Anhedonia in Parkinson's disease: A systematic review of the literature

Anhedonia, defined as lowered ability to experience physical or social pleasure, is a key symptom of several psychiatric illnesses. In this systematic review, we aimed to evaluate the role of anhedonia in Parkinson's Disease and its relationships with other clinical characteristics, dopamine dysfunction, and antiparkinsonian therapy. The database was selected using PubMed Services. Relevant journals were hand‐searched, and the bibliographies of all the important articles were scrutinized to find additional publications. Fifteen studies assessed the topic of anhedonia in Parkinson's disease from 1984 to 2009 and mainly described it as a core symptom of depression in patients with Parkinson's disease. Some studies investigated the relationship between anhedonia and neuropsychological symptoms and found correlations with frontal lobe functions. Reports on the relationship between anhedonia and illness severity or motor symptoms are rather inconclusive. No definitive conclusions can be drawn because few studies have been published on this topic. Nevertheless, some evidence suggests that in Parkinson's disease anhedonia is a secondary phenomenon linked to depression, apathy severity, and frontal lobe dysregulation and that it could respond to antiparkinsonian treatment. Future studies of larger samples of patients are strongly required to definitively clarify the relationship between anhedonia and other clinical features, such as depression, anxiety, apathy, cognition, and motor status. Furthermore, more reliable tools and validated diagnostic criteria are necessary to assess anhedonia in patients with Parkinson's disease. © 2011 Movement Disorder Society     

Alexithymia in Parkinson's disease: A systematic review of the literature

IntroductionIn this systematic review, we aimed to evaluate the role of alexithymia in Parkinson's disease (PD) and its relationship to neurological, neuropsychiatric, cognitive, and neuroimaging correlates.MethodsThe database was selected using PubMed Services, Cochrane, PsycNET and Scopus and a number of key words. Further studies were sought by manually searching for secondary sources, including relevant journals and references in primary articles. The search was restricted to articles written in English between January 1980 and August 2015.ResultsTen studies reported that alexithymia prevalence was about double in PD patients compared to control subjects and that specific dimensions of alexithymia might be related to depression, anxiety, apathy and impulsivity. Some studies investigated the relationship between alexithymia and neuropsychological symptoms and found correlations with frontal and parietal lobe functions. Two studies on neurological features reported a link between alexithymia and disease stage or a specific motor subtype of PD; the remaining studies found that alexithymia was independent from neurological symptoms, dopaminergic therapy and laterality of motor symptom onset.Data on neuroimaging correlates and therapeutic intervention on alexithymia in PD patients are still lacking.ConclusionAlthough results suggest that alexithymia is a primary characteristics of PD, further studies with larger patient samples are needed to definitively clarify the impact of alexithymia on the clinical features of PD patients.     

Living positively with dementia: a systematic review and synthesis of the qualitative literature

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.     

The clinical spectrum of late-onset Alexander disease: a systematic literature review

Following the discovery of glial fibrillary acidic protein (GFAP) mutations as the causative factor of Alexander disease (AxD), new case reports have recently increased, prompting a more detailed comprehension of the clinical features of the three disease subtypes (infantile, juvenile and adult). While the clinical pattern of the infantile form has been substantially confirmed, the late-onset subtypes (i.e., juvenile and adult), once considered rare manifestations of AxD, have displayed a wider clinical spectrum. Our aim was to evaluate the clinical phenotype of the adult and juvenile forms by reviewing the previously reported cases. Data were collected from previously published reports on 112 subjects affected by neuropathologically or genetically proven adult and juvenile Alexander disease. Although the late-onset forms of AxD show a wide clinical variability, a common pattern emerges from comparing previously reported cases, characterized by pseudo-bulbar signs, ataxia, and spasticity, associated with atrophy of the medulla and upper cervical cord on neuroimaging. Late-onset AxD cases can no longer be considered as rare manifestations of the disease. The clinical pattern usually reflects the topographic localization of the lesions, with adult cases displaying a predominant infratentorial localization of the lesions. Juvenile cases show clinical and radiological features which are intermediate between adult and infantile forms.     

Antenatal depression in East Asia: a review of the literature

This current study's goal is to summarize the literature regarding Antenatal Depression (AD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea. The main search utilized a Pub med Chinese Electronic Periodical Service (CEPS) literature review using keywords 'AD', and 'Prenatal Depression' with searches for 'Japan', 'Korea', 'Taiwan', 'Hong Kong' and Macau'. The rates of AD in East Asia appear to be relatively close to those in the Western literature, although certain studies showed slightly decreased rates. Many of the risk factors for AD were the same in the Eastern and Western literature. These risk factors included demographic factors such as younger age, smoking, low education and income, and unemployment. Other risk factors were physical symptoms such as menstrual pains and nausea. Finally, psychological factors such as a poor response to the pregnancy, poor spousal support, and poor family support were associated with AD. With regard to treatment, there were no studies examining the administration of psychotropic medications for AD. The literature from East Asia both confirmed many Western findings and made unique contributions to the literature on AD. The treatment of AD in East Asia appears to be an entity which, despite its morbidity, has not been adequately studied.     

