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Frontiers in Aging Neuroscience 2024Parkinson's disease (PD) is a progressive neurodegenerative condition. Chinese medicine therapies have demonstrated effectiveness for PD in controlled settings. However,...
BACKGROUND
Parkinson's disease (PD) is a progressive neurodegenerative condition. Chinese medicine therapies have demonstrated effectiveness for PD in controlled settings. However, the utilization of Chinese medicine therapies for PD in real-world clinical practice and the characteristics of patients seeking these therapies have not been thoroughly summarized.
METHOD
The study retrospectively analyzed initial patient encounters (PEs) with a first-listed diagnosis of PD, based on electronic medical records from Guangdong Provincial Hospital of Chinese Medicine between July 2018 and July 2023.
RESULTS
A total of 3,206 PEs, each corresponding to an individual patient, were eligible for analyses. Approximately 60% of patients made initial visits to the Chinese medicine hospital after receiving a PD diagnosis, around 4.59 years after the onset of motor symptoms. Over 75% of the patients visited the Internal Medicine Outpatient Clinic at their initial visits, while a mere 13.85% visited PD Chronic Care Clinic. Rest tremor (61.98%) and bradykinesia (52.34%) are the most commonly reported motor symptoms, followed by rigidity (40.70%). The most commonly recorded non-motor symptoms included constipation (31.88%) and sleep disturbance (25.27%). Integration of Chinese medicine and conventional medicine therapies was the most common treatment method (39.15%), followed by single use of Chinese herbal medicine (27.14%). The most frequently prescribed herbs for PD included Fisch. (), Bunge (), Koidz. (), (Oliv.) Diels (), (Gaertn.) DC. (), Pall. (), DC. (), L. (/), C. A. Mey. (), and (Schw.) Wolf (). These herbs contribute to formulation of (BZYQT).
CONCLUSION
Patients typically initiated Chinese medical care after the establishment of PD diagnosis, ~4.59 years post-onset of motor symptoms. The prevalent utilization of CHM decoctions and patented Chinese herbal medicine products, underscores its potential in addressing both motor and non-motor symptoms. Despite available evidence, rigorous clinical trials are needed to validate and optimize the integration of CHM, particularly BZYQT, into therapeutic strategies for PD.
PubMed: 38756536
DOI: 10.3389/fnagi.2024.1362948 -
Tidsskrift For Den Norske Laegeforening... May 2024Parkinson's disease is characterised by the core motor symptoms: bradykinesia, rigidity and tremor. The disease also has a number of non-motor symptoms, such as visual... (Review)
Review
Parkinson's disease is characterised by the core motor symptoms: bradykinesia, rigidity and tremor. The disease also has a number of non-motor symptoms, such as visual impairment. Patients may experience blurred vision, sensitivity to light, difficulties in reading, and a subjective feeling of rapid eye fatigue. The visual impairments also affect the patients' motor skills, as vision compensates for poor postural control and difficulty initiating movement. It is important to identify common but frequently underdiagnosed visual impairment, and initiate measures that can increase quality of life and pattern of movement. In this clinical review we present the most common visual impairments in Parkinson's disease, as well as providing advice for improved visual function.
Topics: Humans; Parkinson Disease; Vision Disorders; Quality of Life
PubMed: 38747667
DOI: 10.4045/tidsskr.23.0716 -
Frontiers in Neuroscience 2024Parkinson's disease (PD) is characterized by three main motor symptoms: bradykinesia, rigidity and tremor. PD is also associated with diverse non-motor symptoms that may...
