Parkinson’s disease sleep scale, sleep logs, and actigraphy in the evaluation of sleep in parkinsonian patients

The aim of this study was to compare the results of the day-to-day self-evaluation of sleep quality by sleep logs with Parkinson’s disease sleep scale (PDSS) in Parkinson’s disease (PD) patients. Actigraphy was used as an independent analysis of nighttime activity interfering with sleep. A total of 71 idiopathic PD patients and 21 age- and sex-matched normal individuals lacking any type of sleep disturbance were recruited. Sleep was evaluated by PDSS, 7-d sleep log and actigraphy. Sleep logs and PDSS showed reduced sleep quality and daytime somnolence scores in moderate/severe PD patients as compared to healthy controls. Significant correlations were found between sleep quality in sleep logs and all domains of PDSS sleep quality, except for the presence of nocturia, which correlated with nocturnal activity. PD severity and depression were the only predictors of reduced sleep quality. The retrospective and day-to-day sleep self-evaluations were coincident. Reduced sleep quality was related to increased PD severity and depression scores.     

The impact of sleep and mood disorders on quality of life in Parkinson’s disease patients

Sleep disturbances are common and often severe in patients with Parkinson’s disease (PD) and their symptoms can be present at any time of day. The purpose of our study was to examine how excessive daytime sleepiness or poor nocturnal sleep quality and mood disorders influence the quality of life (QoL) in PD patients. Ninety-three PD patients from eastern Slovakia were recruited (49.5% males, mean age 68.0 ± 9.5 years, mean disease duration 6.1 ± 5.9 years). Sleep disturbances were measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI); QoL with the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39); depression and anxiety with the Hospital Anxiety and Depression Scale (HADS) and disease severity with the Unified Parkinson’s Disease Rating Scale (UPDRS). χ ² test, bivariate correlations and multiple linear regressions were performed. PSQI and ESS had significant correlations with worse QoL (p < 0.01, p < 0.05, respectively). HADS-D (p < 0.01), HADS-A (p < 0.01), UPDRS (p < 0.01) and disease duration (p < 0.05) were also significantly related to worse QoL. In the linear regression analysis, however, only PSQI (p < 0.01), anxiety (p < 0.001) and UPDRS (p < 0.001) remained significant. The model with PSQI explained 74% of the variance, and the model with ESS explained 63% of the variance in PDQ-39 when analyses were performed separately. In an overall model, however, only PSQI remained significant, accounting for 82% of the variance in PDQ-39. Nighttime poor sleep and anxiety are important contributors leading to a worse QoL. As these are treatable conditions, they should be recognized by clinicians and managed properly.     

Observational study of sleep-related disorders in Italian patients with Parkinson’s disease: usefulness of the Italian version of Parkinson’s disease sleep scale

Sleep disturbances are common in patients with Parkinson's disease (PD). We aimed to evaluate prevalence and severity of nighttime sleep disturbances in Italian PD patients and to validate the Italian version of the Parkinson's disease sleep scale. A total of 221 PD patients and 57 healthy controls participated in a cross-sectional study with retest. PDSS, Epworth Sleepiness Scale (ESS), Hamilton Depression Rating Scale, Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr staging were applied. PDSS total and individual items scores from patients were significantly lower than those in controls. Internal consistency of PDSS scale was satisfactory and intraclass correlation coefficient for test-retest reliability was 0.96 for total PDSS score. A significant negative correlation was found between total PDSS and ESS scores, and between total PDSS and HDRS scores. PDSS scores were also related to UPDRS sections II, III and IV, and H&Y stage. PDSS and ESS scores were not related to levodopa equivalent dose. Daytime sleepiness, depressive symptoms and disease severity correlate with sleep disturbances in Italian PD patients. The PDSS is a valid and reliable tool to evaluate sleep disturbances in Italian patients.     

Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson’s disease

The objective of this study is to assess how the non-motor symptoms of Parkinson’s disease (PD), such as depression, cognitive deterioration, neuropsychiatric and sleep disorders, affect the quality of life, and to compare them with the motor symptoms in order to determine their real impact. A cross-sectional study was designed including 99 patients (mean age 68.5 ± 9.9 years, duration of disease 8.7 ± 6.2 years). Demographic data, onset of PD, years on treatment with levodopa (LD), class of dopaminergic drug prescribed, and dosages were obtained. The following scales were used: quality of life (PDQ-39), Unified Parkinson’s Disease Rating Scale (UPDRS I–IV), Parkinson Disease Sleep Scale (PDSS) and daytime sleepiness (Epworth), Mini-Mental State Examination, depression (HAM-D), and the neuropsychiatric inventory (NPI-10). The PDQ-39 summary index (PDQ-39 SI) was 24.7 ± 13.2. A linear regression model including all variables showed that four independent variables accounted for 67.2% of the variance in the PDQ-39 SI (F = 33,277; p < 0.001): NPI, PDSS, UPDRS IV, and UPDRS I. When sub-items of the NPI, PDSS and UPDRS IV scales are analyzed, significant correlations (p < 0.001) are found between the PDQ-39 SI and depression, agitation, apathy, anxiety, hallucinations, delusions, incontinence of urine, morning painful posturing, restlessness in bed, morning fatigue, duration of off periods, unpredictable and predictable off periods, early morning dystonia, and sudden off periods. Neuropsychiatric symptoms, especially depression, nighttime sleep disorders such as urinary incontinence, nighttime restlessness, morning fatigue and somnolence, off-period dystonia and motor fluctuations are the variables that most affect the quality of life of patients with PD.     

Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?

Objective

Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing.

Changes in the blood–brain barrier status closely correlate with the rate of disease progression in patients with multiple system atrophy: A longitudinal study

BackgroundThe pathomechanisms responsible for disease progression in multiple system atrophy are unknown. The blood–brain barrier status may act as a modifier of disease progression in neurodegenerative diseases.MethodsWe evaluated the 12-month longitudinal change of the blood–brain barrier in 16 multiple system atrophy patients and analyzed its correlation with changes in clinical severity.ResultsThe baseline blood–brain barrier index did not correlate significantly with change in disease severity. However, changes in the blood–brain barrier indices over 12 months had significant positive correlations with changes in total unified multiple system atrophy rating scale (r = 0.56, p = 0.024) and part II scores (r = 0.56, p = 0.025). These correlation coefficients were higher after adjusting for baseline neurological deficits.ConclusionsThese data suggest that changes in the blood–brain barrier status are closely coupled with the rate of disease progression in multiple system atrophy, potentially acting as a contributor to disease progression.     

Maintenance of wakefulness test: how does it predict accident risk in patients with sleep disorders?

Study ObjectiveTo determine whether the objective level of alertness measured by the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents related to sleepiness in patients with sleep disorders.MethodsThis case-control study was conducted over a three–year period in four French sleep centers during a 4140 min MWT in patients driving more than 5000 Km/year. Relationship between mean sleep latency on the MWT (MWT latency) and age, sex, driving, sleepiness-related near misses and accidents reported during the previous year, and sleep disorder characteristics was analyzed.ResultsOf 377 patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome, 176 were included. 74 cases reported an accident or near miss related to sleepiness at the wheel in the past year, and 102 reported no accident/near miss (control patients). Thirty-one (37.8 %) cases and 9 (8.8 %) controls reported being sleepy at the wheel more than once a week (p < 0.0001). After adjusted regression analyses, patients with MWT latency between 19 and 33 minutes had a 3.2- (CI 95%[1.5; 6.8], p < 0.0001) fold increase in risk of reporting a near miss/ accident and patients with MWT latency <19 min had a 5.5- (CI 95%[2.2; 13.8], p = 0.003) fold increase in this risk, compared to the referent group (MWT latency>33 min).ConclusionsMWT latency is associated with self-reported, sleepiness-related near misses and accidents related to sleepiness in the past year in patients routinely investigated in sleep clinics. The MWT could be used to assess driving risk together with clinical interviews assessing sleepiness at the wheel.     

