Diagnosis and Treatment of Parkinson Disease

JAMA, Год журнала: 2020, Номер 323(6), С. 548 - 548

Опубликована: Фев. 11, 2020

Importance

Parkinson disease is the most common form of parkinsonism, a group neurological disorders with disease–like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have disease.

Observations

Diagnosis based on history examination. History can include prodromal features (eg, rapid eye sleep behavior disorder, hyposmia, constipation), characteristic difficulty tremor, stiffness, slowness), psychological or cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia both. Dopamine transporter single-photon emission computed tomography improve accuracy diagnosis when presence parkinsonism uncertain. has multiple variants different prognoses. Individuals diffuse malignant subtype (9%-16% disease) prominent early motor nonmotor symptoms, poor response to medication, faster progression. mild motor-predominant (49%-53% good dopaminergic medications carbidopa-levodopa, dopamine agonists), slower Other an intermediate subtype. For all patients disease, treatment symptomatic, focused improvement in bradykinesia) constipation, cognition, mood, sleep) signs symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies help initial Nonmotor symptoms require nondopaminergic approaches selective serotonin reuptake inhibitors for psychiatric cholinesterase cognition). Rehabilitative therapy exercise complement treatments. experiencing complications, worsening functional impairment medication dose wears off ("off periods"), medication-resistant dyskinesias, benefit from advanced levodopa-carbidopa enteral suspension deep brain stimulation. Palliative care part management.

Conclusions Relevance

heterogeneous rapidly slowly progressive forms. Treatment involves (typically levodopa preparations prescribed without other medications) nonpharmacologic (such physical, occupational, speech therapies). Approaches stimulation off, dyskinesias.

Язык: Английский

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Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

Movement Disorders, Год журнала: 2019, Номер 34(2), С. 180 - 198

Опубликована: Янв. 17, 2019

ABSTRACT Objective To update evidence‐based medicine recommendations for treating nonmotor symptoms in Parkinson's disease (PD). Background The International Parkinson and Movement Disorder Society Evidence‐Based Medicine Committee's treatments of PD were first published 2002, updated 2011, now again through December 31, 2016. Methods Level I studies testing pharmacological, surgical, or nonpharmacological interventions the treatment reviewed. Criteria inclusion quality scoring as previously reported. disorders covered a range neuropsychiatric symptoms, autonomic dysfunction, sleep wakefulness, pain, fatigue, impaired olfaction, ophthalmologic dysfunction. Clinical efficacy, implications clinical practice, safety conclusions are Results A total 37 new qualified review. There no randomized controlled trials that met criteria anxiety disorders, rapid eye movement behavior disorder, excessive sweating, We identified clinically useful possibly depression, apathy, impulse control related dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal urinary erectile pain. to treat non‐dementia‐level cognitive impairment. Conclusions evidence base has grown substantially recent years. However, options overall remain limited given high prevalence adverse impact these so development remains top priority. © 2019 Authors. Disorders by Wiley Periodicals, Inc. on behalf Society.

Язык: Английский

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Parkinson’s disease: etiopathogenesis and treatment

Journal of Neurology Neurosurgery & Psychiatry, Год журнала: 2020, Номер 91(8), С. 795 - 808

Опубликована: Июнь 23, 2020

The concept of ‘idiopathic’ Parkinson’s disease (PD) as a single entity has been challenged with the identification several clinical subtypes, pathogenic genes and putative causative environmental agents. In addition to classic motor symptoms, non-motor manifestations (such rapid eye movement sleep disorder, anosmia, constipation depression) appear at prodromic/premotor stage evolve, along cognitive impairment dysautonomia, progresses, often dominating advanced stages disease. key molecular mechanisms include α-synuclein misfolding aggregation, mitochondrial dysfunction, protein clearance (associated deficient ubiquitin-proteasome autophagy-lysosomal systems), neuroinflammation oxidative stress. involvement dopaminergic well noradrenergic, glutamatergic, serotonergic adenosine pathways provide insights into rich variable phenomenology associated PD possibility alternative therapeutic approaches beyond traditional dopamine replacement therapies. One biggest challenges in development potential neuroprotective therapies lack reliable sensitive biomarkers progression. Immunotherapies such use vaccination or monoclonal antibodies directed against aggregated, toxic α-synuclein.as anti-aggregation strategies are currently investigated trials. application glucagon-like peptide one receptor agonists, specific gene target agents GBA LRRK2 modifiers) other modifying drugs cautious optimism that more effective on horizon. Emerging therapies, new symptomatic drugs, innovative drug delivery systems novel surgical interventions give hope patients about their future outcomes prognosis.

