Duodenal levodopa/carbidopa infusion therapy in patients with advanced Parkinson’s disease leads to improvement in caregivers’ stress and burden

Background: Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson’s disease (PD). However, the impact of DLI on caregivers’ stress and burden has not been reported. Methods: We evaluated prospectively open‐label seven advanced PD patients (65.7 ± 9.6 years, 71.4% men) treated with DLI. Schwab & England Activities of Daily Living Scale (ADLS), 39‐item Parkinson’s disease QoL Questionnaire Summary Index score (PDQ‐39SI), Zarit Caregiver Burden Interview (ZCBI), and Caregiver Strain Index (CSI) were used. Comparisons were made between scores obtained at baseline and those at a mean follow‐up of 31.4 ± 7.9 months (range, 23–42). Results: In patients, mean ± SD ADLS was increased from 50 ± 8.2 to 80 ± 11.6 (P = 0.014), and mean ± SD PDQ‐39SI was decreased from 53.7 ± 11.9 to 33.6 ± 12.8 (P = 0.018). In caregivers, ZCBI decreased from 43 ± 13.3 to 20.7 ± 12.1 (P = 0.018) and CSI from 6.3 ± 2.5 to 1.6 ± 0.9 (P = 0.018). At baseline, 57.1% of caregivers reported moderate to severe burden (ZCBI 41–88) compared to 28.6% at the end of the follow‐up (P = 0.015); at that time, no caregiver reported high level of stress (CSI ≥ 7) compared to 57.1% at baseline (P = 0.046). There were significant correlations between ZCBI and CSI improvement (r = 0.813, P = 0.026), ZCBI and PDQ‐39SI (r = 0.875, P = 0.01), and ZCBI and ADLS (r = 0.813, P = 0.026). Conclusions: Duodenal levodopa infusion‐related clinical improvement in patients with advanced PD leads to substantial reductions in caregivers’ stress and burden.     

Comparison of dysphagia before and after deep brain stimulation in Parkinson's disease

Although dysphagia is a common problem for many Parkinson's disease (PD) patients, the effect of deep brain stimulation (DBS) on swallowing is unclear. Fourteen subjects with advanced PD underwent videofluorographic swallowing studies prior to bilateral DBS of the subthalamic nucleus (STN) and at 3 and 12 months postprocedure. They were tested under several stimulation and medication conditions. Subjects completed the Dysphagia Handicap Index at each time. There was a strong trend toward improved swallowing response for solid intake in the medication‐free condition with the stimulator on compared with the stimulator off (P = .0107). Also, there was a trend toward improved oral preparation of thin liquids (P = .0368) in the medication‐free condition when the stimulator was on versus off 12 months later. The remaining swallowing parameters showed no change or worsening of swallowing function regardless of stimulator or medication status. Results of the Dysphagia Handicap Index revealed significant improvement in subject self‐perception of swallowing 3 and 12 months following the procedure compared with baseline on the functional subscale (P = .020 and P = .010, respectively), the emotional subscale (P = .013 and P = .003, respectively), and the total score (P = .025 and P = .003, respectively). These data suggest that bilateral STN‐DBS does not substantively impair swallowing in PD. In addition, it may improve motor sequencing of the oropharyngeal swallow for solid consistencies (which are known to provide increased sensory feedback to assist motor planning of the oropharyngeal swallow). Subjects with advanced PD who are undergoing DBS may perceive significant improvement in swallowing ability despite the lack of objective improvements in swallowing function. © 2012 Movement Disorder Society     

Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being

Santos‐García D, Sanjurjo LF, Macías M, Llaneza M, Carpintero P, de la Fuente‐Fernández R. Long‐term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well‐being.
Acta Neurol Scand: 2012: 125: 187–191.
© 2011 John Wiley & Sons A/S. Background – Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson′s disease (PD). However, in which aspects improve the patients their QoL has been poorly documented. Methods – We evaluated 39‐item Parkinson′s disease Quality of Life Questionnaire Summary Index score (PDQ‐39SI) changes analyzing its different domains in nine patients with advanced PD treated with DLI. Results – All the patients (64.7 ± 11.1 years, 55.5% men) improved PDQ‐39SI 6 months after beginning with DLI (29.7 ± 8.6, P = 0.008) and after median duration infusion of 25.3 ± 8.8 months (34.8 ± 11.2, P = 0.008) compared with baseline (55.6 ± 11.5). All domains except social support improved significantly at 6 months. Mobility (P = 0.012), activities of daily living (P = 0.015), and emotional well‐being (P = 0.008) improved significantly at the end of the follow‐up. Conclusions– DLI improves QoL in patients with advanced PD after short‐ and long‐term exposure. Whereas all domains except social support improve after 6 months under DLI, only mobility, activities of daily living and emotional well‐being improve significantly after long‐term exposure to DLI.     

Myasthenia gravis: sleep quality, quality of life, and disease severity

Introduction: There is much research on quality of life in myasthenia gravis (MG), and its relationship to disease severity is well‐established. However, evidence regarding sleep disturbance in MG is inconclusive. Methods: To evaluate sleep and quality of life among clinically stable MG patients, 54 subjects were investigated by means of the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and 15‐Item‐Quality‐Of‐Life Instrument for MG (MG‐QOL15). Results: A pathological PSQI score, which was observed in 59% of patients, was increased in subjects with active disease compared with patients in clinical remission [odds ratio = 4.3; confidence interval 95% (1.0–17.6); P = 0.04]. We found a relationship between PSQI and MG‐QOL15 scores in patients with clinically active disease (r = 0.62; P < 0.001). Conclusions: Our study highlights the high prevalence of sleep disturbance among MG patients. Disease severity may be considered to be a MG‐specific risk factor for patient‐reported sleep disturbance. The MG‐QOL15 and PSQI should be used to estimate the impact of the disease on sleep and quality of life. Muscle Nerve 46: 174–180, 2012     

Quality of life in early Parkinson's disease treated with levodopa/carbidopa/entacapone

We aimed to investigate whether treatment with levodopa/carbidopa/entacapone when compared with levodopa/carbidopa improves quality of life in Parkinson's disease (PD) patients with no or minimal, nondisabling motor fluctuations. This is a multicenter, randomized, double‐blind study. One hundred eighty‐four patients on 3 to 4 equal doses of 100/25 to 200/50 mg levodopa/carbidopa or levodopa/benserazide, 0 to 3 hours of nondisabling OFF time over a 48 hour period and no dyskinesia were randomized to levodopa/carbidopa/entacapone or levodopa/carbidopa treatment for 12 weeks. The primary outcome measure was quality of life as assessed by the PDQ‐8. Secondary outcome measures were the UPDRS parts I–IV, and the Wearing Off Card. Treatment with levodopa/carbidopa/entacapone resulted in significantly greater improvements in PDQ‐8 scores compared to treatment with levodopa/carbidopa (mean difference 1.4 points, P = 0.021). Statistically significant improvements were seen predominantly in nonmotor domains (depression, personal relationships, communication, stigma, all P < 0.05; dressing P = 0.056). Patients who were randomly assigned to levodopa/carbidopa/entacapone also showed significantly greater improvement in UPDRS part II scores (P = 0.032) with UPDRS part III scores showing borderline significance. Differences in UPDRS parts I and IV and Wearing Off Card scores were not significant. Treatment with levodopa/carbidopa/entacapone results in improved quality of life compared with levodopa/carbidopa in PD patients with mild or minimal, nondisabling motor fluctuations. © 2007 Movement Disorder Society     