Progress in clinical neurosciences: Status epilepticus: a critical review of management options

Although generalized tonic-clonic status epilepticus (SE) is frequently seen, an evidence-based approach to management is limited by a lack of randomized clinical studies. Clinical practice, therefore, relies on a combination of expert recommendations, local hospital guidelines and dogma based on individual preference and past successes. This review explores selected and controversial aspects of SE in adults and provides a critical appraisal of currently recommended management strategies.     

Relationship satisfaction in couples raising a child with autism spectrum disorder: A systematic review of the literature

BackgroundCouples raising a child with autism spectrum disorder (ASD) face challenges that may impact on their relationship. The purpose of this review was to compare relationship satisfaction in couples raising children with and without ASD and to identify factors associated with satisfaction in couples with a child with ASD.MethodsThirteen databases were searched and studies were systematically screened against predetermined inclusion criteria. Twenty six articles, ranging from good to strong methodological quality, met the criteria for inclusion. Of these, seven were included in a meta-analysis comparing relationship satisfaction in couples raising a child with ASD with couples raising children without disabilities.ResultsThe meta-analysis showed that couples raising a child with ASD were found to experience less relationship satisfaction than couples raising a child without a disability (Hedges’s g = 0.41, p < 0.001); however, evidence from the narrative synthesis was mixed when compared with couples raising children with other disabilities. The most consistent evidence implicated challenging child behaviours, parental stress and poor psychological wellbeing as risk factors, and positive cognitive appraisal and social support as protective factors.ConclusionFindings demonstrate that couples raising a child with ASD would benefit from support to assist them in maintaining satisfaction in their relationship with their partner. However, further studies are needed to gain a greater understanding of the risk and protective factors and how these co-vary with relationship satisfaction over time. A theoretical framework has been developed to scaffold future research.     

Paraphilias and paraphilic disorders in Parkinson's disease: A systematic review of the literature

Paraphilias are intense urges or behaviors involving non‐normative sexual interests. The newly approved diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) have established that, although paraphilias should not be regarded as inherently pathological, they ought to be qualified as paraphilic disorders if resulting in distress, impairment, or harm to the affected individual or others. Recent evidence documents that both phenomena can emerge as relatively uncommon iatrogenic consequences in Parkinson's disease (PD) patients. To outline the clinical characteristics of paraphilias and paraphilic disorders in PD patients, we summarized the available evidence on these phenomena. The review encompasses all studies on paraphilias in PD patients identified by a search on the Pubmed and Scopus online databases through May 2014. Twenty‐two case reports on a total of 31 PD patients with paraphilias or paraphilic disorders were identified. These phenomena were typically associated with dopaminomimetic treatment (with a mean levodopa‐equivalent daily dose of 1,303 ± 823 mg/d) in male patients with motor complications, young age at PD onset, and long disease duration. Paraphilias were highly concomitant with impulse‐control disorders or dopamine dysregulation syndrome. Although evidence on paraphilias and paraphilic disorders in PD patients remains anecdotal, available data point to these phenomena as likely sequelae of high‐dose dopaminomimetic treatment. Accordingly, the intensity of paraphilic urges is typically attenuated by the reduction of dopaminomimetic doses, sometimes in association with atypical antipsychotics. Failure to recognize paraphilic disorders may significantly impair the relational functioning of the affected PD patients. Practitioners should routinely inquire about paraphilias during their clinical assessment of PD patients. © 2015 International Parkinson and Movement Disorder Society     

Schizophrenia in homeless persons: a systematic review of the literature

OBJECTIVE: This article systematically reviews studies of prevalence of schizophrenia in homeless persons. METHOD: Medline and PsychInfo were searched using the key words: homeless person, mental illness, psychosis, and schizophrenia. The bibliographies of identified articles were also reviewed. RESULTS: Study designs varied considerably. The rate of schizophrenia in homeless persons reported in the 33 published reports, representing eight different countries, ranged from 2 to 45%. In the 10 methodologically superior studies, the prevalence range was 4-16% and the weighted average prevalence was 11%. In addition, rates were higher in younger persons, women and the chronically homeless. Slightly less than half of the homeless persons with schizophrenia were not currently receiving treatment. CONCLUSION: Schizophrenia is much more prevalent among homeless persons than in the population at large. Future research should focus on better ways of meeting the mental health care needs of homeless people with schizophrenia.     

