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dementia, falls, incontinence, parkinson

Shahid Mukhtar, Rashid Imran, Mohsin Zaheer, Huma Tariq
OBJECTIVE: To determine the frequency of non-motor symptoms (NMS) in patients of Parkinson's disease (PD) presenting to a movement disorder clinic at a tertiary care centre in Pakistan, and how frequency of NMS is different in male and female patients. STUDY DESIGN: Observational, cross-sectional study. SETTING: Tertiary care centre. PARTICIPANTS: Out of 102 patients, 85 were included. Inclusion criteria were patients with PD diagnosed according to the UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria, age ≥18 years, able to give consent and have no difficulty in answering questions...
May 16, 2018: BMJ Open
Gregory S Day, Tae Sung Lim, Jason Hassenstab, Alison M Goate, Elizabeth A Grant, Catherine M Roe, Nigel J Cairns, John C Morris
OBJECTIVE: To identify clinical features that reliably differentiate individuals with cognitive impairment due to corticobasal degeneration (CBD) and Alzheimer disease (AD). METHODS: Clinical features were compared between individuals with autopsy-proven CBD (n = 17) and AD (n = 16). All individuals presented with prominent cognitive complaints and were evaluated annually with semistructured interviews, detailed neurologic examinations, and neuropsychological testing...
March 28, 2017: Neurology
Davide L Vetrano, Andrea D Foebel, Alessandra Marengoni, Vincenzo Brandi, Agnese Collamati, George A Heckman, John Hirdes, Roberto Bernabei, Graziano Onder
BACKGROUND: Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province. METHODS: Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC...
January 2016: European Journal of Internal Medicine
Thiago Cardoso Vale, Paulo Caramelli, Francisco Cardoso
OBJECTIVE: To compare the clinical and radiological features of vascular parkinsonism (VP) and Parkinson's disease (PD). METHODS: Cross-sectional study where 15 patients with VP (8 (53.3%) men; aged 75.7 ± 10.4 years) and 30 patients with PD (17 (56.7%) men; aged 67.3 ± 7.5 years) underwent motor and cognitive evaluation and brain MRI. RESULTS: Patients with VP were, on average, 8.4 years older (p = 0.004); all had arterial hypertension...
May 2015: Journal of Neurology, Neurosurgery, and Psychiatry
Thiago Cardoso Vale, Paulo Caramelli, Francisco Cardoso
OBJECTIVE: To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). METHODS: Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. RESULTS: All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88...
October 2013: Arquivos de Neuro-psiquiatria
Kajsa Stubendorff, Dag Aarsland, Lennart Minthon, Elisabet Londos
INTRODUCTION: Autonomic dysfunction is a well-known feature in neurodegenerative dementias, especially common in α-synucleinopathies like dementia with Lewy bodies and Parkinson's disease with dementia. The most common symptoms are orthostatic hypotension, incontinence and constipation, but its relevance in clinical practice is poorly understood. There are no earlier studies addressing the influence of autonomic dysfunction on clinical course and survival. The aim of this study was to investigate the frequency of the three most common features of autonomic dysfunction and analyze how it affects survival...
2012: PloS One
Philip George Glass, Andrew J Lees, Aroldo Bacellar, Jan Zijlmans, Regina Katzenschlager, Laura Silveira-Moriyama
OBJECTIVE: To evaluate in detail the clinical features in a large series of pathologically confirmed cases of vascular Parkinsonism (VP). BACKGROUND: In the absence of widely accepted diagnostic criteria for VP pathological confirmation of diagnosis is necessary to ensure diagnostic reliability, and has only been reported in a few small series. DESIGN/METHODS: The archival records of the Queen Square Brain Bank (QSBB) have been used to identify cases of Parkinsonism where cerebrovascular disease was the only pathological finding...
October 2012: Journal of Neurology, Neurosurgery, and Psychiatry
Aristide Merola, Maurizio Zibetti, Serena Angrisano, Laura Rizzi, Valeria Ricchi, Carlo A Artusi, Michele Lanotte, Mario G Rizzone, Leonardo Lopiano
Clinical findings in Parkinson's disease suggest that most patients progressively develop disabling non-levodopa-responsive symptoms during the course of the disease. Nevertheless, several heterogeneous factors, such as clinical phenotype, age at onset and genetic aspects may influence the long-term clinical picture. In order to investigate the main features of long-term Parkinson's disease progression, we studied a cohort of 19 subjects treated with subthalamic nucleus deep brain stimulation after >20 years of disease, reporting clinical and neuropsychological data up to a mean of 30 years from disease onset...
July 2011: Brain: a Journal of Neurology
Juan Idiaquez, Gustavo C Roman
Syncope associated to orthostatic hypotension (OH), urinary incontinence and constipation is common symptoms in demented patients, mainly in dementia with Lewy bodies (DLB) and in Parkinson's disease dementia (PDD). Alzheimer's disease (AD) and fronto temporal lobar degeneration (FTLD) show less autonomic dysfunction. Urinary symptoms are a prominent component of normal pressure hydrocephalus (NPH). There are non invasive tests including standard cardiovascular tests, 123 I-metaiodobenzylguanide (MIBG) cardiac scintigraphy, urodynamic tests, gastrointestinal motility studies, sweating reflexes and pupillary responses that assess autonomic dysfunction in these patients...
June 15, 2011: Journal of the Neurological Sciences
Seema Kalra, Donald G Grosset, Hani T S Benamer
Vascular parkinsonism (VP) remains a loose constellation of various clinical features. We systematically reviewed studies comparing clinical, neuroimaging and other investigations that might distinguish VP from idiopathic Parkinson's disease (PD). Medline, Embase, Cinahl (R), and PsycINFO were searched by querying appropriate key words. Reports were included if the study population contained comparative findings between patients with VP and PD. Twenty-five articles fulfilled the selection criteria. Patients with VP were older, with a shorter duration of illness, presented with symmetrical gait difficulties, were less responsive to levodopa, and were more prone to postural instability, falls, and dementia...