Impulse control disorders in Parkinson’ disease: the role of personality and cognitive status

This study reviews empirical findings on two debated issues related to the phenomenon of impulse control disorders (ICD) in patients with Parkinson’s disease (PD) treated with dopamine agonists: the role of “premorbid” or “baseline” personality traits and the role of cognitive status. A review of both these issues may help clinicians to understand why only some PD patients, when treated with dopamine agonists, develop an ICD: besides the treatment, which other neuropsychiatric characteristics represent a risk factor to develop an ICD? A literature review was performed on studies of ICD in PD patients, in electronic databases ISI Web of Knowledge, Medline and PsychInfo, conducted in January 2011. In the general population, impulsivity, depression and difficulties with executive functions, especially of inhibitory control, are factors associated with ICD development. As regards cognitive functions, PD patients present executive difficulties, and patients with ICD present more difficulties in comparison to patients without ICD. As regards personality characteristics, PD patients present a trait of negative affect, which could predispose them to affective disorders and could represent an affective risk factor for the development of ICD; as regards impulsivity, preliminary findings support the hypothesis that premorbid “baseline” levels may moderate the decrease of impulsivity because of the progressive dopaminergic deficit in PD patients and therefore also moderate the development of ICD. Longitudinal psychometric and cognitive studies, following PD patients since the clinical diagnosis and during dopaminergic treatment, are needed to confirm the role of personality traits and cognitive status on ICD development in this clinical population.     

Perception of sleep: Subjective versus objective sleep parameters in patients with Parkinson’s disease in comparison with healthy elderly controls

Introduction Subjective sleep perception, as measured against objective parameters such as those obtained by polysomnography, have not been examined thoroughly to date. Little is known about subjective sleep perception in patients with chronic somatic diseases. Patients and methods Patients with Parkinson’s disease (PD) and healthy elderly controls filled in a sleep log over 14 days, which included a self–rating questionnaire concerning sleep and quality of time awake, sleep times and somatic complaints. All participants underwent polysomnography in the sleep lab on nights 7 and 8, and slept all other nights at home. Results Seventeen patients with PD (64 ± 6 years, 6 female, Hoehn and Yahr median = 2), and 62 healthy controls of the same age without sleep disturbances (64 ± 8 years, 36 female) were included. Patients with PD showed reduced subjective sleep (p = 0.001) and quality of time awake (p = 0.02), decreased sleep duration (p = 0.01) and reduced sleep efficiency (p = 0.004) compared with the controls. Subjective sleep efficiency at home was no different from that in the sleep lab for both groups. Patients with PD reported more somatic complaints (p = 0.001) than controls but did not show a firstnight effect. Conclusion In summary, patients with PD have subjectively and objectively disturbed sleep as compared to healthy controls of the same age. However, they may not rate this poor sleep as much changed from their baseline sleep at home, and they have more somatic complaints. Increasing sleep efficiency might be of importance in PD patients, as it shows an association with subjective quality of time awake in the morning.     

The internal auditory clock: what can evoked potentials reveal about the analysis of temporal sound patterns, and abnormal states of consciousness?

Whereas in vision a large amount of information may in theory be extracted from instantaneous images, sound exists only in its temporal extent, and most of its information is contained in the pattern of changes over time. The "echoic memory" is a pre-attentive auditory sensory store in which sounds are apparently retained in full temporal detail for a period of a few seconds. From the long-latency auditory evoked potentials to spectro-temporal modulation of complex harmonic tones, at least two automatic sound analysis processes can be identified whose time constants suggest participation of the echoic memory. When a steady tone changes its pitch or timbre, "change-type" CP1, CN1 and CP2 potentials are maximally recorded near the vertex. These potentials appear to reflect a process concerned with the distribution of sound energy across the frequency spectrum. When, on the other hand, changes occur in the temporal pattern of tones (in which individual pitch changes are occurring at a rate sufficiently rapid for the C-potentials to be refractory), a large mismatch negativity (or MN1) and following positivity (MP2) are generated. The amplitude of these potentials is influenced by the degree of regularity of the pattern, larger responses being generated to a "deviant" tone when the pitch and time of occurrence of the "standards" are fully specified by the preceding pattern. At the sudden cessation of changes, on resumption of a steady pitch, a mismatch response is generated whose latency is determined with high precision (in the order of a few milliseconds) by the anticipated time of the next change, which did not in fact occur. The mismatch process, therefore, functions as spectro-temporal auditory pattern analyser, whose consequences are manifested each time the pattern changes. Since calibration of the passage of time is essential for all conscious and subconscious behaviour, is it possible that some states of unconsciousness may be directly due to disruption of internal "clocks"? Abnormal mismatch potentials may provide a manifestation of a disordered auditory time-sense, sometimes being abolished in comatose patients while the C-potentials and similar responses to the onset of tones are preserved. Both C- and M-potentials were usually found to be preserved, however, in patients who had emerged from coma and were capable of discriminating sounds. Substantially intact responses were also recorded from three patients who were functionally in a "vegetative" state. The C- and M-potentials were once again dissociated in a group of patients with multiple sclerosis, only the mismatch potentials being found to be significantly delayed. This subclinical impairment of a memory-based process responsible for the detection of change in temporal sound patterns may be related to defects in other memory domains such as working memory.     

