The effect of the Mediterranean diet on cognitive function in patients with Parkinson’s disease: A randomized clinical controlled trial

ObjectivesParkinson’s disease (PD) is the second most common neurodegenerative disorder. It is proposed that adherence to the Mediterranean diet might have a beneficial effect on the prevention and treatment of PD and its complications. Thus, the aim of this study was to investigate the effects of the Mediterranean diet on cognitive function in patients with PD.DesignThe study was a single-center, randomized clinical trial. Eighty patients with idiopathic PD were randomly allocated to the Mediterranean diet (n = 40) or control (n = 40) group. Patients in the intervention group received an individualized dietary plan based on Mediterranean diet for 10 weeks. The Persian version of Montreal Cognitive Assessment (MoCA) test was used to assess the cognitive function at baseline and the end of the study.ResultsThirty-five PD patients with a mean age of 59.3 ± 8.3 and 35 patients with a mean age of 58.6 ± 9.3 finished the study in intervention and control groups, respectively. After the intervention, the mean score of the dimensions of executive function, language, attention, concentration, and active memory and the total score of cognitive assessment significantly increased in the intervention compared with the control group (p < 0.05, for all). Nevertheless, the mean of the other scores including spatial-visual ability, memory learning task, and navigation versus time and place did not significantly change in both intervention and control groups.ConclusionsThe findings of this study showed that adherence to the Mediterranean diet remarkably increased the dimensions of executive function, language, attention, concentration, and active memory and finally the total score of cognitive assessment in PD patients.     

A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance,balance and quality of life in patients with Parkinson’s disease

Purpose: To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance, balance, activities of daily living (ADL) and quality of life in individuals with Parkinson’s disease (PD). Method: Twenty-three subjects were recruited from the Parkinson’s database of the neurology service in a large urban teaching hospital. Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control. Assessments were carried out at baseline, week 7 following the control phase, and week 14 following the intervention phase. Intervention consisted of 30-min cycle ergometry training once weekly. Outcome measures included Six Minute Walk Test, Physiological Cost Index, Berg Balance Scale, Timed Up and Go Test (TUAG), ADL and mobility sections of the Unified Parkinson’s disease Rating Scale (UPDRS) and the Parkinson’s disease questionnaire (PDQ). Results: Statistically significant improvements were noted for the Berg Balance Scale (p = 0.003), TUAG (p = 0.019) and ADL (p = 0.006) and mobility (p = 0.021) sections of the UPDRS. A trend towards improvement was found for exercise tolerance. No significant effect on quality of life was found. Conclusion: A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample, but improved balance, functional abililty and PD-related disability were noted.

Implications for Rehabilitation

• Individuals with Parkinson’s disease demonstrate lower levels of exercise tolerance than healthy controls.

• Individuals with Parkinson’s disease could participate in 30?min of cycle ergometry training, with no rest periods required.

• Cycle ergometry training has a positive effect on balance, function and PD-related disability.

     

The effects of synbiotic supplementation on thyroid function and inflammation in hypothyroid patients: A randomized,double‑blind,placebo‑controlled trial

BackgroundThere is a positive link between thyroid homeostasis and the composition of gut microbiota. A limited number of studies have suggested the efficacy of probiotic products on levothyroxine metabolism and thyroid hormone activity. Therefore, the purpose of this study was to investigate the effect of synbiotic supplementation on thyroid function, inflammation markers, and blood pressure in subjects with hypothyroidism.MethodsThis study was conducted as a randomized, double-blind, placebo-controlled trial involving 60 patients with hypothyroidism. Participants were randomly recruited into two groups to receive either 500 mg/day of synbiotic (n = 30) or a placebo (n = 30) for 8 weeks.ResultsThyroid-stimulating hormone concentration, levothyroxine dose, and fatigue severity scale score were significantly decreased after the 8-week intervention in the synbiotic group (P < 0.05), while there were no significant differences seen in the placebo group. In addition, FT₃ at the end of intervention was significantly higher (P = 0.001) in both groups, although these changes were not significant between the two groups (P = 0.259). Synbiotic supplements led to a significant elevation in serum CRP (P = 0.006), but this increase was not significant between groups (P = 0.699). Moreover, no statistical significance was observed within or between groups in terms of anti-thyroid peroxidase, systolic blood pressure and diastolic blood pressure (P > 0.05).ConclusionSynbiotic supplementation among hypothyroid patients for 8 weeks may have beneficial effects on thyroid function. Further studies with larger sample size and longer duration are needed to confirm the current findings.     

Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients: A randomized controlled trial

Objectives

Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical treatment and reduce the risk of readmission of elderly newly discharged patients.

Design and setting

The patients were randomized to either an intervention group receiving a structured home visit by the GP and the district nurse one week after discharge followed by two contacts after three and eight weeks, or to a control group receiving the usual care.

Patients

A total of 331 patients aged 78+ years discharged from Glostrup Hospital, Denmark, were included.

Main outcome measures

Readmission rate within 26 weeks after discharge among all randomized patients. Control of medication, evaluated 12 weeks after discharge on 293 (89%) of the patients by an interview at home and by a questionnaire to the GP.

Results

Control-group patients were more likely to be readmitted than intervention-group patients (52% v 40%; p = 0.03). In the intervention group, the proportions of patients who used prescribed medication of which the GP was unaware (48% vs. 34%; p = 0.02) and who did not take the medication prescribed by the GP (39% vs. 28%; p = 0.05) were smaller than in the control group.

Conclusion

The intervention shows a possible framework securing the follow-up on elderly patients after discharge by reducing the readmission risk and improving medication control.Key Words: Discharge, elderly, family practice, home visit, medication, primary care, readmissionFewer readmissions and better control of medication is generally strived for. A follow-up programme by the GPs and district nurses after discharge found:

• A 23% relative readmission risk reduction within six months after discharge.
• Better follow-up including better control of medication after discharge.
• A cost-neutral intervention featuring a tendency towards reduced costs.

Because of their often frail condition, discharged, impaired elderly patients face a high risk of readmission [1–5] and they risk being “left in limbo” if a healthcare professional is not assigned explicit responsibility for their bio-psychosocial situation upon their discharge [6]. Readmission can be diminished according to studies of home follow-up on elderly patients involving advanced practice nurses and geriatric teams drawn from hospital staff and other kinds of intervention with improved discharge support for elderly patients with specific diseases [1–3,5,7,8]. Two reviews found that the documented impact of discharge planning without follow-up care was uncertain [4,5]. They concluded that more research and health economic analysis were needed, exploring intervention across the hospital–community interface.In Denmark (5.5 million inhabitants), the healthcare system is tax-financed with no payment at the point of care. GPs are independent contractors to public health insurance. They act as gatekeepers for 98% of the population. Municipalities run a district nurse system that mainly focuses on care for the frail elderly [9].Inappropriate medical treatment often has inadvertent effects, and a considerable number of admissions are attributable to inappropriate medical treatment that could be avoided [10,11].Only a few trials have focused on the effect of improved effort by the existing staff in the primary sector [12]. The aim of this study was to evaluate a simple intervention aimed at improving the interdisciplinary care given by GPs and district nurses.     

The effect of Benson’s relaxation response on sleep quality and anorexia in cancer patients undergoing chemotherapy: A randomized controlled trial