Functional MRI in ADHD: a systematic literature review

Functional MRI (fMRI) research in attention-deficit/hyperactivity disorder (ADHD) is a fast developing and very complex field. Every study appears to show differences in patterns of brain activation between cases and controls, but the interpretation of such differences is not as straightforward as it may seem. We present here a systematic review of the fMRI literature in ADHD; areas covered include executive functions, reward processing, the effects of methylphenidate, comorbidity and spontaneous brain activity in the resting state. To facilitate the interpretation of research in this area, we discuss important conceptual issues, such as the need to take group differences in performance into account or to consider the role of errors. We present common themes that emerge from these studies and we discuss possible reasons for the many discrepancies that were observed. Finally, based on existing literature and current advancements in fMRI research, we discuss the role that fMRI could play in the future as a diagnostic tool or in treatment outcome predictions, and we make predictions for the future directions of research in this field.     

The identification of Parkinson's disease subtypes using cluster analysis: A systematic review

The clinical variability between patients with Parkinson's disease (PD) may point at the existence of subtypes of the disease. Identification of subtypes is important, since a focus on homogeneous groups may enhance the chance of success of research on mechanisms of disease and may also lead to tailored treatment strategies. Cluster analysis (CA) is an objective method to classify patients into subtypes. We systematically reviewed the methodology and results of CA studies in PD to gain a better understanding of the robustness of identified subtypes. We found seven studies that fulfilled the inclusion criteria. Studies were limited by incomplete reporting and methodological limitations. Differences between studies rendered comparisons of the results difficult. However, it appeared that studies which applied a comparable design identified similar subtypes. The cluster profiles “old age‐at‐onset and rapid disease progression” and “young age‐at‐onset and slow disease progression” emerged from the majority of studies. Other cluster profiles were less consistent across studies. Future studies with a rigorous study design that is standardized with respect to the included variables, data processing, and CA technique may advance the knowledge on subtypes in PD.© 2010 Movement Disorder Society     

Manganese and epilepsy: a systematic review of the literature

Manganese is an essential trace element for the development and function of the central nervous system. Alterations in manganese concentrations, whether excessive or deficient, can be accompanied by convulsions. This article represents a systematic review of available quantitative evidence that might clarify this issue. We searched The Cochrane Library, Medline and LILACS databases from January 1966 through June 2006 and reviewed all resulting English and Spanish language publications, as well as those possibly relevant in other languages based on their abstracts. The final selection included for this review comprises all investigations in humans and animals that compared manganese levels in any tissue of a group with spontaneous or induced convulsions (with or without antiepileptic treatment) and a convulsion-free control group. The literature search identified thirteen publications since then relevant to the issue, four of which failed to meet our criteria for inclusion. Of the remaining nine, six were in humans and three in rodents. At present, there is no satisfactory explanation for the relationship between low manganese levels and the presence of convulsions. There is a documented correlation between low blood manganese levels and the presence of convulsions in both humans and animals. The lack of evidence indicating whether this is a cause or an effect of the convulsions clearly justifies more detailed follow-up investigations in humans.     

Handedness correlates with the dominant Parkinson side: a systematic review and meta-analysis

Parkinson's disease (PD) characteristically presents with asymmetrical symptoms, contralateral to the side of the most extensive cerebral affection. This intriguing asymmetry, even included in the definition for diagnosing PD, however, is still part of a mystery. The relation with handedness as a common indicator of cerebral asymmetry might provide a clue in the search for causal factors of asymmetrical symptom onset in PD. This possible relationship, however, is still under debate. The objective of this study was to establish whether a relation between handedness and dominant PD side exists. We searched for cross-sectional or cohort studies that registered handedness and onset side in PD patients in PubMed, EMBASE, and Web of Science from their first record until 14 February 2011. Data about handedness and dominant PD side was extracted. Authors who registered both but not described their relation were contacted for further information. Odds ratios (ORs) were analyzed with a fixed effect Mantel-Haenszel model. Heterogeneity and indications of publication bias were limited. Our electronic search identified 10 studies involving 4405 asymmetric PD patients. Of the right-handed patients, 2413 (59.5%) had right-dominant and 1644 (40.5%) had left-dominant PD symptoms. For the left-handed patients this relation was reversed, with 142 (40.8%) right-dominant and 206 (59.2%) left-dominant PD symptoms. Overall OR was 2.13 (95% confidence interval [CI], 1.71-2.66). Handedness and symptom dominance in PD are firmly related with each other in such a way that the PD symptoms emerge more often on the dominant hand-side. Possible causal factors are discussed.