Paradigm shift in Parkinson's disease: using continuous telemonitoring to improve symptoms control. Results from a 2-years journey

IntroductionConventional care in Parkinson's disease (PD) faces limitations due to the significant time and location commitments needed for regular assessments, lacking quantitative measurements. Telemonitoring offers clinicians an opportunity to evaluate patient symptomatology throughout the day during activities of daily living.MethodsThe progression of PD symptoms over a two-year period was investigated in patients undergoing traditional evaluation, supplemented by insights from ambulatory measurements. Physicians integrated a telemonitoring device, the PDMonitor®, into daily practice, using it for informed medication adjustments.ResultsStatistical analyses examining intra-subject changes for 17 subjects revealed a significant relative decrease of −43.9% in the device-reported percentage of time spent in “OFF” state (from 36.2 to 20.3%). Following the 24-month period, the majority of the subjects improved or exhibited stable symptom manifestation. In addition to positively impacting motor symptom control, telemonitoring was found to enhance patient satisfaction about their condition, medication effectiveness, and communication with physicians.DiscussionConsidering that motor function is significantly worsened over time in patients with PD, these findings suggest a positive impact of objective telemonitoring on symptoms control. Patient satisfaction regarding disease management through telemonitoring can potentially improve adherence to treatment plans. In conclusion, remote continuous monitoring paves the way for a paradigm shift in PD, focusing on actively managing and potentially improve symptoms control

Foot Pressure Wearable Sensors for Freezing of Gait Detection in Parkinson’s Disease

Freezing of Gait (FoG) is a common symptom in Parkinson's Disease (PD) occurring with significant variability and severity and is associated with increased risk of falls. FoG detection in everyday life is not trivial, particularly in patients manifesting the symptom only in specific conditions. Various wearable devices have been proposed to detect PD symptoms, primarily based on inertial sensors. We here report the results of the validation of a novel system based on a pair of pressure insoles equipped with a 3D accelerometer to detect FoG episodes. Twenty PD patients attended a motor assessment protocol organized into eight multiple video recorded sessions, both in clinical and ecological settings and both in the ON and OFF state. We compared the FoG episodes detected using the processed data gathered from the insoles with those tagged by a clinician on video recordings. The algorithm correctly detected 90% of the episodes. The false positive rate was 6% and the false negative rate 4%. The algorithm reliably detects freezing of gait in clinical settings while performing ecological tasks. This result is promising for freezing of gait detection in everyday life via wearable instrumented insoles that can be integrated into a more complex system for comprehensive motor symptom monitoring in PD

