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The Lancet. Healthy Longevity Jul 2024Parkinson's disease is the second most common neurodegenerative disorder, exhibiting an upward trend in prevalence. We aimed to investigate the prevalence of Parkinson's... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Parkinson's disease is the second most common neurodegenerative disorder, exhibiting an upward trend in prevalence. We aimed to investigate the prevalence of Parkinson's disease, temporal trends between 1980 and 2023, and variations in prevalence by location, age, sex, survey period, sociodemographic index (SDI), human development index (HDI), and study characteristics (sample size, diagnostic criteria, and data source).
METHODS
In this systematic review and meta-analysis we searched PubMed, Cochrane, Web of Science, Embase, Scopus, and Global Health for observational studies that reported Parkinson's disease prevalence in the general population from database inception to Nov 1, 2023. We included studies if they were original observational investigations, had participants from the general population or community-based datasets, and provided numerical data on the prevalence of Parkinson's disease either with 95% CIs or with sufficient information to calculate 95% CIs. Studies were excluded if they were conducted in a specific population, had a sample size smaller than 1000, or were review articles, case reports, protocols, meeting abstracts, letters, comments, short communications, posters, and reports. The publication characteristics (first author and publication year), study location (countries, WHO regions, SDI, and HDI), survey period, study design, diagnostic criteria, data source, participant information, and prevalence data were extracted from articles using a standard form. Two authors independently evaluated eligibility, and discrepancies were resolved through discussion with the third author. We used random effect models to pool estimates with 95% CIs. Estimated annual percentage change (EAPC) was calculated to assess the temporal trend in prevalence of Parkinson's disease. The study was registered with PROSPERO, CRD42022364417.
FINDINGS
83 studies from 37 countries were eligible for analysis, with 56 studies providing all-age prevalence, 53 studies reporting age-specific prevalence, and 26 studies providing both all-age and age-specific prevalence. Global pooled prevalence of Parkinson's disease was 1·51 cases per 1000 (95% CI 1·19-1·88), which was higher in males (1·54 cases per 1000 [1·17-1·96]) than in females (1·49 cases per 1000 [1·12-1·92], p=0·030). During different survey periods, the prevalence of Parkinson's disease was 0·90 cases per 1000 (0·48-1·44; 1980-89), 1·38 cases per 1000 (1·17-1·61; 1990-99), 1·18 cases per 1000 (0·77-1·67; 2000-09), and 3·81 cases per 1000 (2·67-5·14; 2010-23). The EAPC of Parkinson's disease prevalence was significantly higher in the period of 2004-23 (EAPC 16·32% [95% CI 6·07-26·58], p=0·0040) than in the period of 1980-2003 (5·30% [0·82-9·79], p=0·022). Statistically significant disparities in prevalence were observed across six WHO regions. Prevalence increased with HDI or SDI. Considerable variations were observed in the pooled prevalence of Parkinson's disease based on different sample sizes or diagnostic criteria. Prevalence also increased with age, reaching 9·34 cases per 1000 (7·26-11·67) among individuals older than 60 years.
INTERPRETATION
The global prevalence of Parkinson's disease has been increasing since the 1980s, with a more pronounced rise in the past two decades. The prevalence of Parkinson's disease is higher in countries with higher HDI or SDI. It is necessary to conduct more high-quality epidemiological studies on Parkinson's disease, especially in low SDI countries.
FUNDING
National Nature Science Foundation of China.
TRANSLATION
For the Chinese translation of the abstract see Supplementary Materials section.
Topics: Parkinson Disease; Humans; Prevalence; Female; Male; Global Health
PubMed: 38945129
DOI: 10.1016/S2666-7568(24)00094-1 -
Pediatric Neurology Jun 2024Trihexyphenidyl and clonazepam are commonly used to treat dystonia in children with cerebral palsy (CP). However, there is a notable gap in the literature when it comes...
Efficacy of Oral Trihexyphenidyl Plus Clonazepam Versus Trihexyphenidyl for the Treatment of Dystonia in Children With Dystonic Cerebral Palsy: An Open-Label Randomized Controlled Trial.
BACKGROUND
Trihexyphenidyl and clonazepam are commonly used to treat dystonia in children with cerebral palsy (CP). However, there is a notable gap in the literature when it comes to studies that combine these first-line agents for the management of dystonia.