Parkinson's disease (PD) is characterized by three main motor symptoms: bradykinesia, rigidity and tremor. PD is also associated with diverse non-motor symptoms that may develop in parallel or precede motor dysfunctions, ranging from autonomic system dysfunctions and impaired sensory perception to cognitive deficits and depression. Here, we examine the role of the progressive loss of dopaminergic transmission in behaviors related to the non-motor symptoms of PD in a mouse model of the disease (the TIF-IA strain). We found that in the period from 5 to 12 weeks after the induction of a gradual loss of dopaminergic neurons, mild motor symptoms became detectable, including changes in the distance between paws while standing as well as the swing speed and step sequence. Male mutant mice showed no apparent changes in olfactory acuity, no anhedonia-like behaviors, and normal learning in an instrumental task; however, a pronounced increase in the number of operant responses performed was noted. Similarly, female mice with progressive dopaminergic neuron degeneration showed normal learning in the probabilistic reversal learning task and no loss of sweet-taste preference, but again, a robustly higher number of choices were performed in the task. In both males and females, the higher number of instrumental responses did not affect the accuracy or the fraction of rewarded responses. Taken together, these data reveal discrete, dopamine-dependent non-motor symptoms that emerge in the early stages of dopaminergic neuron degeneration.
PubMed: 38745938
DOI: 10.3389/fnins.2024.1375265 -
Cureus Apr 2024Despite being less commonly discussed than other motor symptoms such as tremors and bradykinesia, hypertonia of the hallux holds diagnostic and prognostic significance...
Despite being less commonly discussed than other motor symptoms such as tremors and bradykinesia, hypertonia of the hallux holds diagnostic and prognostic significance in Parkinson's disease (PD). This motor anomaly is dissected within the context of the broader clinical spectrum of PD symptoms, emphasizing its importance alongside its cardinal symptoms. This case report underscores the importance of accurate clinical assessment especially thorough neurological evaluation in discerning hallux hypertonia, potentially enabling early disease recognition and intervention. By synthesizing these clinical insights, we trust that this case report contributes to an enhanced understanding of hypertonia of the hallux as a distinctive clinical presentation in PD fostering improved diagnostic precision.
PubMed: 38741846
DOI: 10.7759/cureus.58203 -
Cureus Apr 2024A coronary artery aneurysm (CAA) is a localized dilatation of a coronary artery segment >1.5 times the diameter of the adjacent normal segment. CAA is more common in men...
A coronary artery aneurysm (CAA) is a localized dilatation of a coronary artery segment >1.5 times the diameter of the adjacent normal segment. CAA is more common in men than women and has multiple etiologies, including genetic causes, infections, and atherosclerotic diseases. Kawasaki disease is the most common cause of CAA in children, whereas atherosclerosis is the most common etiology in adults. We present the case of a male in his 30s who presented with sudden-onset chest pain and inferior ST segment elevation on an ECG. Echocardiography revealed preserved left ventricular function and mild hypokinesia. The patient underwent an emergency coronary angiogram that showed an ostial right CAA with thrombi. He was initially managed with a glycoprotein IIb/IIIa inhibitor tirofiban infusion, followed by triple therapy with aspirin, clopidogrel, and rivaroxaban. The patient underwent magnetic resonance imaging of his head, which was normal, and he did not attend outpatient computed tomography coronary angiography. The patient was discharged with lifelong rivaroxaban 20 mg once daily.
PubMed: 38741823
DOI: 10.7759/cureus.58063 -
Heliyon May 2024Parkinson's disease (PD) is an age-related neurodegenerative disorder characterized by motor deficits, including tremor, rigidity, bradykinesia, and postural...