Background and objectivesPatients with cancer experience many side effects due to its nature and usual treatments. Sleep disorders and anorexia are the most commonly reported symptoms in cancer patients undergoing chemotherapy. The present study aimed to investigate the effect of Benson's Relaxation Response (BRR) on sleep quality and anorexia in cancer patients undergoing chemotherapy.Methodology and participantsIn the present clinical trial, a total of 84 patients were enrolled and randomly divided into two groups of experimental and control. Benson's relaxation response was administered to the experimental group twice a day over 5 consecutive days. Data was collected using St. Mary's Hospital Sleep Questionnaire (SMHSQ) and anorexia questionnaire with Visual Analog Scale (VAS).ResultsThe results of our study showed a significant improvement in the sleep quality in the experimental group at 24 (p = 0.02) and 48 (p = 0.001) hours after the intervention compared to the control group. Benson's relaxation response (BRR) also had a significant effect on the anorexia in the experimental group at 24 (7.5 ± 1.6) and 48 (6.9 ± 2.1) hours after the intervention compared to the control group. No side effects were reported during the study and follow-up period.ConclusionBenson's relaxation response as a complementary method may improve sleep quality and anorexia in cancer patients undergoing chemotherapy. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.     

Laroratory emory and everyday memory in patients with Parkinson‘s disease

Objective To study the recognition,recall and everyday memory in patients with Parkinson‘s dissease,Methods 16 patients with idiopathic PD and 16 matched healthy control were examined using eight subtests of Multiple Memory Assessment Scale(MMAS)-word recall,picture recall,picture reproduction,picture recognition,wored recognition and everyday memory,Results Except for word recognition(P&;gt;0.0t),the performances of patients were significantly worse in picture recall(P&;lt;0.05),word recall(P&;lt;0.01),picture reproduction(P&;lt;0.01),picture recognition(P&;lt;0.01),and everyday memory(P&;lt;0.01)than those of mormal control.The most memory performances of patients with Parkinson‘s disease were significantly negatively correlated with the score of Yale Extapyramidal Symptom Scale(YESS).Conclusion The picture recognition,recall,and everyday memory of PD patients were impaired,and the impairment was related to the deficient function of the striatofrontal circuit.     

Safety and tolerability of intracerebroventricular PDGF-BB in Parkinson’s disease patients

BACKGROUND. Recombinant human PDGF-BB (rhPDGF-BB) reduces Parkinsonian symptoms and increases dopamine transporter (DAT) binding in several animal models of Parkinson’s disease (PD). Effects of rhPDGF-BB are the result of proliferation of ventricular wall progenitor cells and reversed by blocking mitosis. Based on these restorative effects, we assessed the safety and tolerability of intracerebroventricular (i.c.v.) rhPDGF-BB administration in individuals with PD.METHODS. We conducted a double-blind, randomized, placebo-controlled phase I/IIa study at two clinical centers in Sweden. Twelve patients with moderate PD received rhPDGF-BB via an implanted drug infusion pump and an investigational i.c.v. catheter. Patients were assigned to a dose cohort (0.2, 1.5, or 5 μg rhPDGF-BB per day) and then randomized to active treatment or placebo (3:1) for a 12-day treatment period. The primary objective was to assess safety and tolerability of i.c.v.-delivered rhPDGF-BB. Secondary outcome assessments included several clinical rating scales and changes in DAT binding. The follow-up period was 85 days.RESULTS. All patients completed the study. There were no unresolved adverse events. Serious adverse events occurred in three patients; however, these were unrelated to rhPDGF-BB administration. Secondary outcome parameters did not show dose-dependent changes in clinical rating scales, but there was a positive effect on DAT binding in the right putamen.CONCLUSION. At all doses tested, i.c.v. administration of rhPDGF-BB was well tolerated. Results support further clinical development of rhPDGF-BB for patients with PD.TRIAL REGISTRATION. Clinical Trials.gov {"type":"clinical-trial","attrs":{"text":"NCT00866502","term_id":"NCT00866502"}}NCT00866502.FUNDING. Newron Sweden AB (former NeuroNova AB) and Swedish Governmental Agency for Innovation Systems (VINNOVA).     