Quality of life in young‐ compared with late‐onset Parkinson's disease

The impact of Parkinson's disease on quality of life may vary depending on age at onset. We investigated the effect of age at onset on quality of life in a large Parkinson's disease population (n = 426) using a disease‐specific rating scale (PDQ‐39) and with careful adjustment for confounding and intermediary factors. We also explored the relationship between depression and excessive daytime sleepiness by age at onset and compared this with the general population. We found that a younger age at onset was significantly associated with worse overall quality of life scores (odds ratio, 2.66; 95% confidence interval, 1.39–5.09; P = .003), but this was attenuated by adjustment for depression as an intermediary factor (odds ratio, 1.86; 95% confidence interval, 0.84–4.11; P = .13). Younger onset was also a risk factor for poor emotional well‐being independent of depression status. Risk of depression and excessive daytime sleepiness were elevated in patients with Parkinson's disease compared with controls (odds ratio, 2.99; 95% confidence interval, 1.93–4.65; P < .001; and odds ratio, 3.84; 95% confidence interval, 2.56–5.75; P < .001, respectively), with similar findings seen in both early‐ and late‐onset groups. Our study highlights the need for accurate diagnosis and treatment of depression in younger‐onset patients in order to improve quality of life. © 2011 Movement Disorder Society     

Nonmotor symptoms are independently associated with impaired health‐related quality of life in Chinese patients with Parkinson's disease

We performed a cross‐sectional study of 82 Chinese patients with Parkinson's disease (PD) enrolled during an 18‐month period using a clinical interview to assess the prevalence of nonmotor symptoms (NMS), the association with disease severity and motor status, and the impact on patients' health‐related quality of life (Hr‐QoL). The patients' NMS, Hr‐QoL, disease severity, and motor status were assessed by the Nonmotor Symptoms Scale (NMSS), the 39‐item Parkinson's Disease Questionnaire (PDQ‐39), the modified Hoehn and Yahr staging scale (H&Y) and the Unified Parkinson's Disease Rating Scale part III (UPDRS III), respectively. We found that 100% of patients with PD presented with NMS. The NMSS significantly correlated with disease duration (Spearman's r_S = 0.276, P = 0.012), H&Y (r_S = 0.230, P = 0.038), and UPDRS III (r_S = 0.350, P = 0.001). Similarly, the PDQ‐39 SI significantly associated with the disease duration (r_S = 0.258, P = 0.019), H&Y (r_S = 0.340, P = 0.002), and UPDRS III (r_S = 0.453, P < 0.001). NMS domains that influenced the PDQ‐39 SI were sleep/fatigue, mood, gastrointestinal, urinary, and miscellaneous symptoms. This strongly suggested that the five domains played a key role in the manifestation of Hr‐QoL. NMSS explains more of the variability in Hr‐QoL than UPDRS III, when both are the model (stepwise multiple linear regression analysis R² change, 47.8% vs. 5.87%, respectively). Therefore, these findings demonstrate that NMS are independently and negatively associated with Hr‐QoL in PD and that improving NMS should be viewed as an important part in the management of PD. © 2010 Movement Disorder Society     

Gastrointestinal‐specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS

Background Gastrointestinal (GI)‐specific anxiety (GSA) has been proposed to influence symptom severity and quality of life (QOL) in patients with irritable bowel syndrome (IBS). The Visceral Sensitivity Index (VSI) is a recently developed, reliable and valid measure of GSA. Our aim was to evaluate the association between GSA, GI symptom severity, and QOL in IBS patients. Methods Sixty healthy subjects and 306 patients fulfilling the Rome II criteria for IBS were studied. Demographic and disease‐related factors were assessed. Patients completed VSI and GI Symptom Rating Scale (GSRS) and questionnaires to determine psychological symptom severity (Hospital Anxiety and Depression Scale), QOL (Short form 36), and presence of functional GI disorders (Rome II Modular Questionnaire). Key Results Compared with healthy subjects, patients with IBS had more severe GSA (34.7 ± 16.9 vs. 2.2 ± 4.4 [mean ± standard deviation]; P < 0.0001). In the IBS group, more severe GSA was seen in patients with more severe GI symptoms (P < 0.0001), general anxiety (P < 0.0001) and depression (P < 0.0001), and with lower socioeconomic status (P < 0.05). In a regression analysis, GSA was the strongest predictor for GI symptom severity (GSRS total score), followed by number of Rome II diagnoses, presence of meal‐related IBS symptoms, and gender (R² = 0.34). Gastrointestinal‐specific anxiety was also, together with general anxiety, depression, socioeconomic status, and gender, found to be independently associated with mental QOL (R² = 0.62). Conclusions & Inferences Gastrointestinal‐specific anxiety seems to be an important factor for GI symptom severity and QOL in patients with IBS.     

