Nicht motorische Symptome bei Morbus Parkinson (Teil II)

Nonmotor symptoms in Parkinson’s disease have a high relevance for quality of life. A broad range of symptoms can be found in all stages of the disease, including gastrointestinal symptoms, bladder problems, erectile dysfunction, orthostatic hypotension, sleep disturbances, depression, dementia, psychosis, and drug-induced behavioral changes. The guidelines of the Austrian PD society and a recent review of the Movement Disorder Society provide therapy recommendations according to evidence-based data.     

帕金森病早期诊断之生物学标记物

帕金森病是老年人神经系统变性疾病之一,也是老年人最常见的锥体外系疾病,以黑质多巴胺能神经元变性、缺失以及路易小体形成为其主要病理特征。其临床症状主要包括运动症状及非运动症状。目前对于帕金森病仍缺乏最直接有效的诊断方法,常导致帕金森病患者错过最佳的早期诊断时机,故近年来研究发现血液生物化学标记物、脑脊液生物化学标记物、功能神经影像学、基因学等有望成为帕金森病早期诊断的新方法,故本文将对此逐一进行介绍。     

19世纪帕金森病的研究历史

1817年Parkinson首先描述了震颤麻痹,此后的45年中陆续出现了一些相关报道,但并未增加有价值的临床信息。1861年以后,Charcot对此病进行了深入的研究,认识到动作缓慢是本病的核心症状之一,并将其与肌强直鉴别开。他细致地描述了面具脸等症状,认为震颤并非诊断的必要因素,在命名上建议用帕金森病来取代震颤麻痹。     

Dopamin-Dysregulations-Syndrom bei Morbus Parkinson

Parkinson’s disease is a neurodegenerative disease with the cardinal symptoms bradykinesia, rigidity and tremor. In 1817, James Parkinson already described in his "Essay on the Shaking Palsy" in addition to the motor symptoms also autonomic, cognitive and behavioral disturbances (Parkinson, An essay on the shaking palsy. Sherwood, Nealy and Jones, London, 1817). Their impact on quality of life has been underestimated until more recent times. Dopamine dysregulation syndrome is an iatrogenic disturbance, characterized by an addictive pattern of dopamine replacement therapy use. Despite good control of motor symptoms, patients often increase doses of dopamine replacement therapy in excess of those normally required. Consequently these behavioral disorders may also result in social and professional problems.     

Optimized cuttlefish algorithm for diagnosis of Parkinson’s disease

This paper presents an optimized cuttlefish algorithm for feature selection based on the traditional cuttlefish algorithm, which can be used for diagnosis of Parkinson’s disease at its early stage. Parkinson is a central nervous system disorder, caused due to the loss of brain cells. Parkinson's disease is incurable and could eventually lead to death but medications can help to control symptoms and elongate the patient's life to some extent. The proposed model uses the traditional cuttlefish algorithm as a search strategy to ascertain the optimal subset of features. The decision tree and k-nearest neighbor classifier as a judgment on the selected features. The Parkinson speech with multiple types of sound recordings and Parkinson Handwriting sample’s datasets are used to evaluate the proposed model. The proposed algorithm can be used in predicting the Parkinson’s disease with an accuracy of approximately 94% and help individual to have proper treatment at early stage. The experimental result reveals that the proposed bio-inspired algorithm finds an optimal subset of features, maximizing the accuracy, minimizing number of features selected and is more stable.     

Diagnosis of Parkinson’s disease using modified grey wolf optimization

This paper presents the Modified Grey Wolf Optimization (MGWO) algorithm which helps with the identification of the symptoms of Parkinson’s disease at a premature stage. Parkinson disease is kind of a movement malady, which if not cured timely can prove to be fatal.Thus it becomes significant to identify Parkinson’s disease at its premature phase so proper medications can provide longevity to patient by controlling the symptoms. In this work, a new model named Modified Grey Wolf Optimization (MGWO) has been proposed grounded on the traditional Grey Wolf Optimizer (GWO), which acts as a search strategy for feature selection. GWO is a meta-heuristic algorithm which is enthused by hunt down behavior of wolves. Random forest, k-nearest neighbor classifier and decision tree espy on selected features. The proposed model is evaluated using various types of datasets of voice, handwriting (spiral and meander) and speech. The put forward algorithm helps in the prediction of Parkinson disease with an estimated accuracy of 94.83%, detection rate of 98.28%, false alarm rate of 16.03% and further aid the individuals to receive a functional treatment at an early stage. The proposed bio-inspired algorithm is stable enough to find out the optimal subset of features. At last the results derived from the evaluation of proposed algorithm on datasets are compared with the results of Optimized Cuttlefish Algorithm (OCFA). The experimental results depict that the proposed algorithm helps in maximizing the accurateness and minimizing the number of features selected.     