The “enhanced N35” somatosensory evoked potential: its associations and potential utility in the clinical evaluation of dystonia and myoclonus

In median nerve somatosensory evoked potentials, the cortical N35 amplitude sometimes exceeds the P25 amplitude (C3’/C4’ referred to Fz; “enhanced N35” feature). Six hundred consecutive patient median nerve SEPs were retrospectively analysed and compared with 27 controls. The feature was more often present in patients with dystonia (62%) than in patients with other disorders (22%; relative risk for the condition 2.8; Fisher’s exact p = 0.003) or control subjects (7.4%; odds ratio 20; p = 0.0006). Similarly, the feature was more often present in patients with myoclonus (38%) than in patients with other disorders (22%; relative risk 1.7; p = 0.02) or control subjects (odds ratio 7.5; p = 0.006).There was no clear relationship of the feature to short latency SEP abnormalities except in cases of myoclonus. Further comparison was made of the characteristics of 72 patients each, with and without the feature, whose short latency SEP components were normal. The relationship of the feature to dystonia or myoclonus held true in this case-controlled arm of the study. The sensitivity and specificity were 65% and 78% respectively for any form of dystonia; 43% and 79% respectively for any form of myoclonus. The feature was even more specific in both conditions when compared with controls (93%). Most cases of dystonia with an identifiable cause in this study were of secondary forms. It is known that this feature often occurs in association with “giant” SEPs in some myoclonic conditions. However, its occurrence in dystonia may be a useful new finding in an established test, helping to identify a condition where there is increasing evidence for disordered sensorimotor integration. Received in revised form: 13 January 2006     

Functional evaluation of central cholinergic circuits in patients with Parkinson’s disease and REM sleep behavior disorder: a TMS study

Central cholinergic dysfunction has been reported in patients with Parkinson?s disease (PD) and hallucinations by evaluating short latency afferent inhibition (SAI), a transcranial magnetic stimulation protocol which gives the possibility to test an inhibitory cholinergic circuit in the human brain. REM sleep behavior disorder (RBD) was also found to be associated with cognitive impairment in PD patients. The objective of the study was to assess the cholinergic function, as measured by SAI, in PD patients with RBD (PD-RBD) and PD patients without RBD (PD-nRBD). We applied the SAI technique in 10 PD-RBD patients, in 13 PD-nRBD patients and in 15 age-matched normal controls. All PD patients and control subjects also underwent a comprehensive battery of neuropsychological tests. Mean SAI was significantly reduced in PD-RBD patients when compared with PD-nRBD patients and controls. Neuropsychological examination showed mild cognitive impairment in 9 out of the 10 PD-RBD patients, and in 5 out of the 13 PD-nRBD. SAI values correlated positively with neuropsychological tests measuring episodic verbal memory, executive functions, visuoconstructional and visuoperceptual abilities. Similar to that previously reported in the idiopathic form of RBD, SAI abnormalities suggest a cholinergic dysfunction in PD patients who develop cognitive impairment, and present findings indicate that RBD is an important determinant of MCI in PD.     

Glycogen synthase kinase-3β in the platelets of patients with mood disorders: Effect of treatment