Health‐related quality‐of‐life and treatment targets in myasthenia gravis

Introduction: The aim of this study was to determine factors affecting health‐related quality of life (HRQOL) and to propose appropriate treatment targets for patients with myasthenia gravis (MG). Methods: We evaluated 640 consecutive patients with MG seen at 11 neurological centers. Two‐year follow‐up data were obtained for 282 patients. Correlations between detailed clinical factors and the Japanese version of the 15‐item MG‐specific QOL scale score were analyzed. Results: In a cross‐sectional analysis of 640 MG patients, multivariate regression revealed that disease severity, as evaluated by the MG Composite (P < 0.0001), total dose of oral prednisolone during the last year (P = 0.002), and Cushingoid appearance index (P = 0.0004), showed significant negative effects on HRQOL, but the quantitative MG score and current prednisolone dose did not. Conclusions: Achieving minimal manifestations (MM) status or better with prednisolone ≤5 mg/day was found to exert a major positive impact on HRQOL in both the cross‐sectional and 2‐year follow‐up patient samples and can be recommended as a treatment target. Muscle Nerve 50: 493–500, 2014     

Rivastigmine for mild cognitive impairment in Parkinson disease: A placebo‐controlled study

Mild cognitive impairment (MCI) in Parkinson's disease (PD) may be associated with subtle functional impairment and worse quality of life. The objective of this study was to determine the efficacy and tolerability of rivastigmine for PD‐MCI. Patients with PD‐MCI (n = 28) were enrolled in a 24‐week, randomized, double‐blind, placebo‐controlled, crossover, single‐site study of the rivastigmine transdermal patch. The primary outcome measure was the Alzheimer's Disease Cooperative Study—Clinical Global Impression of Change (ADCS‐CGIC). Secondary outcomes included the Montreal Cognitive Assessment (MoCA), Dementia Rating Scale‐2 (DRS‐2), Neurotrax computerized cognitive battery, the Everyday Cognition Battery (ECB), and the Parkinson's Disease Questionnaire (PDQ‐8). Twenty‐six participants (92.9%) completed both study phase assessments, and 23 (82.1%) completed both phases on study medication. The CGIC response rate demonstrated a trend effect in favor of rivastigmine (regression coefficient for interaction term in linear mixed‐effects model = 0.44, F[df] = 3.01 [1, 24], P = 0.096). For secondary outcomes, a significant rivastigmine effect on the ECB (regression coefficient = –2.41, F[df] = 5.81 [1, 22.05], P = 0.03) was seen, but no treatment effect was found on any cognitive measures. Trend effects also occurred in favor of rivastigmine on the PDQ‐8 (regression coefficient = 4.55, F[df] = 3.93 [1, 14. 79], P = 0.09) and the State Anxiety Inventory (regression coefficient = –1.24, F[df] = 3.17 [1, 33], P = 0.08). Rivastigmine in PD‐MCI showed a trend effect for improvements on a global rating of cognition, disease‐related health status, and anxiety severity, and significant improvement on a performance‐based measure of cognitive abilities. © 2015 International Parkinson and Movement Disorder Society     

Fatigue in Japanese patients with Parkinson's disease: A study using Parkinson fatigue scale