METHODS
This open-label, randomized controlled trial aimed to compare the efficacy of adding oral clonazepam to trihexyphenidyl (THP + CLZ) versus using trihexyphenidyl alone (THP) in reducing the severity of dystonia, as measured by the Barry-Albright Dystonia (BAD) score. The study was conducted over a 12-week therapy period in children with dystonic CP aged two to 14 years.
RESULTS
Each group enrolled 51 participants. The THP + CLZ group showed significantly better improvement in dystonia severity at 12 weeks compared with the THP group alone (-4.5 ± 2.9 vs -3.4 ± 1.7, P = 0.02). Furthermore, the THP + CLZ group exhibited superior improvement in the severity of choreoathetosis, upper limb function, pain perception by the child, and quality of life, with P values of 0.02, 0.009, 0.01, and 0.01, respectively. The number of participants experiencing treatment-emergent adverse events was comparable in both groups (P = 0.67). Importantly, none of the participants in any of the groups reported any serious adverse events.
CONCLUSION
A combination of oral THP + CLZ proves to be more efficacious than using THP alone for the treatment of dystonic CP in children aged two to 14 years in terms of reducing the severity of dystonia.
PubMed: 38945037
DOI: 10.1016/j.pediatrneurol.2024.06.004 -
Mymensingh Medical Journal : MMJ Jul 2024Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease with unknown etiology. Some previous studies suggest that elevated serum homocysteine level...
Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease with unknown etiology. Some previous studies suggest that elevated serum homocysteine level is a risk factor for stroke, ischemic heart disease; atherosclerosis and neurodegenerative diseases like Parkinson's disease. Serum homocysteine level relates with Parkinson's disease through various mechanisms including gene defect, apoptosis, oxidative stress and DNA damage. Some recent studies reveal that serum homocysteine level is elevated in Parkinson's disease patient compared to healthy individuals. This study was aimed to compare the serum homocysteine level in Parkinson's disease patients and age and sex matched apparently healthy individuals. This was a case control study which was conducted in Department of Neurology and Medicine, Mymensingh Medical College Hospital, Mymensingh during November 2019 to April 2021. Total 55 cases of Parkinson's disease patients and age and sex matched 55 apparently healthy controls were enrolled in this study. Demographics and clinical data were collected using structured case record form and adopting purposive type of sampling method. Serum homocysteine level was measured in both case and control groups. The study reveals that, average age of the patients and control group was in sixth decade. Male predominance was found with male to female ratio was 1.5:1 in case group. Both groups showed almost similar demographic profiles. Twenty-nine (52.72%) patients of Parkinson's disease observed higher serum homocysteine level in contrast to only 8(14.54%) in control group. The mean serum homocysteine ±SD was 15.43±6.04μmol/L in case group and 10.04±5.31μmol/L in control group; the difference was statistically significant (p=0.001). Mean serum homocysteine levels were measured progressively higher with increased duration and advanced stages of disease. It was concluded that, serum homocysteine level is higher in Parkinson's disease patients than normal healthy individuals. In addition, there was significant positive correlation of elevated serum homocysteine with increased duration of Parkinson's disease and advanced stages of the disease.
Topics: Humans; Homocysteine; Parkinson Disease; Male; Female; Case-Control Studies; Middle Aged; Aged; Adult; Risk Factors
PubMed: 38944701
DOI: No ID Found -
Current Biology : CB Jun 2024Psychiatric disorders with dysfunction of the lateral habenula (LHb) show sleep disturbance, especially a disinhibition of rapid eye movement (REM) sleep in major...
Psychiatric disorders with dysfunction of the lateral habenula (LHb) show sleep disturbance, especially a disinhibition of rapid eye movement (REM) sleep in major depression. However, the role of LHb in physiological sleep control and how LHb contributes to sleep disturbance in major depression remain elusive. Here, we found that functional manipulations of LHb glutamatergic neurons bidirectionally modulated both non-REM (NREM) sleep and REM sleep. Activity recording revealed heterogeneous activity patterns of LHb neurons across sleep/wakefulness cycles, but LHb neurons were preferentially active during REM sleep. Using an activity-dependent tagging method, we selectively labeled a population of REM sleep-active LHb neurons and demonstrated that these neurons specifically promoted REM sleep. Neural circuit studies showed that LHb neurons regulated REM sleep via projections to the ventral tegmental area but not to the rostromedial tegmental nucleus. Furthermore, we found that the increased REM sleep in a depression mouse model was associated with a potentiation of REM sleep-active LHb neurons, including an increased proportion, elevated spike firing, and altered activity mode. Importantly, inhibition of REM sleep-active LHb neurons not only attenuated the increased REM sleep but also alleviated depressive-like behaviors in a depression mouse model. Thus, our results demonstrated that REM sleep-active LHb neurons selectively promoted REM sleep, and a potentiation of these neurons contributed to depression-associated sleep disturbance.