Effectiveness and safety of acupuncture in the treatment of Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThis study aimed to examine the effectiveness and safety of acupuncture in the treatment of Parkinson’s disease (PD).MethodsEnglish, Chinese, and Korean electronic databases were searched up to June 2016. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane’s risk of bias tool. Meta-analysis was performed using RevMan 5.3.ResultsIn total, 42 studies involving 2625 participants were systematically reviewed. Participants treated using combined acupuncture and conventional medication (CM) showed significant improvements in total Unified PD Rating Scale (UPDRS), UPDRS I, UPDRS II, UPDRS III, and the Webster scale compared to those treated using CM alone. The combination of electroacupuncture and CM was significantly superior to CM alone in total UPDRS, UPDRS I, UPDRS II, and UPDRS IV. Similarly, the combination of scalp electroacupuncture, acupuncture, and CM was significantly more effective than CM alone in total UPDRS. However, our meta-analysis showed that the combination of electroacupuncture and CM was not significantly more effective than CM alone in UPDRS III, the Webster, and the Tension Assessment Scale. The results also failed to show that acupuncture was significantly more effective than placebo acupuncture in total UPDRS. Overall, the methodological quality of the RCTs was low. No serious adverse events were reported.ConclusionsWe found that acupuncture might be a safe and useful adjunctive treatment for patients with PD. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. More rigorous and well-designed placebo-controlled trials should be conducted.     

Factors contributing to postural instability in patients with idiopathic Parkinson’s disease

Background:

Postural instability is a cardinal sign of idiopathic Parkinson’s disease (IPD) leading to increased fall risk; however, the exact reason for this instability is unclear.

Objectives:

This systematic review critically explored the relationships between factors contributing to or impacting on postural instability in people with IPD.

Methods:

Ten databases were searched for studies, with an experimental or observational design, which met the following criteria: (1) participants diagnosed with IPD; (2) included a measure or perturbation of postural stability or balance; and (3) investigated at least one factor contributing to or impacting on postural instability. The Generic Appraisal Tool for Epidemiology (GATE) checklist was used to rate the methodological quality of selected studies.

Results:

Fifty-seven studies were selected, of which 42 were rated to have moderate-to-high quality. Factors contributing to or impacting on postural instability were broadly categorized as: (1) sensory dysfunction (n?=?12); (2) abnormal postural response patterns (n?=?11); (3) bradykinesia (n?=?2); (4) stiffness (n?=?7); (5) cognitive function (n?=?5); and miscellaneous factors (n?=?5). From the studies rated as of high quality, five factors were identified to significantly impact on postural stability: sensory dysfunction, bradykinesia, abnormal postural response patterns, L-dopa induced dyskinesia, and hypotension (the latter two factors were categorized as ‘miscellaneous’).

Conclusions:

Using a reductionist approach, this review identified five factors that appear to significantly impact on postural stability in IPD; however, this may be a simplistic summary and it is more likely that postural instability is a complex interplay of many factors. Further research is suggested to elucidate more fully the factors involved in postural instability.     

Effect of foot reflexology on neonates’ clinical outcomes with hyperbilirubinemia undergoing phototherapy: A randomized controlled trial

BackgroundNeonatal hyperbilirubinemia is the most common reason for neonatal admissions to the Neonatal Intensive Care Unit that can progress to critical levels. Foot reflexology therapy is one of the complementary alternative therapies that can help to upgrade neonatal clinical outcomes with hyperbilirubinemia.AimThis study aimed to investigate the effect of foot reflexology on neonates’ clinical outcomes with hyperbilirubinemia undergoing phototherapy.DesignA Quasi-experimental two groups research design was used to accomplish this study.MethodsThis study was conducted at Neonatal Intensive Care Unit in Alexandria University Children's Hospital at Smouha, Alexandria on 60 full-term neonates with hyperbilirubinemia undergoing phototherapy, were randomly assigned to two groups Neonates of the control group were received only phototherapy for hyperbilirubinemia, While foot reflexology neonates received intervention on the gastrointestinal system zone for 20 min in the morning before feeding once daily for consecutive five days beside phototherapy.Resultsfoot reflexology neonates exhibited a decrease in total bilirubin level to 7.9000 ± 1.81545 on the fifth day compared to 10.1633 ± 1.77054 for the control group neonates. A decline in the mean duration of undergoing phototherapy for neonates in the foot reflexology group to 4.30 ± 0.466 on the contrary with 5.00 ± 1.017 days for the control group.ConclusionApplication of foot reflexology is effective in improving the full-term neonates’ clinical outcomes with hyperbilirubinemia undergoing phototherapy. Thus, this non-pharmacological method is recommended as a supplement treatment for neonates with hyperbilirubinemia beside phototherapy.     