Parkinson's disease (PD) is an age-related neurodegenerative disorder characterized by motor deficits, including tremor, rigidity, bradykinesia, and postural instability. According to the World Health Organization, about 1 % of the global population has been diagnosed with PD, and this figure is expected to double by 2040. Early and accurate diagnosis of PD is critical to slowing down the progression of the disease and reducing long-term disability. Due to the complexity of the disease, it is difficult to accurately diagnose it using traditional clinical tests. Therefore, it has become necessary to develop intelligent diagnostic models that can accurately detect PD. This article introduces a novel hybrid approach for accurate prediction of PD using an ANFIS with two optimizers, namely Adam and PSO. ANFIS is a type of fuzzy logic system used for nonlinear function approximation and classification, while Adam optimizer has the ability to adaptively adjust the learning rate of each individual parameter in an ANFIS at each training step, which helps the model find a better solution more quickly. PSO is a metaheuristic approach inspired by the behavior of social animals such as birds. Combining these two methods has potential to provide improved accuracy and robustness in PD diagnosis compared to existing methods. The proposed method utilized the advantages of both optimization techniques and applied them on the developed ANFIS model to maximize its prediction accuracy. This system was developed by using an open access clinical and demographic data. The chosen parameters for the ANFIS were selected through a comparative experimental analysis to optimize the model considering the number of fuzzy membership functions, number of epochs of ANFIS, and number of particles of PSO. The performance of the two ANFIS models: ANFIS (Adam) and ANFIS (PSO) focusing at ANFIS parameters and various evaluation metrics are further analyzed in detail and presented, The experimental results showed that the proposed ANFIS (PSO) shows better results in terms of loss and precision, whereas, the ANFIS (Adam) showed the better results in terms of accuracy, f1-score and recall. Thus, this adaptive neural-fuzzy algorithm provides a promising strategy for the diagnosis of PD, and show that the proposed models show their suitability for many other practical applications.
PubMed: 38720763
DOI: 10.1016/j.heliyon.2024.e30241 -
Frontiers in Neurology 2024This study reported a case of early-onset parkinsonism associated with a novel variant of the PLA2G6 gene. The boy first started showing symptoms at the age of 11, with...
This study reported a case of early-onset parkinsonism associated with a novel variant of the PLA2G6 gene. The boy first started showing symptoms at the age of 11, with gait instability and frequent falls. As the disease progressed, his gait instability worsened, and he developed difficulties with swallowing and speaking, although there was no apparent decline in cognitive function. An MRI of the head revealed significant atrophy of the cerebellum. The initial diagnosis for the boy was early-onset parkinsonism, classified as Hoehn-Yahr grade 5.Genomic sequencing of the patient indicated that he had compound heterozygous variations in the PLA2G6 gene: c.1454G>A (p.Gly485Glu) and c.991G>T (p.Asp331Tyr). Pedigree analysis revealed that his younger brother also carried the same variant, albeit with milder symptoms. The patient's unaffected mother was found to be a carrier of the c.991G>T variant. Additionally, this study reviewed 62 unrelated families with PLA2G6 gene-related early-onset parkinsonism. The analysis showed a higher proportion of female probands, with a mean age of onset of ~23.0 years. Primary symptoms were predominantly bradykinesia and psychosis, with tremors being relatively rare. Cerebellar atrophy was observed in 41 patients (66.1%). Among the reported mutations, the most common mutation was c.991G>T, presenting in 21 families (33.9%), followed by c.2222G>A in eight families (12.9%). Other mutations were less common. Notably, the c.991G>T mutation was exclusive to Chinese families and was a prevalent mutation among this population. The initial symptoms varied significantly among patients with different mutations.
PubMed: 38699051
DOI: 10.3389/fneur.2024.1349861 -
Journal of Medical Case Reports May 2024Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism... (Review)
Review
BACKGROUND
Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism can precipitate cardiac complications, including cardiac ischemia and myocardial infarction, although this has only been described in a few case reports.
CASE PRESENTATION
We present here a clinical scenario involving a 66-year-old male Caucasian patient under Amiodarone for atrial fibrillation, who developed AIT. In the presence of dyspnea, multiple cardiovascular risk factors and ECG abnormalities, a transthoracic echocardiogram was performed, showing inferobasal hypokinesia. This led to further investigations through a cardiac PET-CT, where cardiac ischemia was suspected. Ultimately, the coronary angiography revealed no abnormalities. Nonetheless, these extensive cardiologic investigations led to a delay in initiating an emergency endovascular revascularization for acute-on-chronic left limb ischemia. Although initial treatment using Carbimazole was not successful after three weeks, the patient reached euthyroidism after completion of the treatment with Prednisone so that eventually thyroidectomy was not performed. Endovascular revascularization was finally performed after more than one month.
