compared to that of DAT binding. Compared to ET and healthy controls, PD patients showed micrographia (consistent, 25.6% smaller area of handwriting sample in PD compared to ET, p = 0.002, and 27.2% smaller area of handwriting compared to healthy controls, p = 0.004). PD patients showed 133% more severe progressive micrographia compared with ET patients (median b = - 0.14 in PD, b = - 0.06 in ET, p = 0.021). In early unmedicated cognitively normal patients, consistent micrographia showed 71.2% specificity and 87.5% sensitivity in PD versus ET differentiation, but micrographia had no correlation with striatal or extrastriatal [123I]FP-CIT binding in patients with PD. The one-sentence micrographia test shows moderately good accuracy in PD versus ET differentiation. The severity of micrographia has no relationship with DAT binding, suggesting nondopaminergic mechanism of micrographia in PD. ClinicalTrials.gov identifier: NCT02650843 (NMDAT study).</p

Fecal microbiome alterations in treatment-naive de novo Parkinson's disease

Gut microbiota alterations in Parkinson's disease (PD) have been found in several studies and are suggested to contribute to the pathogenesis of PD. However, previous results could not be adequately adjusted for a potential confounding effect of PD medication and disease duration, as almost all PD participants were already using dopaminergic medication and were included several years after diagnosis. Here, the gut microbiome composition of treatment-naive de novo PD subjects was assessed compared to healthy controls (HC) in two large independent case-control cohorts (n = 136 and 56 PD, n = 85 and 87 HC), using 16S-sequencing of fecal samples. Relevant variables such as technical batches, diet and constipation were assessed for their potential effects. Overall gut microbiome composition differed between PD and HC in both cohorts, suggesting gut microbiome alterations are already present in de novo PD subjects at the time of diagnosis, without the possible confounding effect of dopaminergic medication. Although no differentially abundant taxon could be replicated in both cohorts, multiple short chain fatty acids (SCFA) producing taxa were decreased in PD in both cohorts. In particular, several taxa belonging to the family Lachnospiraceae were decreased in abundance. Fewer taxonomic differences were found compared to previous studies, indicating smaller effect sizes in de novo PD.</p

Kuntoutujalähtöisyys fysioterapian palvelupalautteessa : kuunnellaanko minua?

Opinnäytetyö oli osa laajempaa PAFY (Palvelupalautteen kehittäminen fysioterapiassa - Fysioterapian potilaskertomuksen laadun arviointi) tutkimus- ja kehittämishanketta. Opinnäytetyön tarkoituksena on kehittää toimintatapoja kuntoutujalähtöisemmän kirjaamisen kehittämiseksi. Opinnäytetyön tavoitteena on selvittää, miten kuntoutujalähtöisyys näkyy fysioterapian palvelupalautteissa aineiston hankinta-ajankohtana, syksyllä 2010. Lisäksi opinnäytetyön tavoitteena on lisätä tietoisuutta kuntoutujalähtöisyyden tärkeydestä kuntoutuksessa ja kirjaamisessa. Tavoitteena on myös laatia kirjaamisen kehittämissuunnitelmat vuodelle 2013 Keski-Suomen sairaanhoitopiirin fysiatrian vastuuyksikön ja Päijät-Hämeen sosiaali- ja terveysyhtymän fysiatrian tulosalueen käyttöön. Opinnäytetyön lähestymistapana oli toimintatutkimus. Opinnäytetyö jakautui tutkimukselliseen ja kehittämisen osioihin. Tutkimuksellisen osion analyysimenetelmäksi valittiin sisällönanalyysi. Aineisto oli koottu kahden erikoissairaanhoidon organisaation, Keski-Suomen sairaanhoitopiirin ja Päijät-Hämeen sosiaali- ja terveysyhtymän fysioterapiahenkilöstön tekemistä 223 fysioterapian palvelupalautteesta. Tutkimustulokseksi tuli, että kuntoutujalähtöisyys näkyi vähäisesti ja riittämättömästi. Ilmaisuja kuntoutujalähtöisyydestä esiintyi vain 37 % kaikista palautteista. Fysioterapeutit käyttivät kirjaamisessa pääasiassa terapiakeskeistä dokumentointia, kuvaamalla oireita, toiminnan vajetta, toimintakykyä tai annettuja ohjeita. Yhtenä osana kehittämishanketta toteutettiin kehittämispäivä yhdessä Keski-Suomen sairaanhoitopiirin fysiatrian vastuuyksikön ja Päijät-Hämeen sosiaali- ja terveysyhtymän fysiatrian tulosalueen työntekijöiden kanssa. Kehittämispäivän teemana oli lisätä tietoisuutta kuntoutujalähtöisyydestä ja pohtia toimintatapoja kirjaamisen kehittämiseksi. Kehittämishankkeen tuloksena saatiin organisaatiokohtaiset kehittämissuunnitelmat vuodelle 2013 kuntoutujalähtöisemmän kirjaamisen kehittämiseksi.This thesis was part of a larger PAFY (the development of physiotherapy feedback) research and development project. The purpose of this thesis was to develop a course of action in physiotherapy documentation so that rehabilitee-oriented perspective should be featured more prominently in physiotherapy feedback. The aim was to find out how rehabilitee-oriented perspective appears in physiotherapy feedback during data collection in the autumn of 2010. In addition, the aim was to raise awareness of the importance of rehabilitee-oriented perspective in rehabilitation and documentation and to get development plans on how to develop rehabilitee-oriented perspective in rehabilitation and documentation in 2013. This thesis was divided into research section and development section. We chose content analysis for analysis method of the research section. Data were collected in two specialized organizations, Päijät-Häme Social and Health Care Group and Central Finland Health Care District. The data consisted of 223 pieces of physiotherapy feedback. According to the results of this thesis the rehabilitee-oriented perspective appears slightly and insufficiently in physiotherapy feedback. The terms rehabilitee-oriented rehabilitation occurred in only 37% of all the feedback. Physiotherapists used mainly therapy essential documentation, describing the symptoms, functional disorders, performance or by describing the given instructions. The approach of the development project was an action research. The development day, which was a part of development project carried out together with employees from Päijät-Häme Social and Health Care Group and Central Finland Health Care District. The theme of the day was to raise awareness of the importance of rehabilitee-oriented perspective in rehabilitation and documentation and discuss development course of action in physiotherapy documentation. As a result of the development project we got development plans for each organization on how to develop rehabilitee-oriented perspective in rehabilitation and documentation in 2013

Floating door sign does not differentiate Parkinson’s disease from essential tremor

Diagnostic usefulness of the floating door sign was tested in 144 PD patients, 41 essential tremor patients and 38 controls. There were no differences in the presence of floating door sign between PD and ET patients. The sign does not seem to be a reliable differential diagnostic tool