Язык: Английский

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Parkinson’s Disease

Medical Clinics of North America, Год журнала: 2018, Номер 103(2), С. 337 - 350

Опубликована: Дек. 3, 2018

Язык: Английский

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Old Drugs as New Treatments for Neurodegenerative Diseases

Pharmaceuticals, Год журнала: 2018, Номер 11(2), С. 44 - 44

Опубликована: Май 11, 2018

Neurodegenerative diseases are increasing in number, given that the general global population is becoming older. They manifest themselves through mechanisms not fully understood, many cases, and impair memory, cognition movement. Currently, no neurodegenerative disease curable, treatments available only manage symptoms or halt progression of disease. Therefore, there an urgent need for new this kind disease, since World Health Organization has predicted affecting motor function will become second-most prevalent cause death next 20 years. New therapies can come from three main sources: synthesis, natural products, existing drugs. This last source known as drug repurposing, which most advantageous, drug’s pharmacokinetic pharmacodynamic profiles already established, investment put into strategy significant classic development There have been several studies on potential old drugs relevant diseases, including Alzheimer’s Parkinson’s Huntington’s Multiple Sclerosis Amyotrophic Lateral Sclerosis.

Язык: Английский

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Apomorphine subcutaneous infusion in patients with Parkinson's disease with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-controlled trial

The Lancet Neurology, Год журнала: 2018, Номер 17(9), С. 749 - 759

Опубликована: Июль 25, 2018

Язык: Английский

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Treatment Options for Motor and Non-Motor Symptoms of Parkinson’s Disease

Biomolecules, Год журнала: 2021, Номер 11(4), С. 612 - 612

Опубликована: Апрель 20, 2021

Parkinson’s disease (PD) usually presents in older adults and typically has both motor non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss the mid-brain substantia nigra pars compacta region. Outlined here an integrative medicine health strategy that highlights five treatment options for people with (PwP): rehabilitate, therapy, restorative, maintenance, surgery. Rehabilitating begins following diagnosis throughout any additional processes, especially vis-à-vis consulting physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either dopamine precursor levodopa (with carbidopa) or agonist, compounds preserve residual dopamine, other specific motor/non-motor-related compounds. Restorative strenuous aerobic exercise programs can be neuroprotective. Maintenance complementary alternative substances potentially support protect brain microenvironment. Finally, surgery, including deep stimulation, pursued when PwP fail to respond positively options. There currently no cure PD. In conclusion, best treating hope slow progression strive achieve stability neuroprotection. The ultimate goal management program improve quality-of-life person disease.

Язык: Английский

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Sex differences in movement disorders

Nature Reviews Neurology, Год журнала: 2020, Номер 16(2), С. 84 - 96

Опубликована: Янв. 3, 2020

Язык: Английский

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EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease

Movement Disorders, Год журнала: 2019, Номер 34(3), С. 353 - 365

Опубликована: Фев. 4, 2019

Abstract Objective Real‐life observational report of clinical efficacy bilateral subthalamic stimulation (STN‐DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality life, motor, nonmotor symptoms (NMS) in Parkinson's disease (PD). Methods In this prospective, multicenter, international, real‐life cohort observation study 173 PD patients undergoing STN‐DBS (n = 101), IJLI 33), or APO 39) were followed‐up using PDQuestionnaire‐8, NMSScale (NMSS), Unified Rating Scale (UPDRS)‐III, UPDRS‐IV, equivalent daily dose (LEDD) before 6 months after intervention. Outcome changes analyzed with Wilcoxon signed‐rank paired t test when parametric tests applicable. Multiple comparisons corrected (multiple treatments/scales). Effect strengths quantified relative changes, effect size, number needed to treat. Analyses computed propensity score matching, balancing demographic characteristics. Results all groups, NMSS total scores improved significantly at follow‐up. Levodopa was reduced STN‐DBS. Explorative domain analyses resulted distinct profiles: urinary/sexual functions, mood/cognition, sleep/fatigue, the miscellaneous domain. 3 latter domains gastrointestinal symptoms. perceptual problems/hallucinations, attention/memory, Overall, seemed favorable for score, neuropsychological/neuropsychiatric NMS PDQuestionnaire‐8 outcome. Conclusions This is first comparison nonmotor. motor outcomes STN‐DBS, IJLI, a cohort. Distinct profiles identified each treatment option. Our results highlight importance holistic assessments personalize choices. © 2019 International Parkinson Movement Disorder Society

Язык: Английский

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Initiation of pharmacological therapy in Parkinson's disease: when, why, and how

The Lancet Neurology, Год журнала: 2020, Номер 19(5), С. 452 - 461

Опубликована: Март 12, 2020

Язык: Английский

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