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By Marianne De Nobel i'm a physician in the elderly care at an Hospice and in a nursing home, with people with dementia and /or chronic diseases also i'm working in the primary care
Siobhan Fox, Alison Cashell, W George Kernohan, Marie Lynch, Ciara McGlade, Tony O'Brien, Sean S O'Sullivan, Mary J Foley, Suzanne Timmons
BACKGROUND: Palliative care is recommended for non-malignant illnesses, including Parkinson's disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a 'fear' in their patients about introducing palliative care. However, less is known about the views of people with Parkinson's disease and their carers about palliative care. AIM: (1) To explore the palliative care and related issues most affecting people with Parkinson's disease and their families and (2) to examine perceptions about/understanding of palliative care...
September 28, 2016: Palliative Medicine
Oluwadamilola O Ojo, Hubert H Fernandez
Psychosis in Parkinson's disease (PD) is one of the greatest determinants of nursing home placement and caregiver stress. Traditionally associated with medications with dopaminergic effect, it has now been linked to other medications and other stressors e.g. systemic illnesses. The development of hallucinations in a PD patient can herald the onset of dementia and usually predicts increased mortality risk. Medication reduction in PD psychosis usually reduces the symptoms; however, this comes at the cost of worsening motor function...
October 2016: Current Psychiatry Reports
Amit Batla, Natalie Tayim, Mahreen Pakzad, Jalesh N Panicker
Urogenital dysfunction is commonly reported in Parkinson's disease (PD), and history taking and a bladder diary form the cornerstone of evaluation. The assessment of lower urinary tract (LUT) symptoms include urinalysis, ultrasonography, and urodynamic studies and help to evaluate concomitant urological pathologies such as benign prostate enlargement. Antimuscarinic medications are the first line treatment for overactive bladder (OAB) symptoms and solifenacin has been specifically studied in PD. Antimuscarininc drugs may exacerbate PD-related constipation and xerostomia, and caution is advised when using these medications in individuals where cognitive impairment is suspected...
October 2016: Current Treatment Options in Neurology
Wolfgang Oertel, Jörg B Schulz
Over a period of more than 50 years, the symptomatic treatment of the motor symptoms of Parkinson disease (PD) has been optimized using pharmacotherapy, deep brain stimulation, and physiotherapy. The arsenal of pharmacotherapies includes L-Dopa, several dopamine agonists, inhibitors of monoamine oxidase (MAO)-B and catechol-o-methyltransferase (COMT), and amantadine. In the later course of the disease, motor complications occur, at which stage different oral formulations of L-Dopa or dopamine agonists with long half-life, a transdermal application or parenteral pumps for continuous drug supply can be subscribed...
October 2016: Journal of Neurochemistry
Armando De Virgilio, Antonio Greco, Giovanni Fabbrini, Maurizio Inghilleri, Maria Ida Rizzo, Andrea Gallo, Michela Conte, Chiara Rosato, Mario Ciniglio Appiani, Marco de Vincentiis
Parkinson's disease is a neurodegenerative disease that causes the death of dopaminergic neurons in the substantia nigra. The resulting dopamine deficiency in the basal ganglia leads to a movement disorder that is characterized by classical parkinsonian motor symptoms. Parkinson's disease is recognized as the most common neurodegenerative disorder after Alzheimer's disease. PD ethiopathogenesis remains to be elucidated and has been connected to genetic, environmental and immunologic conditions. The past decade has provided evidence for a significant role of the immune system in PD pathogenesis, either through inflammation or an autoimmune response...
October 2016: Autoimmunity Reviews
José Fidel Baizabal-Carvallo, Marlene Alonso-Juarez
INTRODUCTION: Traditionally, deep brain stimulation (DBS) for movement disorders (MDs) is provided using stimulation frequencies equal to or above 100 Hz. However, recent evidence suggests that relatively low-frequency stimulation (LFS) below 100 Hz is an option to treat some patients with MDs. OBJECTIVES: We aimed to review the clinical and pathophysiological evidence supporting the use of stimulation frequencies below 100 Hz in different MDs. RESULTS: Stimulation of the subthalamic nucleus at 60 Hz has provided benefit in gait and other axial symptoms such as swallowing and speech...