Exercise on balance and function for knee osteoarthritis: A randomized controlled trial

Objectives

To assess balance and function of symptomatic and asymptomatic subjects with knee osteoarthritis (OA) and investigate the influence of physical exercise.

Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial

ObjectiveThe effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks’ gestation between women receiving prenatal yoga and those receiving routine prenatal care.DesignFor this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks’ gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n = 48) or control (n = 46) groups using Clinstat block randomization.InterventionThe 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care.Main outcome measuresIn both groups, participants’ salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks’ gestation.ResultsThe intervention group had lower salivary cortisol (p < 0.001) and higher immunoglobulin A (p < 0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p = 0.018), and infants born to women in the intervention group weighed more than those born to the control group (p < 0.001).ConclusionPrenatal yoga significantly reduced pregnant women’s stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.     

The effects of family-centered affective stimulation on brain-injured comatose patients’ level of consciousness: A randomized controlled trial

BackgroundDespite the well-defined effects of sensory stimulation, the knowledge of the pure effects of affective stimulation is scarce.ObjectiveTo evaluate the effects of family-centered affective stimulation on the level of consciousness among comatose patients with brain injuries.DesignThis study was designed as a three-group double-blinded Randomized Controlled Trial.MethodsNinety consecutive patients with traumatic brain injuries and a Glasgow Coma Scale score of 5–8 were selected. Patients were randomly allocated to an experimental, a placebo, and a control group using permuted block randomization. Affective stimulation intervention was provided to patients in the experimental group by their family members twice a day during the first seven days of their hospitalization. In the placebo group, a sensory stimulation program was implemented by a fixed trained person who was not familiar with the patients. Patients in the control group solely received sensory stimulation which was routinely provided to all patients. The level of consciousness among the patients using the Glasgow Coma Scale and Coma Recovery Scale-Revised were measured both before and after a family visit. The SPSS software (version 17.0) was used to analyze the data through running the one-way and the repeated measure analyses of variance.ResultsDespite an insignificant difference among the groups regarding baseline level of consciousness, the results of the one-way analysis of variance revealed at the seventh day of this study, however, the level of consciousness in the experimental group was significantly higher (9.1 ± 2.1) than the placebo (7.2 ± 1.1), the control groups (6.6 ± 1.7) (P < 0.001), subsequently. Moreover, at the seventh day of the study, the Coma Recovery Scale score in the experimental group (11.9 ± 3.7) was significantly greater than the placebo (9.0 ± 2.0) and the control (6.6 ± 1.6) groups (P < 0.001). Recovery rate and effect size values also confirmed the greater effectiveness of affective stimulation compared with pure sensory stimulation.ConclusionOur findings in this study indicate that early family-centered affective stimulation is more effective than sensory stimulation in improving the level of consciousness among comatose patients with brain injuries. Family-centered affective stimulation is recommended to be integrated into the nursing curricula and routine care plans for comatose trauma patients in intensive care units.     