Examining multiple feature evaluation and classification methods for improving the diagnosis of Parkinson’s disease

An accurate diagnosis of Parkinson’s disease by specialists involves many neurological, psychological and physical examinations. The specialists investigate a number of symptoms and signs when examining the nervous system conditions of a person. The diagnosis involves reviewing the medical history and genetic factor of the person. The recent diagnosis methodology to Parkinson’s disease relies on voice disorders analysis. This methodology entails extracting feature sets of a recorded person’s voice then utilizing a machine learning technique to identify the healthy and Parkinson’s cases from the voice. This paper attempts to improve the diagnoses of Parkinson’s disease by testing multiple feature evaluation and classification machine learning methods based on the voice disorders analysis. The aim of this paper is to find the optimal solution to the problem by (i) proposing a new Multiple Feature Evaluation Approach (MFEA) of a multi-agent system (ii) implementing five independent classification schemas which are Decision Tree, Naïve Bayes, Neural Network, Random Forests, and Support Vector Machine on the Parkinson’s diagnosis before and after applying the MFEA, and (iii) evaluating the diagnosis accuracy of the results. The methodology of the tests encompasses 10-fold cross-validation to evaluate the learning of methods and track variation in their performance. The test results show that the MFEA of the multi-agent system finds the best set of features and improves the performance of the classifiers. The average rate of improvement in the diagnostic accuracy of the classifiers are Decision Tree 10.51%, Naïve Bayes 15.22%, Neural Network 9.19%, Random Forests 12.75%, and Support Vector Machine 9.13%. These results show that the MFEA makes a significant improvement to the classifiers’ diagnosis results.     

Kasuistik eines Patienten mit Morbus Parkinson,der häufig wegen Schwindels stürzt

Reported is a case of a 73-year-old patient suffering from Parkinson’s disease, coronary artery disease with stable angina pectoris, polyneuoropathie NNB and untreated diabetes mellitus. For over a year, the patient reports experiencing dizziness which leads to falls. Presented is a case report in which the typical neurological cardinal symptoms have nothing to do with the neurological underlying illness. Without interdisciplinary cooperation no success can be achieved in these multimorbid patients.     

O rem 自护理论消除帕金森退化反应的应用前景

由于帕金森的发病率逐年上升,并对患者生理、心理、社会等方面造成影响,本文对国内外O rem自护理论消除退化反应的相关文献以及在帕金森疾病中的应用前景进行报道。使用检索电子数据库以及查阅期刊文献。结果发现随着疾病的进展,帕金森会诱发机体一系列的退化反应,这严重影响了患者的生理、心理以及生活质量。大量文献报道了O rem自护理论在消除高血压、糖尿病等慢性疾病退化反应中的应用,但很少文献提及O rem自护理论在消除帕金森退化反应中的应用。笔者认为O rem自护理论有望在消除帕金森退化反应中应用。     

帕金森病诊断标记物系统回顾与展望

本篇综述总结了帕金森病的诊断、鉴别诊断和病程监测的各领域的生物学标记物的研究进展。其中重点介绍了神经影像学和生物化学领域的生物学标记物,也是当前研究较为成熟的两大领域。神经影像学标记物以多巴胺能影像及非多巴胺能影像为代表,生物化学标记物为包括a一突触核蛋白在内的多种蛋白和激素,两者的结合能够有效提高疾病诊断的特异性和灵敏性。同时文章还介绍了当前研究的热点——帕金森病的前驱诊断手段,即在疾病典型的运动症状和非运动症状出现前便可预测帕金森病的诊断手段。     

Cognitive changes following subthalamic nucleus stimulation in two patients with Parkinson disease

The limits of a drug therapy in severe forms of Parkinson disease have led to refining neurosurgery on the basal ganglia. Deep brain stimulation of the subthalamic nucleus has been recognized as one of the most promising techniques to decrease "off" motor symptoms and motor fluctuations, allowing a reduction of drug therapy and limiting side effects of the drugs. There is still open debate on the possible consequences of chronic subthalamic stimulation in other ways, apart from motor symptoms, of general cognitive performance. We examined and followed two patients with Parkinson disease for 9 mo. after surgery for deep stimulation, studying their cognitive performances. There is a general amelioration of cognitive performances, in particular as far as linguistic capabilities is concerned. We discuss the possible significance of these results, reminding strenuously that only two patients were involved, so the potential for generalization is seriously limited.     

系统论引领帕金森病治疗思路

帕金森病的病因、不单是多巴胺的缺失或减少,西医学的多巴胺替代疗法忽略了帕金森病发病的复杂性和整体性;中医的辨证论治缺乏对系统内部的深入研究,带有很大的主观性和盲目性。而在系统论指导下的结构还原,深化了对帕金森病的中西医发病机制的系统认识。中西医结合治疗是还原论和系统论的统一,是帕金森病系统治疗的最佳形式。     

An Application of Psychoanalysis to Education by Richard M. Jones

Abstract

This report describes a psychosocial therapy group for Parkinson’s patients, focusing on the therapeutic processes arising when group members and therapist share the diagnosis of Parkinson’s disease. The paper explores the question, “What is the therapeutic effect on the group when the therapist suffers and displays the same illness as members of the group” ? Countertransference issues are described.     