October 2016: Parkinsonism & related Disorders
Nevena Divac, Radan Stojanović, Katarina Savić Vujović, Branislava Medić, Aleksandar Damjanović, Milica Prostran
Psychotic symptoms are present in up to 50% of patients with Parkinson's disease. These symptoms have detrimental effects on patients' and caregivers' quality of life and may predict mortality. The pathogenesis of psychotic symptoms in Parkinson's disease is complex, but the use of dopaminergic medications is one of the risk factors. The treatment of psychotic symptoms in Parkinson's disease is complicated due to the ability of antipsychotic medications to worsen motor symptoms. The efficacy of clozapine in the treatment of psychosis in patients with Parkinson's disease has been confirmed in several clinical trials; however, the adverse effects and the necessity of blood count monitoring are the reasons why the use of this drug is challenging...
2016: Behavioural Neurology
Josip Anđelo Borovac
Dopamine agonists (DA) are therapeutic agents that are commonly used in the treatment of Parkinson's disease (PD). They can reduce undesired motor fluctuations and delay the administration of levodopa therapy. However, this drug family is associated with specific side effects that can significantly diminish the quality of life among PD patients. Some of them impose significant risks for individuals who have a history of cardiovascular diseases, psychosis, and depression, or those older patients who suffer from renal or hepatic insufficiency...
March 2016: Yale Journal of Biology and Medicine
Song Li, Jie Dong, Cheng Cheng, Weidong Le
Parkinson's disease (PD) is the second most common neurodegenerative disorder caused by the selective and progressive loss of dopaminergic neurons in the substantia nigra pars compacta. Although PD has been heavily researched, the precise etiology and pathogenesis for PD are still inconclusive. Consequently, current pharmacological treatments for PD are largely symptomatic rather than preventive and there is still no cure for this disease nowadays. Moreover, nonmotor symptoms caused by intrinsic PD pathology or side effects induced by currently used pharmacological interventions are gaining increasing attention and urgently need to be treated due to their influence on quality of life...
November 2016: Journal of Neural Transmission
Adam Basiago, Devin K Binder
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson's disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system...
August 16, 2016: Brain Sciences
Adam Nassery, Christina A Palmese, Harini Sarva, Mark Groves, Joan Miravite, Brian Harris Kopell
Deep brain stimulation (DBS) is effective for Parkinson's disease (PD), dystonia, and essential tremor (ET). While motor benefits are well documented, cognitive and psychiatric side effects from the subthalamic nucleus (STN) and globus pallidus interna (GPi) DBS for PD are increasingly recognized. Underlying disease, medications, microlesions, and post-surgical stimulation likely all contribute to non-motor symptoms (NMS).
October 2016: Current Neurology and Neuroscience Reports
Sara Garcia-Ptacek, Milica G Kramberger
Dementia is a frequent complication of Parkinson disease (PD) with a yearly incidence of around 10% of patients with PD. Lewy body pathology is the most important factor in the development of Parkinson disease dementia (PDD) and there is evidence for a synergistic effect with β-amyloid. The clinical phenotype in PDD extends beyond the dysexecutive syndrome that is often present in early PD and encompasses deficits in recognition memory, attention, and visual perception. Sleep disturbances, hallucinations, neuroleptic sensitivity, and fluctuations are often present...
September 2016: Journal of Geriatric Psychiatry and Neurology
David Devos, Caroline Moreau, David Maltête, Romain Lefaucheur, Alexandre Kreisler, Alexandre Eusebio, Gilles Defer, Thavarak Ouk, Jean-Philippe Azulay, Pierre Krystkowiak, Tatiana Witjas, Marie Delliaux, Alain Destée, Alain Duhamel, Régis Bordet, Luc Defebvre, Kathy Dujardin
BACKGROUND: Even with optimal dopaminergic treatments, many patients with Parkinson's disease (PD) are frequently incapacitated by apathy prior to the development of dementia. We sought to establish whether rivastigmine's ability to inhibit acetyl- and butyrylcholinesterases could relieve the symptoms of apathy in dementia-free, non-depressed patients with advanced PD. METHODS: We performed a multicentre, parallel, double-blind, placebo-controlled, randomised clinical trial (Protocol ID: 2008-002578-36; clinicaltrials...