The objective of this multicenter cross‐sectional study was to determine the prevalence of fatigue and factors contributing to it in a large sample of Japanese patients with Parkinson's disease (PD). We used the 16‐item Parkinson Fatigue Scale (PFS‐16), which was designed to assess fatigue exclusively associated with PD. We carried out this study using PFS‐16, the Unified Parkinson's Disease Rating Scale, Zung's Self‐Rating Depression Scale, Parkinson's Disease Sleep Scale (PDSS), and the PD quality of life (QOL) scale (PDQ‐39) by interview using questionnaires and physical examination by neurologists in 361 nondemented PD patients. Fatigue (an average PFS score of 3.3 or greater) was revealed in 151 patients (41.8%). Multiple logistic regression analysis indicated that the significant independent variables related to the presence of fatigue were the scores of PDSS and PDQ‐39. Depression score was not a significant contributing factor. Our study revealed that the prevalence of fatigue in Japanese PD patients is as high as that in Western countries, and that fatigue is a relatively independent symptom, although sleep disturbance may be associated with fatigue. Since fatigue is significantly related to QOL reduction, therapeutic interventions including treatment of sleep disturbance are important. © 2009 Movement Disorder Society     

Posturography reflects clinical imbalance in Parkinson's disease

Assessment of imbalance in idiopathic Parkinson's disease (IPD) usually relies on semi‐quantitative ratings. Posturography has been proposed as an objective means to assess imbalance but its relationship to clinical disequilibrium is questionable. In this study static and dynamic posturography was performed in 58 patients with IPD and 29 healthy controls. In patients, posturography was related to performance in established clinical tests (pull‐test and tandem gait). Posturography did not differentiate between controls and patients with impaired pull‐test (IPDimb, n = 28). Patients with normal pull‐test (IPDstab n = 30) had lower sway than controls in static (P = 0.042) and dynamic posturography (P = 0.001) and also differed from patients with impaired pull‐test in static (P = 0.007) and dynamic (P < 0.001) conditions. In patients with side‐steps in tandem gait (n = 21), sway in static and dynamic posturography was increased. Sway measures did not differentiate between patients with pull‐test scores 1 and 2 or one and >1 side step in tandem‐gait, respectively. Results of ANOVA showed that variance of static posturography was related to performance in tandem‐gait (P < 0.0001) but not to pull‐test performance (P = 0.91). In contrast, dynamic posturography was related to both, tandem‐gait (P = 0.012) and pull‐test (P = 0.03). Posturographic sway is increased in patients with IPD with disturbance of tandem gait and pull‐test. Posturographic measures did not distinguish between different degrees of deficits in clinical tests. © 2010 Movement Disorder Society     

Effects of effortful swallow on esophageal function in healthy adults

Background Treatment for esophageal dysmotility is currently limited to primarily pharmacologic intervention, which has questionable utility and frequently associated negative side effects. A potential behavioral intervention for esophageal dysmotility is the effortful oropharyngeal swallow. A previous pilot study using water perfusion manometry found an increase in distal esophageal amplitudes during effortful vs non‐effortful swallowing. The current study sought to duplicate the previous study with improvements in methodology. Methods The effects of swallow condition (effortful vs non‐effortful), sensor site, and gender on esophageal amplitude, duration, velocity, and bolus clearance were examined for 18 adults (nine males and nine females, mean age = 29.9 years) via combined solid‐state manometry and intraluminal impedance. Key Results The effortful swallow condition yielded significantly higher esophageal amplitudes across all sensor locations (P < 0.05). Further, the effortful swallowing decreased the risk of incomplete bolus clearance when compared with non‐effortful swallowing (OR: 0.51; 95% CI: 0.30–0.86). Conclusions & Inferences With improved manometric instrumentation, larger participant numbers, and methodology that controlled for potential confounding factors, this study confirms and advances the results of the previous pilot study: Volitional manipulation of the oropharyngeal phase of swallowing using the effortful swallow indeed affects esophageal physiology. Thus, the effortful swallow offers a behavioral manipulation of the esophageal phase of swallowing, and future studies will determine its clinical potential for treating esophageal dysmotility in patient populations.     

