Imaging Parkinson\u27s Disease: Gray Matter Atrophy Associated With Motor Dysfunction

Parkinson’s disease (PD) is a progressive neurodegenerative disorder with common symptoms including rigidity, tremors, and bradykinesia. While current medication can alleviate symptoms, no treatment exists to stop or slow neuronal cell death and disease progression. There is an unmet need for a biomarker associated with progression that could aide in development of treatments by monitoring disease progression. Since Magnetic Resonance Imaging (MRI) allows for the measure of gray matter (GM) density in the human brain noninvasively, this study was designed to investigate the association between brain atrophy, measured by MRI, and motor dysfunction in PD subjects, as a biomarker. MRI and voxel-based morphometry methods were used to investigate GM atrophy and the association with motor impairment in 43 PD and 59 control subjects. T1-weighted whole-brain MRI images were acquired in collaborative studies in Germany and at Indiana University on 3T MRI scanners. Group differences in GM density between PD and control subjects were examined voxel by voxel with SPM12 using cluster-corrected two-sample t-tests. Among PD subjects, associations of GM density with motor dysfunction (measured by UPDRS- III) were analyzed by multiple regression. Compared to controls, PD subjects show significant GM atrophy in the supplementary motor cortex (p \u3c 0.005). This is a critical brain region, linking cognition to action. Among PD subjects, there is a significant association (p \u3c 0.001) of GM atrophy with motor dysfunction (high UPDRS-III) bilaterally in the superior parietal lobules of the motor cortex. These findings agree with the hypothesis that motor dysfunction is associated with GM atrophy in the motor cortex, and that imaging GM density by MRI is a good display of neurodegenerative progression in PD

IMPROVING END-OF-LIFE CARE FOR PATIENTSWITH IDIOPATHIC PULMONARY FIBROSIS AND THEIR CARE PARTNERS

Palliative care is increasingly recognized as relevant to the care of advanced disease in a variety of settings. Idiopathic pulmonary fibrosis (IPF) results in scarring of the lung, respiratory failure and, commonly, death within 3-5 years of diagnosis. The purpose of this study was to evaluate the impact of a 6-week program designed using palliative care concepts (PRISIM) on symptom burden and health-related quality of life (HRQoL) in patients with IPF and their care partners. Subjects were 42 participants randomized to an experimental (10 patients/care partners) or control (11 patients/care partners) group. The experimental group attended the 6-week PRISIM program and the control group received usual care. Prior to and immediately after attending the program, all participants completed questionnaires designed to assess anxiety, depression, perceived stress, and HRQoL. Participation in PRISIM decreased perceptions of physical HRQoL and tended to increase anxiety. Nevertheless, post course evaluations were highly positive. Post study qualitative interviews with experimental group participants yielded three common themes that reached saturation: "patients did not feel isolated", were "able to put their disease into perspective", and felt it "important to participate in research and help others". Palliative interventions may increase anxiety but appear to yield other positive effects. Further exploration of the impact of such interventions is needed using both qualitative and quantitative methodology