June 2014: Journal of Neurology, Neurosurgery, and Psychiatry
Ryuji Sakakibara, Jalesh Panicker, Enrico Finazzi-Agro, Valerio Iacovelli, Homero Bruschini
Parkinson's disease (PD) is a common neurodegenerative disorder, and lower urinary tract (LUT) dysfunction is one of the most common autonomic disorders with an estimated incidence rate of 27-80%. Studies have shown that bladder dysfunction significantly influences quality-of-life (QOL) measures, early institutionalisation, and health economics. We review the pathophysiology of bladder dysfunction in PD, lower urinary tract symptoms (LUTS), objective assessment, and treatment options. In patients with PD, disruption of the dopamine D1-GABAergic direct pathway may lead to LUTS...
June 2016: Neurourology and Urodynamics
Katrijn Smulders, Marian L Dale, Patricia Carlson-Kuhta, John G Nutt, Fay B Horak
Gait impairments are a hallmark of Parkinson's disease (PD), both as early symptom and an important cause of disability later in the disease course. Although levodopa has been shown to improve gait speed and step length, the effect of dopamine replacement therapy on other aspects of gait is less well understood. In fact, falls are not reduced and some aspects of postural instability during gait are unresponsive to dopaminergic treatment. Moreover, many medications other than dopaminergic agents, can benefit or impair gait in people with PD...
October 2016: Parkinsonism & related Disorders
Javier Pagonabarraga, Jaime Kulisevsky, Antonio P Strafella, Paul Krack
Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers...
May 2015: Lancet Neurology
C Waters
Two inhibitors of catechol-O-methyl transferase (COMT), tolcapone and entacapone, have recently been introduced as adjuncts to levodopa in the treatment of Parkinson's disease patients. Both have been shown to provide PD patients with increased "on" time, decreased "off" time, and improved motor scores. There are, however, a number of practical issues that must be considered in order to achieve maximal benefits with this class of agent. They include dosing and administration, efficacy, adverse events, and patient education...
2000: Neurology
Antoniya Todorova, K Ray Chaudhuri
Non-motor symptoms (NMS) are now recognized to occur across all stages of Parkinson's disease (PD) and as a result there has been an increasing focus on their diagnosis, quantification and effective management. While in some subjects, NMS may be present before diagnosis, in advanced PD, NMS can contribute to hospitalization, severe disability and a shortened life expectancy. Strategies for continuous drug delivery have been reported to have a beneficial effect on NMS in PD and while the efficacy of apomorphine on motor function in PD has been confirmed in a number of studies, in addition to its possible anti-dyskinetic effect, a number of reports have also outlined the possible beneficial effect of apomorphine on NMS...
December 2013: Parkinsonism & related Disorders
Gila Bronner
Sexual problems are common in Parkinson's disease and contribute to poor quality of life of patients and partners. Nonmotor and motor disease manifestations can affect sexual function. This article reviews the progressive and multidimensional sexual manifestations and provides practical suggestions for taking sexual history and treating sexual problems, which may enable clinicians to contribute to the sexual wellbeing of patients.
November 15, 2011: Journal of the Neurological Sciences
Kai Li, Heinz Reichmann, Tjalf Ziemssen
Symptoms of dysautonomia are common in Parkinson's disease (PD), and almost all the functional autonomic subsystems can be involved in PD. However, they are still under-recognized in everyday clinical practice. Autonomic dysfunction can be observed in the early stages of PD, affect a substantial proportion of patients, impact quality of life and can also help in differential diagnosis. This review aims to provide an overview of the pathophysiology, clinical manifestations, relevant examination and treatment of cardiovascular, gastrointestinal, urogenital, thermoregulatory and pupil autonomic dysfunctions in Parkinson's disease...
October 2015: Expert Review of Neurotherapeutics
2016-07-23 09:11:23
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