Glycogen synthase kinase (GSK)-3β, an important component of the Wnt signaling pathway, is involved in numerous cellular functions. That GSK-3β may be involved in the pathophysiology of bipolar (BP) illness is based on the observation that lithium, a mood-stabilizing drug, inhibits GSK-3β both in vitro and in vivo.We determined the protein expression of GSK-3β in the cytosol and membrane fractions of the platelets obtained from patients with major depressive disorder (MDD) and BP illness, before treatment and after treatment with antidepressants or mood-stabilizing drugs, respectively. Protein expression was determined using the Western blot technique.We observed that the protein expression of GSK-3β was significantly reduced in the membrane and cytosol fractions of platelets from drug-free patients with BP illness, but not from the drug-free patients with MDD, compared with normal control subjects. Treatment with mood-stabilizing drugs significantly increased the protein expression of GSK-3β in the membrane and cytosol fractions of platelets from BP patients compared with pre-treatment levels, and the post-treatment levels were similar to those observed in normal control subjects. On the other hand, there was no significant effect of treatment with antidepressants on GSK-3β protein expression either in the membrane or in the cytosol fractions of platelets from MDD patients.These results suggest that GSK-3β may play an important role in the pathophysiology of BP illness but not MDD and that its abnormality may be corrected by treatment with mood-stabilizing drugs, suggesting that GSK-3β may be a state rather than a trait marker for BP illness.     

The screening of Alzheimer’s patients with CSF biomarkers,modulates the distribution of APOE genotype: impact on clinical trials

Polymorphism of the apolipoprotein E gene (APOE) plays a role in the level of neuropathological lesions and in drug response in Alzheimer’s disease (AD). The aim of this study was to investigate whether the selection of AD patients based on cerebrospinal fluid (CSF) biomarkers assessment may be biased by their APOE distribution. We studied the relationships between APOE genotype and CSF biomarkers levels in a total of 432 patients (AD, n = 244; non-AD, n = 188) explored for cognitive disorders. We studied the distribution of APOE genotypes among AD patient subgroups selected by various cut-offs of CSF biomarkers. Strategies of screening based on CSF Aβ1–42 lead to overselection of ε4/ε4 patients in the AD group. Screening based on tau levels did not change Apoe4 distribution in the AD group. CSF Aβ1–42 discriminated better AD patients with at least one ε4 than AD patients with no ε4. A strong allele-effect relationship was detected between APOE genotype and CSF amyloid-β (Aβ1–42) in AD patients. Selecting AD patients on CSF amyloid levels only may create an overselection of ε4/ε4 carriers, and might potentially bias the population of patients included in clinical trial studies.     

The relationship between carers’ report of autistic traits and clinical diagnoses of autism spectrum disorders in adults with intellectual disability

It is often difficult to determine the triad of impairments and whether autistic features are the consequence of intellectual impairment or autism spectrum disorders in people with intellectual disability (ID). The aim of the current study was to investigate the relationship between carer-reported autistic traits and independent diagnoses of autism spectrum disorders (ASD). Data were collected on carers’ subjective report of autistic traits and clinical diagnoses of ASD. Of 1145 adults with ID identified, 220 (19%) individuals had a diagnosis of ASD, and 778 (68%) individuals had at least one autistic trait. Optimal sensitivity and specificity were achieved with two or more autistic traits (sensitivity 63%; specificity 79%) and the positive predictive value increased substantially as the number of autistic traits increased. However, a significant proportion of individuals with ID who did not have a diagnosis of ASD also displayed autistic traits. Our findings suggest that in the absence of other measures, the presence of autistic traits can serve as a useful proxy measure for ASD in research (and/or clinical settings). However, although information on autistic traits may help healthcare practitioners to identify people with possible ASD, it cannot be used alone to make a formal diagnosis.     

Over-specialization versus synergy in neuroscience:professionals’integration is more than the sum of its parts

Health care systems in industrialized countries are built around acute health problems(Etzwiler,1997).This approach is successful when the goal is to improve or overcome pathologies that result in severe health issues or death.With the recent tremendous improvement of the treatments of life-threatening conditions,the clinical focus has moved from short term results to the overall expected quality of life and longterm outcomes.Unfortunately,the new objectives imply to consider a multitude of interacting processes and variables.In fact,a complex interplay of biological systems(nervous,immune,and endocrine)works together in an integrated and synergistic way to deal with a constantly evolving environment,determining our physical,behavioral,and psychological/subjective conditions.This interplay is the mechanism that allows us to adapt promptly and appropriately to circumstances,the key feature for successful living.     

40 Hz auditory steady-state responses in patients with disorders of consciousness: Correlation between phase-locking index and Coma Recovery Scale-Revised score

Objective

We aimed to elucidate whether 40 Hz auditory steady-state response (ASSR) could be sensitive to the state of patients with disorders of consciousness (DOC) as estimated with Coma Recovery Scale-Revised (CRS-R) diagnostic tool.