Neuropharmacology and functional anatomy of the basal ganglia

The most extensively used test for the investigation of neostriatal dopaminergic function is the rotating rat model. During the past several years however it has become apparent that the neostriatum is not an homogeneous structure. Thus in order to investigate regional differences within striatum concerning asymmetric locomotor behaviours, rats with unilateral, total, dorsal or ventral ibotenic acid induced striatal lesions were challenged systematically with various DA and GABA related drugs. In rats with total lesions DA drugs induced an intense ipsilateral rotation, but rats bearing lesions of the dorsal or ventral striatum exhibited different patterns of rotational behaviour. These differences were largely attributed to the distinct topographic localisation of the two major striatal efferent systems within the striatum. It is well established that intrastriatal dopaminergic activity is mediated through the GABAergic striatal efferents projecting mainly to subtantia nigra zona reticulata and globus pallidus. In subsequent experiments local intracaudate injections of the GABA agonist muscimol or the GABA antagonist picrotoxin in d-amp treated rate also revealed differences between dorsal and ventral striatum, pointing out a complex interaction between DA receptor subtypes and GABAergic striatal efferents. It is widely accepted that both D1 and D2 dopamine receptors play a role in dopaminergic activity in the basal ganglia. In an attempt to relate the observed differences to the two DA receptor subtypes we examined the topography of D1- and D2- mediated rotation following localised intrastriatal injections of selective DA related drugs. The results showed that D1 receptors mediate rotation only in ventral striatum, while D2 receptors in both striatal regions. Thus it could be postulated that the two DA receptors may relate to differential striatal efferents. In order to clarify the issue, rats bearing a unilateral lesion of the globus pallidus or the subtantia nigra zona reticulata, received intrastriatal injections of D1- or D2- selective drugs, or the GABA agonist muscimol. The results revealed that globus pallidus is essential for the expression of D2-mediated rotation elicited in the dorsal striatum, while subtantia nigra is essential for the expression of D1-mediated rotation elicited in the ventral striatum. On the basis of these results, it is suggested that the neostriatum can be subdivided into a ventral, limbic-afferented region and a dorsal non-limbic region which give rise to different output lines; the ventral sector projecting (through D1-receptor activation) to subtantia nigra, and the dorsal portion mainly projecting (through D2-receptor activation) to globus pallidus. Finally, the possible clinical use of the new D1- and D2- selective drugs is examined.Στην εργασία αυτή μελετήσαμε την νευροφαρμακολογία και λειτουργική ανατομία των συνδέσεων του νεοραβδωτού σώματος με άλλα τμήματα των βασικών γαγγλίων σε σχέση με την εσωτερική του δομή και οργάνωση. Σαν πειραματικό μοντέλο χρησιμοποιήθηκε αυτό της συμπεριφοράς περιστροφής του επίμυος. Έτσι, σε ζώα με βλάβη στο ραχιαίο ή στο κοιλιακό ραβδωτό με ιβοτενικό οξύ, η συστηματική χορήγηση των DΑεργικών αγωνιστών απομορφίνη και αμφεταμίνη, όπως επίσης η χορήγηση GABΑεργικών και οπιούχων φαρμάκων, προκάλεσε περιστροφή διαφορετικής κατεύθυνσης ανάλογα με την εντόπιση της βλάβης. Ο κύριος εκφραστής της DAεργικής δραστηριότητας στα βασικά γάγγλια είναι το GABA. Έτσι στα επόμενα πειράματα, η κατευθείαν ενδεγκεφαλική χορήγηση του GΑΒΑεργικού αγωνιστή μουσκιμόλη ή του αγωνιστή του GABA πικροτοξίνη, σε ζώα που έπαιρναν συστηματικά αμφεταμίνη αποκάλυψε επίσης διαφορετική περιστροφή στο ραχιαίο και στο κοιλιακό ραβδωτό. Αποδείχθηκε έτσι, μια λειτουργική διαφοροποίηση του ραβδωτού σε ραχιαίους και κοιλιακούς μηχανισμούς ελέγχου της κινητικής συμμετρίας και συμπεριφοράς που αντανακλούν την διαφορετικήν εντόπιση των δύο κύριων GΑΒΑεργικών οδών εξόδου από το ραβδωτό: προς την ωχρά σφαίρα και την μέλαινα ουσία. Η ύπαρξη στο ΚΝΣ δύο τύπων υποδοχέων DA είναι πια καλά τεκμηριωμένη. Για να μελετήσουμε το ρόλο κάθε τύπου υποδοχέα και τη σχέση τους με τη διαφοροποίηση του ραβδωτού που περιγράφτηκε προηγουμένως, μελετήσαμε τη συμπεριφορά περιστροφής μετά από ενδοραβδωτή χορήγηση εκλεκτικών D1- και D2- ανταγωνιστώ ν (σουλπιρίδη και SCH23390 αντίστοιχα) σε ζώα που διεγείρονταν συστηματικά με απομορφίνη. Τα αποτελέσματα έδειξαν ότι οι D2-υποδοχείς μεσολαβούν την συμπεριφορά περιστροφής τόσο στο ραχιαίο όσο και στο κοιλιακό ραβδωτό, ενώ οι D1- υποδοχείς μόνο στο κοιλιακό ραβδωτό. Στη συνέχεια για την πληρέστερη μελέτη του θέματος, οι ενδοραβδωτές εγχύσεις των εκλεκτικών D1- και D2- φαρμάκων, αλλά και του GΑΒΑεργικού αγωνιστή μουσκιμόλη επαναλήφθηκαν σε ζώα όμως, που έφεραν μια ετερόπλευρη βλάβη στην ωχρά σφαίρα ή την μέλαινα ουσία. Τα αποτελέσματα έδειξαν ότι η ωχρά σφαίρα είναι απαραίτητη για την έκφραση της D2-δραστηριότητας που εκπορεύεται από το ραχιαίο ραβδωτό, ενώ η μέλαινα ουσία είναι απαραίτητη χια την έκφραση της D1- δραστηριότητας που πηγάζει από το κοιλιακό ραβδωτό. Τέλος, η συστηματική χορήγηση αμφεταμίνης προκάλεσε ομόπλευρη περιστροφή στα ζώα με βλάβη της ωχράς σφαίρας αλλά αντίπλευρη σ' αυτά με βλάβη της μέλαινας ουσίας, γεγονός που επιβεβαιώνει το διαφορετικό τρόπο με τον οποίο οι δύο αυτοί πυρήνες εκφράζουν την DΑερχική δραστηριότητα στα βασικά γάγγλια. Τα ευρήματα της μελέτης μας λοιπόν, υποδεικνύουν μια λειτουργική διαφοροποίηση του ραβδωτού σε ένα ραχιαίο τμήμα που δέχεται προσαγωγή νεύρωση από τον κινητικό φλοιό, σχετίζεται με D2-δραστηριότητα και προβάλει στην ωχρά σφαίρα και ένα κοιλιακό τμήμα που δέχεται προσαγωγή νεύρωση από το μεταιχμιακό σύστημα, σχετίζεται κυρίως με D1-δραστηριότητα και προβάλει στην δικτυωτή ζώνη της μέλαινας ουσίας. Τα αποτελέσματα αυτά συζητούνται διεξοδικά, προτείνονται πιθανά νευρωνικά κυκλώματα μέσω των οποίων εκφράζονται και τέλος διερευνάται η πιθανή κλινική χρήση των νέων εκλεκτικών φαρμάκων gια τους D1- και D2- υποδοχείς ντοπαμίνης