PubMed: 38944036
DOI: 10.1016/j.cub.2024.05.075 -
Clinical Neurology and Neurosurgery Jun 2024Parkinson's disease (PD) is the second most prevalent neurodegenerative condition after Alzheimer's disease and it represents one of the fastest emerging neurological... (Review)
Review
Parkinson's disease (PD) is the second most prevalent neurodegenerative condition after Alzheimer's disease and it represents one of the fastest emerging neurological diseases worldwide. PD is usually diagnosed after the third decade of life with symptoms like tremors at rest and muscle stiffness. Rapid Eye Movement sleep behavioral disorder (RBD) is another disorder that is caused by a loss of typical muscle relaxation during sleep with a lot of motor activity. Usually, RBD is strongly associated with PD. Recent studies have demonstrated that PD reduces the life expectancy of patients to 10 and 20 years after being diagnosed. In addition, delayed diagnosis and treatment of these neurological disorders have significant socio-economic impacts on patients, their partners and on the general public. Often, it is not clear about PD associated financial burdens both in low and high-income countries. On the other hand, PD triggers neurological variations that affect differences in the dopamine transporter (DAT) and in glucose metabolism. Therefore, positron emission tomography (PET) using specific DAT radiotracers and fluorine-18 labeled desoxyglucose (FDG) has being considered a key imaging technique that could be applied clinically for the very early diagnosis of RBD and in PD. However, a few myths about PET is that it is very expensive. Here, we looked at the cost of treatment of PD and RBD in relation to early PET imaging. Our finding suggests that PET imaging might also be a cost sparing diagnostic option in the management of patients with PD and RBD, not only for first world countries as it is the case now but also for the third world countries. Therefore, PET is a cost-effective imaging technique for very early diagnostic of RBD and PD.
PubMed: 38944021
DOI: 10.1016/j.clineuro.2024.108404 -
NeuroRehabilitation 2024Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural... (Review)
Review
BACKGROUND
Parkinson's disease (PD) is a progressive neurodegenerative disorder diagnosed by motor symptoms of bradykinesia, in combination with tremor, rigidity, or postural instability. Many studies document the effects of exercise-based interventions, but the benefit of different exercise types remains unclear.
OBJECTIVE
To provide a commentary on the Cochrane Review by Ernst et al. on the effectiveness of different types of physical exercise regarding motor signs, Quality of Life (QoL), and the occurrence of adverse events.
METHODS
A systematic search was performed in CENTRAL, MEDLINE, Embase, and other databases. The search was performed also in trial registries, conference proceedings, and reference list of identified studies.
RESULTS
The review included 154 RCTs (with 7837 participants). The network meta-analyses (NMAs) on the severity of motor signs and QoL included data from 60 (2721 participants) and 48 (3029 participants) trials, respectively. The evidence from the NMA suggests that dance, gait/balance/functional training probably have a moderate beneficial effect on the severity of motor signs, and multi-domain training probably has a small beneficial effect on the severity of motor signs. Endurance, aqua-based, strength/resistance, and mind-body training might have a small beneficial effect on the severity of motor signs. In addition, aqua-based training probably has a large beneficial effect on QoL, and mind-body, gait/balance/functional, and multi-domain training and dance might have a small beneficial effect on QoL.
CONCLUSIONS
Current evidence supports the promotion of physical exercise among people with PD, identifying only small differences between exercises in influencing the severity of motor signs and QoL.
Topics: Humans; Parkinson Disease; Quality of Life; Exercise Therapy
PubMed: 38943407
DOI: 10.3233/NRE-246004 -
NeuroRehabilitation 2024Although clinical machine learning (ML) algorithms offer promising potential in forecasting optimal stroke rehabilitation outcomes, their specific capacity to ascertain...
BACKGROUND
Although clinical machine learning (ML) algorithms offer promising potential in forecasting optimal stroke rehabilitation outcomes, their specific capacity to ascertain favorable outcomes and identify responders to robotic-assisted gait training (RAGT) in individuals with hemiparetic stroke undergoing such intervention remains unexplored.