Is Homatropine 5% effective in reducing pain associated with corneal abrasion when compared with placebo? A randomized controlled trial

Objective: To compare the change in visual analogue scale (VAS) pain ratings over 24 h following mechanical corneal abrasion between patients receiving sixth hourly drops of either 5% homatropine or placebo. Methods: A triple blind randomized controlled trial was conducted on a convenience sample of eligible consenting adults who were randomized to receive either sixth hourly 5% homatropine (active) or 0.5% hypromellose (placebo) eye drops. VAS pain ratings were performed at 0, 6, 12, 18 and 24 h whereas the study drug was instilled at 0, 6, 12 and 18 h. The primary outcome was attainment of a clinically significant reduction in pain on the VAS (>20 mm decrease) from enrolment to each time point. Results: There were no significant differences in baseline variables or VAS pain ratings at any time point between those in the homatropine (n= 20) and placebo (n= 20) groups. The percentages of patients reporting a >20 mm VAS decrease at 12 h were 50% (95% CI –27.2–72.8) and 60% (95% CI –36.1–80.9) for the homatropine and placebo groups, respectively. Conclusion: We found no significant difference in pain score reductions between the two groups but some level of therapeutic benefit is not excluded.     

Role of δ-tocotrienol and resveratrol supplementation in the regulation of micro RNAs in patients with metabolic syndrome: A randomized controlled trial

ObjectiveTo determine the effect of δ-tocotrienol and resveratrol mixture (TRM) supplementation in comparison to placebo for 24 weeks, on the relative expression of miRNAs (miRNA-130b‐5p, miRNA-221–5p, miR-15b‐5p, miRNA-122–5p, and miRNA-376b‐5p) in patients with Metabolic syndrome (MetS).DesignThis randomized placebo-controlled trial was conducted at the tertiary care institute of the NUMS, Rawalpindi, Pakistan. A total of 82 adult MetS patients were enrolled and randomly grouped into the TRM group (n = 41) and the Placebo group (n = 41). Patients in the TRM group were given 400 mg capsules (δ-tocotrienol 250 mg; Resveratrol 150 mg) and placebo received (cellulose 400 mg capsule) twice daily for 24 weeks.ResultsThe TRM supplementation revealed a significant (p < 0.001) upregulation of 3.05-fold in miRNA-130b-5p and 2.45-fold in miRNA-221–5p while miRNA-122–5p was downregulated by 2.22-fold as compared to placebo. No significant difference was observed in miRNA-15b-5p and miRNA-376b-5p. Moreover, TRM group participants with reverted MetS had significantly (p < 0.05) upregulated miRNA-130b-5p, miRNA-221–5p, and downregulated miRNA-122–5p relative to non-reverted patients with MetS.ConclusionDaily TRM supplementation may improve metabolic syndrome by upregulated miR-130b-5p, which is involved in central obesity and inflammation, as well as miR-221–5p, which is involved in insulin resistance. Additionally, TRM downregulate of miRNA 122, which improved dyslipidemia     

Prolonged sedation with sevoflurane in comparison to intravenous sedation in critically ill patients – A randomized controlled trial

BackgroundVolatile anesthetics are used more commonly for sedation in the intensive-care-unit (ICU). However, evidence for long-term use remains low. We therefore conducted a randomized-controlled trial comparing sevoflurane with intravenous sedation with particular focus on efficacy and safety.MethodsIn this prospective, randomized-controlled phase-IIb monocentric clinical-trial ICU patients requiring at least 48 h of sedation were randomized to receive sevoflurane (S) or propofol/midazolam (P). Sedation quality was monitored using the Richmond-Agitation-Sedation-Scale. Following termination of sedation, the time to spontaneous breathing and extubation, opioid consumption, hemodynamics, ICU and hospital length of stay (LOS) and adverse events were recorded.Results79 patients were eligible to randomization. Sedation quality was comparable between sevoflurane (n = 39) and propofol (n = 40). However, the use of sevoflurane lead to a reduction in time to spontaneous breathing (26 min vs. 375 min, P < 0.001). Patients sedated with propofol had lower opioid requirements (remifentanil:400 μg/h vs. 500 μg/h, P = 0.007; sufentanil:40 μg/h vs. 30 μg/h, P = 0.007) while hemodynamics, LOS or the occurrence of adverse events did not differ.ConclusionICU patients sedated with sevoflurane >48 h may return to spontaneous breathing faster, while the quality of sedation is comparable to a propofol-based sedation regime. Sevoflurane might be considered to be safe for long-term sedation in this patient population, while being non-inferior compared to propofol.     