Health‐related quality of life in early Parkinson's disease: The impact of nonmotor symptoms

Nonmotor symptoms (NMS) are common in patients with established Parkinson's disease (PD) and have a major impact upon quality of life. We investigated the significance of NMS in relation to health‐related quality of life (HRQoL) in patients with newly diagnosed PD. Patients and healthy controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease Study. Prevalence of NMS was determined with the Non‐Motor Symptom Questionnaire. HRQoL was recorded with the 39‐item Parkinson's Disease Quality of Life Questionnaire (PDQ‐39). Further assessments included measures of motor disability, depression, sleep, and cognition. One hundred and fifty‐eight patients with newly diagnosed PD and 99 controls participated in this cross‐sectional study. Patients reported greater numbers of NMS than controls (mean 8.3 ± 4.3 versus 2.8 ± 2.5 symptoms; P < 0.001). Patients reported lowest HRQoL in the domains assessing bodily discomfort, mobility, and activities of daily living. Motor and nonmotor symptoms impacted negatively upon HRQoL scores. Patients with the postural instability and gait difficulty motor subtype reported worse HRQoL, compared with those with tremor‐dominant disease. Depression (P < 0.001), incomplete bowel emptying (P < 0.001), anxiety (P < 0.001), impaired concentration (P < 0.001), memory complaints (P < 0.001), and insomnia (P = 0.001) had the greatest negative impact upon HRQoL. NMS are common in patients with early PD and represent a significant cause of poorer health‐related quality of life. Cognitive, neuropsychiatric, and sleep disturbances are particularly associated with reduced well‐being. Screening and management of these symptoms should be prioritized at the time of diagnosis. © 2013 International Parkinson and Movement Disorder Society     

A randomized controlled trial of patient‐reported outcomes with tai chi exercise in Parkinson's disease

A previous randomized, controlled trial of tai chi showed improvements in objectively measured balance and other motor‐related outcomes in patients with Parkinson's disease. This study evaluated whether patient‐reported outcomes could be improved through exercise interventions and whether improvements were associated with clinical outcomes and exercise adherence. In a secondary analysis of the tai chi trial, patient‐reported and clinical outcomes and exercise adherence measures were compared between tai chi and resistance training and between tai chi and stretching exercise. Patient‐reported outcome measures were perceptions of health‐related benefits resulting from participation, assessed by the Parkinson's Disease Questionnaire (PDQ‐8) and Vitality Plus Scale (VPS). Clinical outcome measures included motor symptoms, assessed by a modified Unified Parkinson's Disease Rating Scale–Motor Examination (UPDRS‐ME) and a 50‐foot speed walk. Information on continuing exercise after the structured interventions were terminated was obtained at a 3‐month postintervention follow‐up. Tai chi participants reported significantly better improvement in the PDQ‐8 (?5.77 points, P = 0.014) than did resistance training participants and in PDQ‐8 (?9.56 points, P < 0.001) and VPS (2.80 points, P = 0.003) than did stretching participants. For tai chi, patient‐reported improvement in the PDQ‐8 and VPS was significantly correlated with their clinical outcomes of UPDRS‐ME and a 50‐foot walk, but these correlations were not statistically different from those shown for resistance training or stretching. However, patient‐reported outcomes from tai chi training were associated with greater probability of continued exercise behavior than were either clinical outcomes or patient‐reported outcomes from resistance training or stretching. Tai chi improved patient‐reported perceptions of health‐related benefits, which were found to be associated with a greater probability of exercise adherence. The findings indicate the potential of patient perceptions to drive exercise behavior after structured exercise programs are completed and the value of strengthening such perceptions in any behavioral intervention.     