Action naming deficits in Parkinson’s disease: the role of semantic complexity

Background: Previous studies have suggested that individuals with Parkinson’s disease (PD) have difficulty retrieving verbs and nouns. Among the factors that have been proposed to contribute to this verb retrieval difficulty is the semantic properties of the verbs. Aims: The aim of this study was to investigate the verb and noun naming abilities in Greek speaking individuals with PD. Furthermore, the effect of semantic complexity on verb retrieval ability was explored. Specifically, two verb categories were investigated mainly, instrumental verbs as semantically heavy and non-instrumental verbs that are considered semantically light verbs. Methods and Procedures: Participants were 24 non-demented individuals with PD matched for age and education with 15 healthy control participants. Word retrieval abilities for nouns and verbs were evaluated using the Greek Object and Action Test (GOAT), a picture-based assessment of single word retrieval. Outcomes and Results: The results revealed that participants with PD performed significantly worse on naming verbs and nouns compared to healthy controls. Specifically, the PD group had a greater difficulty in retrieving verbs compared to nouns. In addition, a positive effect of instrumentality on verb retrieval abilities was observed. Conclusion: The results of this study suggest that semantic complexity may play a critical role in verb retrieval abilities in PD. Furthermore, verbs related to upper limb movement with the inclusion of instrumental verbs may have a facilitatory effect on lexical retrieval. This finding emphasizes the need for the inclusion of the evaluation of different verb categories for naming during the initial clinical assessment of cognitive-linguistic abilities of patients with PD

Configurable Offline Sensor Placement Identification for a Medical Device Monitoring Parkinson’s Disease

Sensor placement identification in body sensor networks is an important feature, which could render such a system more robust, transparent to the user, and easy to wear for long term data collection. It can be considered an active measure to avoid the misuse of a sensing system, specifically as these platforms become more ubiquitous and, apart from their research orientation, start to enter industries, such as fitness and health. In this work we discuss the offline, fixed class, sensor placement identification method implemented in PDMonitor®, a medical device for long-term Parkinson’s disease monitoring at home. We analyze the stepwise procedure used to accurately identify the wearables depending on how many are used, from two to five, given five predefined body positions. Finally, we present the results of evaluating the method in 88 subjects, 61 Parkinson’s disease patients and 27 healthy subjects, when the overall average accuracy reached 99.1%

Feasibility of an mHealth closed-loop system for the optimization of Parkinson's disease treatment

<p>In this work we present the design of a treatment management system for Parkinson's disease (PD). The system is based on patient and device reported outcomes that combined with patient's health record data provide recommendations to treating physicians. The recommendations are based on a twolevel system. In the first level patient data are incorporated in a clinical decision support system (CDSS) which provides a number of treatment alternatives based on expert rules and evidencebased guidelines. The second level is based on Pharmacokinetic and Pharmacodynamic (PK/PD) models enabling the evaluation of the expected benefit of each recommendation. The main components and requirements of the specific system are discussed and a real life example supporting its potential is presented.</p&gt

The validation of abbreviate mental test score (AMTS) in Greek patients with Alzheimer’s disease and related dementia's suffering from communication deficits. [Abstract]

16th Congress of the European Federation of Neurological Societies, Stockholm – Sweden, 8 – 11 September 2012

Early diagnosis of dementia in Parkinson’s disease patients using subtests of the Arizona Battery of Communication Disorders Dementia (A.B.C.D.). [Abstract]

11th International Conference on Alzheimer’s and Parkinson’s Diseases, 6 – 10 March, 2013

2nd Pilot study of Arizona Battery For Communication Disorders Of Dementia in Greek Language. [Abstract]

8th International Congress on Vascular Dementia – ICVD 2013, which will be held in Athens, Greece, October 17-20, 201