Antisaccades in Parkinson’s Disease: A Meta-Analysis

Neuropsychology Review - The usefulness of eye-tracking tasks as potential biomarkers for motor or cognitive disease burden in Parkinson’s disease (PD) has been subject of debate for many...     

Textured Foot Orthotics on Dynamic Stability and Turning Performance in Parkinson’s Disease

Abstract

The purpose of this study was to facilitate sensory feedback, with textured foot orthotics, to evaluate dynamic stability and turning behavior in Parkinson’s disease individuals. Seven participants with a diagnosis of idiopathic Parkinson’s disease, aged 55–80?years old, participated in this study. Participants completed three testing sessions; baseline, 4?weeks post-baseline, and 5?weeks post-baseline. Three experimental conditions were tested: footwear only (F), footwear?+?non-textured orthotic (FO), and footwear?+?textured orthotic (FOT). Kinematic, kinetic, and video data were collected during the steps preceding a turn task. Variables of interest included dynamic stability (maximum mediolateral (ML), minimum ML, and ML range of the center of mass (COM)-base of support (BOS) relationship) and turning performance (gait velocity and step count). There was a statistically significant increase in maximum ML COM-BOS distance (week 4 [0.1298 m?±?0.054] compared to week 0 [0.1069 m?±?0.050] p = .0076), and a significant decrease in step count (week 0-F [5.52 steps ± 1.08] to week 0-FO [5.23 steps ± 0.87] p = .0296) and (week 4-FO [5.24 steps ± 1.31] to week 4–FOT [4.67 steps ± 0.76] p = .0004). Textured foot orthotics modified dynamic stability and turning performance in Parkinson’s disease individuals completing a 180° degree turn. These preliminary results support this potential treatment option for rehabilitation professionals treating Parkinson’s disease.     

Genetic Counseling Dilemmas for a Patient with Sporadic Amyotrophic Lateral Sclerosis,Frontotemporal Degeneration & Parkinson’s Disease

Amyotrophic lateral sclerosis (ALS), frontotemporal degeneration and Parkinson’s disease may be different expressions of the same neurodegenerative disease. However, association between ALS and parkinsonism-dementia complex (ALS-PDC) has only rarely been reported apart from the cluster detected in Guam. We report a patient presenting with ALS-PDC in whom pathological mutations/expansions were investigated. No other family members were reported to have any symptoms of a neurological condition. Our case demonstrates that ALS-PDC can occur as a sporadic disorder, even though the coexistence of the three clinical features in one patient suggests a single underlying genetic cause. It is known that genetic testing should be preferentially offered to patients with ALS who have affected first or second-degree relatives. However, this case illustrates the importance of genetic counseling for family members of patients with sporadic ALC-PDC in order to provide education on the low recurrence risk. Here, we dicuss the ethical, psychological and practical consequences for patients and their relatives.     

Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease: A Meta-Analysis of Mood Effects

Neuropsychology Review - This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson’s disease (PD). Deep brain...     

The nature of working memory gating in Parkinson’s disease: A multi-domain signal detection examination

Distractions are ubiquitous; our brains are inundated with task-irrelevant information. Thus, to remember successfully, one must actively maintain relevant information and prevent distraction from entering working memory. Researchers suggest the basal ganglia-prefrontal pathways are vital to this process by acting as a working memory gate. Using Parkinson’s disease as a model of frontostriatal functioning and with signal detection analyses, the present study aims to better characterize the contribution of frontostriatal pathways of this gating process and to determine how it operates across multiple domains. To achieve this, Parkinson’s disease patients and healthy controls completed verbal and spatial working memory tasks consisting of three conditions: low-load without distraction; low-load with distraction; and high-load without distraction. Patients were tested both ON and OFF dopaminergic medication, allowing for assessment of the contribution of dorsal and ventral frontostriatal pathways. The results demonstrate that when medication is withheld, Parkinson’s patients have a response bias to answer “NO” across all conditions and domains, supporting our hypothesis that the basal ganglia-prefrontal pathways allow or prevent updates of working memory. Contrastingly, medication status affects d′ in the distraction condition but not in the high- or low-load conditions. We attribute this to stimulus valuation processes that were impaired by dopaminergic medication overdosing the ventral pathway. These findings are both consistent with the hypothesis that the working memory gate filters spatial and verbal information before it enters into the working memory system, adding support for the gate being a domain-general mechanism of the central executive.     

Family Therapy with Couples and Individuals with Parkinson’s Disease

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.     

Computer simulation of some of the motor circuits underlying Parkinson’s disease

Many researchers have published functional models of brain structures involved in Parkinson’s disease. These models include the primary structures of the basal ganglia and related cortical areas, and have hypothesized normal and dysfunctional states. Simple computer simulation of the hypothesized excitatory and inhibitory interactions among brain structures can be used to evaluate these models. A computer simulation can be programmed to simulate normal function, disease function, and treatment effects described in published models.