Psychometric properties of the SCOPA‐AUT Brazilian Portuguese version

Cross‐cultural adaptation and psychometric assessment of the Scales for Outcomes in Parkinson's Disease‐Autonomic questionnaire (SCOPA‐AUT) Brazilian Portuguese version. 150 consecutive Parkinson's disease (PD) patients were evaluated by means of the SCOPA‐motor scale (SCOPA‐M), SCOPA‐cognition (SCOPA‐COG), Hoehn and Yahr staging (H&Y), nonmotor symptoms scale (NMSS), PD questionnaire (PDQ‐39), and SCOPA‐AUT. The following psychometric attributes were explored: acceptability, scaling assumptions, reliability, precision, and construct validity. Patients' age (mean ± standard deviation) was 63.1 ± 11.1 years (56.7% men; duration of disease, 8.7 ± 5.3 years; median H&Y, 2). Mean SCOPA‐AUT was 23.0 ± 11.2. SCOPA‐AUT did not show floor or ceiling effect. As a whole, the SCOPA‐AUT item‐domain correlation was satisfactory, except for items 2 (Saliva), 7 (Faecal incontinence), 16 (Syncope), and 19 (Cold intolerance) (|r_S| = 0.03–0.32). Internal consistency was adequate, except for thermoregulatory and cardiovascular domains (alpha coefficients, 0.56 and 0.63, respectively). Intraclass correlation coefficient for the total score was 0.71, whereas weighted kappa for individual items ranged from 0.15 to 0.71 (only items 4 and 7 were <0.40). Standard error of measurement was 6.04. The SCOPA‐AUT total score correlated closely with the NMSS total score (r_S = 0.65) and PDQ‐39 Summary Index (r_S = 0.61) and at a moderate level with H&Y staging (r_S = 0.35) and SCOPA‐MS total score (r_S = 0.39) (all r_S values, P < 0.0001). Correlation of SCOPA‐AUT with SCOPA‐COG was weak. SCOPA‐AUT significantly increased as the H&Y stage increased (Kruskal‐Wallis, P < 0.0001). The SCOPA‐AUT Brazilian Portuguese version is an acceptable, reliable, and valid questionnaire to evaluate autonomic dysfunction in PD. © 2009 Movement Disorder Society     

Differential involvement of nigral subregions in idiopathic parkinson's disease

In this study, the prevalence of abnormality in putative nigrosome 1 and nigrosome 4 (N1 and N4, respectively) was investigated in early versus late‐stage idiopathic Parkinson's disease (IPD) patients. A total of 128 IPD patients (early stage[n = 89]; late stage[n = 39]) and 15 healthy subjects were scanned for high‐resolution (0.5 × 0.5 × 1.0 mm³) multiecho gradient‐recalled echo MRI and dopamine transporter PET imaging. The MRI data were processed for susceptibility map‐weighted imaging (SMWI) to improve a contrast‐to‐noise ratio, and the images were resliced at 0.5 mm to define N1 and N4. When each side of N1 and N4 was assessed separately for the loss of hyperintensity by two independent reviewers, the consensus review results showed that in early‐stage IPD (178 substantia nigras [SNs]), the loss of hyperintensity was observed more often in only the N1 region (65.2%) when compared to in both N1 and N4 regions (34.8%). In late‐stage IPD (78 SNs), on the other hand, the loss in only the N1 region (25.6%) was less prevalent than in both N1 and N4 (74.4%) (P < 0.0001). Additionally, intact SNs (both in N1 and N4) were observed 17 SNs (9.6%) of the early‐stage IPD patients, whereas it was not found in any SNs of the late‐stage IPD patients (P = 0.005). Moreover, involvement of both N1 and N4 on both sides was found in 19.1% of the early‐stage IPD patients, whereas its incidence was higher (61.5%) in the late‐stage IPD patients (P < 0.0001), suggesting that the loss of hyperintensity in IPD progresses from N1 to N4 as the disease advances. Hum Brain Mapp 39:542–553, 2018. © 2017 Wiley Periodicals, Inc.     