January 30, 2010: Movement Disorders: Official Journal of the Movement Disorder Society
F W Bergert, D Conrad, K Ehrenthal, J Fessler, J Gross, K Gundermann, B Kluthe, W Lang Heinrich, A Liesenfeld, P G Loew, E Luther, R Pchalek, J Seffrin, A Sterzing, H-J Wolfring, U Zimmermann
The part "Special pharmacology of the aged" of this guideline contains recommendations for typical conditions in the family doctors practice: in the January issue 2009 dementia and Morbus Parkinson, in this issue osteoporosis and urinary incontinence and in the next issue rectal incontinence and obstipation. This issue of the IJCPT contains the third part of the Pharmacotherapy guidelines for the aged by family doctors for family doctors. Part 3: Osteoporosis and urinary incontinence. Osteoporosis is a systematic disease characterized by low bone mass and declining bone structure...
March 2009: International Journal of Clinical Pharmacology and Therapeutics
Pravin Kamble, Hua Chen, Jeff Sherer, Rajender R Aparasu
BACKGROUND: Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of atypical agents in the 1990s. OBJECTIVE: The goal of this study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States...
October 2008: American Journal of Geriatric Pharmacotherapy
Marco Inzitari, Claudia Pozzi, Luigi Ferrucci, Daniela Chiarantini, Lucio A Rinaldi, Marco Baccini, Riccardo Pini, Giulio Masotti, Niccolò Marchionni, Mauro Di Bari
BACKGROUND: Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases. We investigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals. METHODS: In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (N(SNA)) was obtained by summing SNAs detected with a simple neurological examination...
June 23, 2008: Archives of Internal Medicine
Mariese A Hely, Wayne G J Reid, Michael A Adena, Glenda M Halliday, John G L Morris
After 20 years follow-up of newly diagnosed patients with Parkinson's disease (PD), 100 of 136 (74%) have died. The mortality rate fell in the first 3 years of treatment, then rose compared to the general population, the standardized mortality ratio from 15 to 20 years reaching 3.1. Drug induced dyskinesia and end of dose failure were experienced by most patients, but the main current problems relate to the non-levodopa responsive features of the disease. Dementia is present in 83% of 20-year survivors. Dementia correlates with increasing age and probably reflects an interplay of multiple pathologies...
April 30, 2008: Movement Disorders: Official Journal of the Movement Disorder Society
Litsa Morfis, Dennis John Cordato
We report the case of an elderly man of Greek background who presented with progressive cognitive decline and motor parkinsonism on a background of a strong family history of Parkinson's disease. Associated symptoms included visual hallucinations, excessive daytime drowsiness, recurrent falls, orthostatic hypotension and urinary incontinence. His major clinical symptoms and signs fulfilled consensus criteria for a clinical diagnosis of dementia with Lewy bodies. An alpha-synuclein gene mutation analysis for the G209A substitution was positive...
November 2006: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Rita Moretti, Paola Torre, Rodolfo M Antonello, Gilberto Pizzolato
Behavioral problems produce excess disability that can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisias. On examination of the consequences of adverse events, somnolence, as well as postural instability and postural hypotension, have been noted...
May 2006: Expert Review of Neurotherapeutics
Felix Geser, Gregor K Wenning, Werner Poewe, Ian McKeith
Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in older people that has only been recognized in the past decade and that remains widely underdiagnosed. At postmortem examination, affected patients show numerous alpha-synuclein-positive Lewy bodies (LB) in many parts of the cerebral cortex, particularly neocortical and limbic areas in addition to the nigral LB degeneration characteristic of Parkinson's disease (PD). Clinical presentation, unlike PD, is with progressive cognitive decline with particular deficits of visuospatial ability as well as frontal executive function accompanied by usually only mildly to moderately severe parkinsonism, which is often akineto-rigid without the classical parkinsonian rest-tremor...
August 2005: Movement Disorders: Official Journal of the Movement Disorder Society
Rita Moretti, Paola Torre, Rodolfo M Antonello, Tatiana Cattaruzza, Giuseppe Cazzato
Behavioral problems produce excess disability, potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisia. We followed up (for 12 months) a group of 346 consecutive outpatients, with a diagnosis of subcortical vascular dementia or multi-infarctual dementia...
October 2005: Journal of Neurology
Mariese A Hely, John G L Morris, Wayne G J Reid, Robert Trafficante
One-third of the 149 people recruited 15 to 18 years ago in the Sydney Multicenter Study of Parkinson's disease have survived. The original study compared low-dose levodopa with low-dose bromocriptine. We now report the problems experienced by people who survive 15 years from diagnosis. The standardized mortality ratio is significantly elevated at 1.86 and is not significantly different between treatment arms. Falls occur in 81% of patients, and 23% sustained fractures. Cognitive decline is present in 84%, and 48% fulfill the criteria for dementia...
February 2005: Movement Disorders: Official Journal of the Movement Disorder Society
Rita Moretti, Paola Torre, Rodolfo M Antonello, Tatiana Cattaruzza, Giuseppe Cazzato, Antonio Bava
Disabilities caused by behavioral problems can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety, and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they can be accompanied by significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism, and akathisias. Agitation is a major problem in older patients with dementia. Agitation and aggression have always been difficult behaviors to manage, and when it is severe, agitation can be a behavioral emergency that requires urgent and immediate intervention...
March 2004: American Journal of Alzheimer's Disease and Other Dementias
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