Physical inactivity in Parkinson’s disease

Patients with Parkinson’s disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10–44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R2 = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD

Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients

<p>Abstract</p> <p>Background</p> <p>Many patients with Parkinson's disease (PD) lead a sedentary lifestyle. Promotion of physical activities may beneficially affect the clinical presentation of PD, and perhaps even modify the course of PD. However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity.</p> <p>Methods</p> <p>We developed the ParkFit Program: a PD-specific and multifaceted behavioral program to promote physical activity. The emphasis is on creating a behavioral change, using a combination of accepted behavioral motivation techniques. In addition, we designed a multicentre randomized clinical trial to investigate whether this ParkFit Program increases physical activity levels over two years in sedentary PD patients. We intended to include 700 sedentary patients. Primary endpoint is the time spent on physical activities per week, which will be measured every six months using an interview-based 7-day recall.</p> <p>Results</p> <p>In total 3453 PD patients were invited to participate. Ultimately, 586 patients - with a mean (SD) age of 64.1 (7.6) years and disease duration of 5.3 (4.5) years - entered the study. Study participants were younger, had a shorter disease duration and were less sedentary compared with eligible PD patients not willing to participate.</p> <p>Discussion</p> <p>The ParkFit trial is expected to yield important new evidence about behavioral interventions to promote physical activity in sedentary patients with PD. The results of the trial are expected in 2012.</p> <p>Trial registration</p> <p><url>http://clinicaltrials.gov</url> (nr NCT00748488).</p

Product relationships in rewriting Arabic numerals from written verbal numerals: a selective difficulty in aphasia

4nonenoneGRANA' A; MONDOLO F; DI BENEDETTO P; SEMENZA C.Grana', A; Mondolo, F; DI BENEDETTO, P; Semenza, Carl

Preserved and impaired task-switching abilities in non-demented patients with Parkinson's disease

Existing studies on task switching in Parkinson's disease (PD) patients have led to somewhat different results. In particular, it is unclear whether PD patients have a deficit in attentional control. In this study, we assessed task-switching abilities in samples of non-demented PD patients and elderly controls. We used a paradigm in which there was a random task sequence and the task was cued in every trial. This allowed the investigation of both task-set reconfiguration and task-set dissipation. In terms of the proportion of errors made, the patients showed increased switch cost and congruency effects. For reaction times, PD patients showed enlarged congruency effects on switch trials, specifically in the condition in which we used a short constant response-cue interval (RCI). Nevertheless, in a similar fashion to older controls, the patients showed reductions in reaction time switch cost from a short to a long cue-target interval (CTI) and from a short to a long RCI. While these latter findings, respectively, suggest unimpaired task preparation and task dissipation on correct trials in the PD patients, the overall results show that they have a deficit in biasing and selecting currently relevant task sets and more generally argue in favour of a failure of attentional control in P

Generalized anxiety disorder and the Hamilton Anxiety Rating Scale in Parkinson's disease Transtorno de ansiedade generalizada e a Escala de Ansiedade de Hamilton na doença de Parkinson

Anxiety is common in Parkinson's disease (PD), but studies concerning specific anxiety disorders are scarce. Essential psychometric properties of anxiety rating scales are also lacking. OBJECTIVE: To investigate general anxiety disorder (GAD) in PD and psychometric properties of the Hamilton Anxiety Rating Scale (Ham-A). METHOD: Ninety-one PD patients underwent neurological and psychiatric examination, which included the MINI-Plus, the Ham-A and the Hamilton Depression Rating Scale (Ham-D). RESULTS: GAD was present in 30.8% of PD patients. Patients with GAD had longer disease duration (p=0.044) and were in use of higher doses of levodopa (p=0.034). They also tended to have more motor fluctuations and dyskinesias. The group with GAD scored higher in Ham-A (p<0.001), in the somatic (p=0.004) and psychic (p<0.001) subscales of Ham-A, and in Ham-D (p=0.004). The Ham-A showed good internal consistency (Cronbach's alpha=0.893) and a cutoff score of 10/11 is suggested to screen for GAD. CONCLUSION: GAD is frequent in PD and the Ham-A may be a useful instrument to screen for this disorder.<br>Ansiedade é comum na doença de Parkinson (DP), mas estudos sobre transtornos de ansiedade específicos são ainda escassos. Faltam também estudos sobre propriedades psicométricas essenciais das escalas de ansiedade. OBJETIVO: Investigar o transtorno de ansiedade generalizada (TAG) na DP e propriedades psicométricas da Escala de Ansiedade de Hamilton (Ham-A). MÉTODO: Noventa e um pacientes com DP se submeteram a exames neurológico e psiquiátrico, que incluiu o MINI-Plus, a Ham-A e a Escala de Depressão de Hamilton (Ham-D). RESULTADOS: TAG esteve presente em 30,8% dos participantes. Pacientes com TAG tinham maior duração de doença (p=0,044) e estavam em uso de maiores doses de levodopa (p=0,034). Também havia uma tendência desses pacientes terem mais flutuações motoras e discinesias. O grupo com TAG pontuou mais alto na Ham-A (p<0,001), nas subescalas somática (p<0,001) e psíquica da Ham-A (p<0,001), e na Ham-D (p=0,004). A Ham-A mostrou boa consistência interna (alfa de Cronbach=0,893) e um ponto de corte de 10/11 é sugerido para triar o TAG. CONCLUSÃO: TAG é freqüente na DP e a Ham-A pode ser um instrumento útil para triar esse transtorno