OBJECTIVE
We aimed to determine the best predictive model based on the international classification of functioning impairment domain features (Fugl- Meyer assessment (FMA), Modified Barthel index related-gait scale (MBI), Berg balance scale (BBS)) and reveal their responsiveness to robotic assisted gait training (RAGT) in patients with subacute stroke.
METHODS
Data from 187 people with subacute stroke who underwent a 12-week Walkbot RAGT intervention were obtained and analyzed. Overall, 18 potential predictors encompassed demographic characteristics and the baseline score of functional and structural features. Five predictive ML models, including decision tree, random forest, eXtreme Gradient Boosting, light gradient boosting machine, and categorical boosting, were used.
RESULTS
The initial and final BBS, initial BBS, final Modified Ashworth scale, and initial MBI scores were important features, predicting functional improvements. eXtreme Gradient Boosting demonstrated superior performance compared to other models in predicting functional recovery after RAGT in patients with subacute stroke.
CONCLUSION
eXtreme Gradient Boosting may be an invaluable prognostic tool, providing clinicians and caregivers with a robust framework to make precise clinical decisions regarding the identification of optimal responders and effectively pinpoint those who are most likely to derive maximum benefits from RAGT interventions.
Topics: Humans; Stroke Rehabilitation; Machine Learning; Female; Male; Middle Aged; Aged; Gait Disorders, Neurologic; Robotics; Exoskeleton Device; Stroke; Recovery of Function; Adult; Prognosis; Outcome Assessment, Health Care; Exercise Therapy; Gait
PubMed: 38943406
DOI: 10.3233/NRE-240070 -
Journal of Parkinson's Disease Jun 2024
PubMed: 38943399
DOI: 10.3233/JPD-249006 -
Journal of Parkinson's Disease Jun 2024Natural health products have emerged as a potential symptomatic therapeutic approach for people with Parkinson's disease (PD).
BACKGROUND
Natural health products have emerged as a potential symptomatic therapeutic approach for people with Parkinson's disease (PD).
OBJECTIVE
To determine the prevalence of natural health product use, interest in natural health products, awareness of potential herb-drug interactions, and consultation of healthcare professionals regarding natural health products use among people with PD.
METHODS
Cross-sectional 4-item survey embedded in the PRIME-NL study, which is a population-based cohort of PD.
RESULTS
Of 367 people with PD, 36% reported having used natural health products to alleviate PD-related symptoms, with coffee, cannabis and turmeric being the most popular. Furthermore, 71% of people with PD were interested in learning more about natural health products. 39% of natural health products users were aware that these products could interact with PD medication and 39% had discussed their use with their healthcare professional.
CONCLUSIONS
Natural health products are commonly used to alleviate symptoms by people with PD, but most users are unaware that these products can interact with PD medication and do not discuss their consumption with their healthcare professional.
PubMed: 38943398
DOI: 10.3233/JPD-240102 -
Movement Disorders Clinical Practice Jun 2024Primary mitochondrial diseases (PMDs) are the most common inborn errors of energy metabolism, with a combined prevalence of 1 in 4300. They can result from mutations in... (Review)
Review
BACKGROUND
Primary mitochondrial diseases (PMDs) are the most common inborn errors of energy metabolism, with a combined prevalence of 1 in 4300. They can result from mutations in either nuclear DNA (nDNA) or mitochondrial DNA (mtDNA). These disorders are multisystemic and mainly affect high energy-demanding tissues, such as muscle and the central nervous system (CNS). Among many clinical features of CNS involvement, parkinsonism is one of the most common movement disorders in PMDs.
METHODS
This review provides a pragmatic educational overview of the most recent advances in the field of mitochondrial parkinsonism, from pathophysiology and genetic etiologies to phenotype and diagnosis.
RESULTS
mtDNA maintenance and mitochondrial dynamics alterations represent the principal mechanisms underlying mitochondrial parkinsonism. It can be present in isolation, alongside other movement disorders or, more commonly, as part of a multisystemic phenotype. Mutations in several nuclear-encoded genes (ie, POLG, TWNK, SPG7, and OPA1) and, more rarely, mtDNA mutations, are responsible for mitochondrial parkinsonism. Progressive external opthalmoplegia and optic atrophy may guide genetic etiology identification.
CONCLUSION
A comprehensive deep-phenotyping approach is needed to reach a diagnosis of mitochondrial parkinsonism, which lacks distinctive clinical features and exemplifies the intricate genotype-phenotype interplay of PMDs.
PubMed: 38943319
DOI: 10.1002/mdc3.14148