CONCLUSIONS
We discuss here cardiac abnormalities in patients with AIT, which may be due to relative ischemia secondary to increased metabolic demand during hyperthyroidism. Improvement of cardiac complications is expected through an optimal AIT therapy including medical therapy as the primary approach and, when necessary, thyroidectomy. Cardiac investigations in the context of AIT should be carefully considered and may not justify delaying other crucial interventions. If considered mandatory, diagnostic procedures such as coronary angiography should be preferred to functional testing.
Topics: Humans; Amiodarone; Male; Aged; Anti-Arrhythmia Agents; Myocardial Ischemia; Atrial Fibrillation; Positron Emission Tomography Computed Tomography; Hyperthyroidism; Echocardiography
PubMed: 38698496
DOI: 10.1186/s13256-024-04552-w -
Neurology India Mar 2024A central role for apolipoprotein E (APOE) has been suggested in modulating processes of neurodegeneration.
BACKGROUND
A central role for apolipoprotein E (APOE) has been suggested in modulating processes of neurodegeneration.
OBJECTIVE
To study the association between serum APOE levels, APOE gene polymorphisms, and Parkinson's disease (PD).
MATERIAL AND METHODS
Fifty-five patients with PD and 30 healthy subjects were enrolled. PD patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr scale, and Schwab-England Activities of Daily Living scale. Serum APOE level and genotyping for APOE polymorphisms were done for PD patients and controls using enzyme-linked immunosorbent assay and polymerase chain reaction, respectively.
RESULTS
Mean serum APOE level was significantly higher in PD patients compared with healthy controls. APOE ε2/4 genotype was present in a significantly higher proportion of patients compared with controls. APOE ε4 allele was significantly associated with a higher score on the "mentation, behavior, and mood section" of UPDRS compared with ε2 allele. APOE ε2 allele was significantly associated with a shorter disease duration compared with ε3 and ε4 alleles. Mean serum APOE level was significantly higher in patients presenting predominantly by rigidity and bradykinesia compared with those presenting predominantly by tremors. Serum APOE level was positively correlated with mean scores of "mentation, behavior, and mood section" of UPDRS and disease duration. Serum APOE level was a significant predictor for the scores of "mentation, behavior, and mood section" of UPDRS.
CONCLUSION
APOE ε2/4 genotype might be a susceptibility variant for PD. There may be a possible role for APOE in modulating the process of neurodegeneration in PD.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Apolipoproteins E; Genetic Predisposition to Disease; Genotype; Parkinson Disease; Polymorphism, Genetic; Severity of Illness Index
PubMed: 38691476
DOI: 10.4103/ni.ni_940_21 -
Journal of Integrative Neuroscience Apr 2024Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for the motor symptoms of Parkinson's disease (PD). While PD is primarily...
BACKGROUND
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for the motor symptoms of Parkinson's disease (PD). While PD is primarily characterized by motor symptoms such as tremor, rigidity, and bradykinesia, it also involves a range of non-motor symptoms, and anxiety is one of the most common. The relationship between PD and anxiety is complex and can be a result of both pathological neural changes and the psychological and emotional impacts of living with a chronic progressive condition. Managing anxiety in PD is critical for improving the patients' quality of life. However, patients undergoing STN DBS can occasionally experience increased anxiety.
METHODS
This study investigates changes in risk-avoidant behavior following STN DBS in a pre-motor animal model of PD under chronic and acute unilateral high frequency stimulation.
RESULTS
No significant changes in risk-avoidant behaviors were observed in rats who underwent STN DBS compared with sham stimulation controls. Chronic stimulation prevented sensitization in the elevated zero maze.
CONCLUSIONS
These results suggest that unilateral stimulation of the STN may have minimal effects on risk-avoidant behaviors in PD. However, additional research is required to fully understand the mechanisms responsible for changes in anxiety during STN DBS for PD.
Topics: Subthalamic Nucleus; Deep Brain Stimulation; Animals; Oxidopamine; Male; Disease Models, Animal; Behavior, Animal; Parkinsonian Disorders; Anxiety; Rats; Rats, Sprague-Dawley; Avoidance Learning; Parkinson Disease
PubMed: 38682230
DOI: 10.31083/j.jin2304084