Non-motor features in essential tremor

Introduction – Essential tremor (ET) is increasingly recognized to have several non‐motor manifestations. The aim of this study was to determine the prevalence of non‐motor manifestations in ET and its impact on the quality of life (QOL). Methods – This was a cross‐sectional case–control questionnaire‐based study. The subjects were 50 patients with ET and 50 matched healthy controls. All subjects were assessed by Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Parkinson Fatigue Scale, Brief Pain Inventory, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. In addition, QOL in Essential Tremor questionnaire was administered to patients with ET. Results – Patients with ET, when compared with controls, had significantly higher prevalence and higher mean scores of sleep disturbances (46% vs 8%, P < 0.001; 5.9 ± 4.6 vs 2.6 ± 2.3, P < 0.001), fatigue (30% vs 8%, P = 0.009; 5.8 ± 0.8 vs 2.5 ± 0.4, P < 0.001), anxiety (66% vs 18%, P = 0.009; 7.4 ± 9.0 vs 0.7 ± 2.6, P < 0.001), depression (44% vs 8%, P = 0.009; 7.8 ± 7.9 vs 1.7 ± 3.3, P < 0.001) as well as higher mean score of pain severity (1.9 ± 2.3 vs 0.6 ± 1.2, P = 0.001) and interference owing to pain (2.0 ± 2.9 vs 0.5 ± 1.2, P = 0.001). Following hierarchical regression analysis, depression was the only non‐motor feature that affected the QOL. Conclusion – There was a significantly higher prevalence and greater severity of sleep disturbances, fatigue, pain, anxiety, and depression in patients with ET and depression significantly affected the QOL.     

The self-report Barthel Index: preliminary validation in people with Parkinson's disease

Background and purpose: To make a preliminary assessment of the reliability and validity of the self‐report Barthel Index (SRBI) in people with Parkinson’s (PWP) disease. Methods: Thirty‐nine PWP completed the SRBI, the self‐report Schwab & England (S & E) scale and the PDQ‐39. Standard statistical procedures were incorporated to assess the reliability and validity of the SRBI. Results: A Cronbach’s alpha coefficient of 0.69 was calculated, indicating adequate internal consistency. Reliability was further demonstrated through a Guttman split‐half reliability coefficient of 0.74. Validity was demonstrated through highly significant correlations between the SRBI and the S & E scale (r = 0.64, P < 0.00), the activities of daily living dimension of the PDQ‐39 (r = ?0.60, P < 0.00) and mobility dimension of the PDQ‐39 (r = ?0.49, P < 0.01). Conclusions: Results suggest that the SRBI has the potential to be a reliable and valid indicator of ADL in PWP and utilized in studies that make comparisons across conditions. Further validation is required in a larger sample and through assessment of additional psychometric properties.     

Predictors of Oral Feeding Resumption after Stroke in a Rehabilitation Hospital: A Retrospective Study

Background: Dysphagia is common after stroke, requiring exclusive enteral feeding in 20% of patients. Recovery of oral feeding is associated with increased quality of life, better functional outcomes, and decreased mortality rates. However, evidence is heterogeneous and not conclusive on which factors are predictive of oral feeding recovery for stroke patients in rehabilitation units. Aim: To investigate predictors of complete oral feeding recovery. Design: Retrospective study. Setting: Intensive inpatient rehabilitation hospital. Population: Poststroke dysphagic individuals with enteral feeding. Methods: Retrospective chart review of demographic, clinical, rehabilitation, and swallowing factors. Univariate analysis and multivariate regression analysis were used to compare variables between the oral feeding recovery group and the enteral feeding group at discharge. Results: One hundred thirty-nine patients were included in the analysis. A total of 61.9% of the sample population resumed complete oral intake at discharge. There were statistically significant differences between the 2 groups in Functional Independence Measure cognitive score, clinical swallow evaluation, and instrumental swallow evaluation at admittance, and dysphagia rehabilitation. Multiple logistic regression analysis identified the absence of aspiration signs with liquids associated with a higher probability of the resumption of complete oral feeding (odds ratio [OR] 3.57; 95% confidence interval [CI] 1.07-11.89). Age between 73 and 79 years (OR .96; 95% CI .01-.58), the presence of aspiration and/or penetration (OR .22; 95% CI .07-.72), and the presence of residue (OR .14; 95%CI .04-.43) during fiberoptic endoscopic evaluation of swallowing presented lower probability of returning to complete oral feeding. Conclusion: Several demographic and swallowing characteristics predicted oral feeding recovery. Absence of dysphagia signs documented on fiberoptic endoscopic evaluation of swallowing was the strongest predictor of complete oral feeding resumption.