A narrative review of turning deficits in people with Parkinson’s disease

Abstract

Purpose: Clinically, people with Parkinson’s disease (PD) demonstrate a loss of axial rotation of the spine often described as moving “enbloc”, with little dissociation between the head, trunk and lower limbs whilst turning. The purpose of this narrative review is to explore the behaviour and relationship of the reported deficits during whole body turning in people with PD, compared to controls. Better understanding of the relationship and impact of the deficits will permit the development of tailored and novel intervention strategies to improve functional performance in turning for people with PD. Methods: Four electronic databases with the search terms: Parkinson* and turn* were used. Results: Seventy-seven papers were reviewed. Turning deficits in people with PD were identified as originating from two hypothetical body segments – perpendicular (i.e. legs) or axial (i.e. head, trunk and pelvis) segments and the relationship between them discussed. Conclusion: Specific movement deficits in turning in people with PD can be categorised into axial and perpendicular deficits. Synthesis of the literature suggests the possibility of axial deficits driving secondary responses in the perpendicular segments. This should be explored when designing rehabilitation aimed at improving turning performance, as current therapy guidelines focus on exercises emphasising perpendicular aspects.

• Implications for Rehabilitation

• Turning performance is compromised in people with PD, which can lead to significant disability, falls and loss of function.

• Specific movement deficits can be categorised into perpendicular deficits (taking more steps and shorter steps and an altered turn strategy) and axial deficits (segment rigidity, altered segment co-ordination and timing, reduced segment rotation and the effects of altered posture).

• Axial deficits may drive secondary responses in the perpendicular segments during turning in people with PD. Therefore, specific focus should be made to the rehabilitation of the axial deficits alongside those of the perpendicular body segments in the design of multi-modal treatment strategies to improve turning performance.

     

Mild and marked executive dysfunction and falls in people with Parkinson’s disease

BackgroundExecutive dysfunction and risk of falling are hallmarks of Parkinson’s disease (PD). However, it is unclear how executive dysfunction predisposes people with PD to falling.ObjectivesTo: (i) identify sensorimotor, balance, and cardiovascular risk factors for falls that discriminate between those with normal executive function and those with mild and marked executive dysfunction in people with PD and (ii) determine whether mild and marked executive dysfunction are significant risk factors for falls when adjusting for PD duration and severity and freezing of gait (FOG).MethodsUsing the Frontal Assessment Battery, 243 participants were classified into normal executive function (n = 87), mild executive dysfunction (n = 100), and marked executive dysfunction (n = 56) groups. Participants were asked if they had episodes of FOG in the last month and were assessed with the Movement Disorders Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr Scale, the physiological profile assessment, and tests of orthostatic hypotension, coordinated stability, and gait and were then followed-up prospectively for falls for 32–52 weeks.ResultsSeveral PD-specific (elevated Hoehn and Yahr stage, higher MDS-UPDRS scale scores, a history of FOG, Postural Instability and Gait Difficulty subtype, and longer PD duration), sensorimotor (poor vision, knee extension weakness, slow simple reaction time), and balance (greater postural sway and poor controlled leaning balance) factors discriminated among the normal executive function and mild and marked executive dysfunction groups. Fall rates (mean ± SD) differed significantly among the groups (normal executive function: 1.0 ± 1.7; mild executive dysfunction: 2.8 ± 5.2; marked executive dysfunction: 4.7 ± 7.3) with the presence of both mild and marked executive dysfunction identified as significant risk factors for falls when adjusting for three measures of PD severity (Hoehn and Yahr scale scores, disease duration, and FOG).ConclusionsSeveral PD-specific, sensorimotor, and balance factors differed significantly among the normal, mild, and marked executive dysfunction groups and both mild and marked executive dysfunction were identified as independent risk factors for falls in people with PD.