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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A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease

npj Parkinson s Disease, Год журнала: 2021, Номер 7(1)

Опубликована: Сен. 10, 2021

Freezing of gait (FOG) in Parkinson's disease (PD) causes severe patient burden despite pharmacological management. Exercise and training are therefore advocated as important adjunct therapies. In this meta-analysis, we assess the existing evidence for such interventions to reduce FOG, further examine which type helps restoration function particular. The primary meta-analysis across 41 studies 1838 patients revealed a favorable moderate effect size (ES = -0.37) various modalities reducing subjective FOG-severity (p < 0.00001), though several were not directly aimed at FOG some included non-freezers. However, exercise also proved beneficial secondary analysis on freezers only -0.32, p 0.007). We that dedicated episodes -0.24) or ameliorating underlying correlates -0.40) was moderately effective 0.01), while generic exercises -0.14, 0.12). Relevantly, no retention effects seen after cessation -0.08, 0.36). This review thereby supports implementation targeted treatment with need long-term engagement.

Язык: Английский

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An Update on Medical and Surgical Treatments of Parkinson’s Disease

Aging and Disease, Год журнала: 2021, Номер 12(4), С. 1021 - 1021

Опубликована: Янв. 1, 2021

Parkinson's disease (PD) is characterized by degeneration of dopaminergic neurons in the substantia nigra pars compacta and other neuronal populations. The worldwide prevalence PD over 7 million has been increasing more rapidly than many neurodegenerative disorders. symptoms can be broadly divided into motor (slowness, stiffness, tremor) non-motor (such as depression, dementia, psychosis, orthostatic hypotension). Patients also have prodromal rapid eye movement sleep behavior disorder, hyposmia, constipation. diagnosis mainly clinical, but dopamine transporter single-photon emission computed tomography improve accuracy diagnosis. Dopamine based therapies are used for treatment symptoms. Non-motor treated with medications such selective serotonin reuptake inhibitors (depression/anxiety), acetylcholinesterase (dementia), atypical antipsychotics (psychosis). fluctuations or uncontrolled tremor, benefit from deep brain stimulation. Levodopa-carbidopa intestinal gel an alternative to stimulation fluctuations. Rehabilitative physical, occupational, speech therapy important during all stages disease. Management complex there significant advancements past few years. This review discusses updates medical surgical management PD.

Язык: Английский

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Stepping up to meet the challenge of freezing of gait in Parkinson’s disease

Translational Neurodegeneration, Год журнала: 2022, Номер 11(1)

Опубликована: Май 1, 2022

Abstract There has been a growing appreciation for freezing of gait as disabling symptom that causes significant burden in Parkinson’s disease. Previous research highlighted some the key components underlie phenomenon, but these reductionist approaches have yet to lead paradigm shift resulting development novel treatment strategies. Addressing this issue will require greater integration multi-modal data with complex computational modeling, there are number critical aspects need be considered before embarking on such an approach. This paper highlights where field needs address current gaps and shortcomings including standardization definitions measurement, phenomenology pathophysiology, well considering what available exist how future studies should constructed achieve greatest potential better understand treat devastating symptom.

Язык: Английский

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Management of freezing of gait — mechanism-based practical recommendations

Nature Reviews Neurology, Год журнала: 2025, Номер unknown

Опубликована: Апрель 1, 2025

Язык: Английский

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A theoretical framework for addressing fear of falling avoidance behavior in Parkinson’s disease

Physiotherapy Theory and Practice, Год журнала: 2022, Номер 39(5), С. 895 - 911

Опубликована: Фев. 18, 2022

Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent fear falling (FOF), which both common and problematic PD. It can vicious cycle FOF avoidance behavior results more sedentary behavior, physical deconditioning, weakening already impaired balance systems. This, turn, may make person PD susceptible future fall even benign daily tasks. While activity be adaptive (appropriate), it also maladaptive (inappropriate or exaggerated). When this contextualized gait/balance performance, provides theoretical framework used by clinicians match patterns concordant treatment approach. In proposed perspective, four different related performance are suggested: appropriate avoiders, non-avoiders, inappropriate non-avoiders. For each patterns, paper suggested focuses, approaches recommendations.

Язык: Английский

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The Impact of Exercise Intervention with Rhythmic Auditory Stimulation to Improve Gait and Mobility in Parkinson Disease: An Umbrella Review

Brain Sciences, Год журнала: 2021, Номер 11(6), С. 685 - 685

Опубликована: Май 22, 2021

Difficulties in walking, controlling balance, and performing activities of daily living are common problems encountered by individuals affected Parkinson disease. Scientific evidence suggests that exercise performed with music or auditory rhythmical cues facilitates movement improves gait, mobility, (ADL) performance patients PD. The aim this umbrella review was to summarize available high-quality from systematic reviews meta-analyses on the effectiveness rhythmically cued improve ADL PubMed, Cochrane, Embase databases were searched January 2010 October 2020 for which had be (1) written English, (2) include studies populations males females PD any age, (3) analyze outcomes related ADL, (4) apply interventions cues. Two independent authors screened potentially eligible assessed methodological quality using AMSTAR 2 tool. Four studies, two meta-analyses, one a review, meta-analysis, selected. Overall results indicated positive effects gait mobility use rhythmic cueing suggested it should incorporated into regular rehabilitation program Nonetheless, more primary level research is needed address identified gaps regarding application method physical interventions.

Язык: Английский

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Physiotherapy management of Parkinson's disease

Journal of physiotherapy, Год журнала: 2021, Номер 67(3), С. 163 - 176

Опубликована: Июнь 19, 2021

Язык: Английский

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Association between Cognitive Impairment and Freezing of Gait in Patients with Parkinson’s Disease

Journal of Clinical Medicine, Год журнала: 2023, Номер 12(8), С. 2799 - 2799

Опубликована: Апрель 10, 2023

Background: Freezing of gait (FOG) is a common disabling symptom in Parkinson’s disease (PD). Cognitive impairment may contribute to FOG. Nevertheless, their correlations remain controversial. We aimed investigate cognitive differences between PD patients with and without FOG (nFOG), explore severity performance assess heterogeneity within the patients. Methods: Seventy-four (41 FOG, 33 nFOG) 32 healthy controls (HCs) were included. Comprehensive neuropsychological assessments testing domains global cognition, executive function/attention, working memory, visuospatial function performed. was compared groups using independent t-test ANCOVA adjusting for age, sex, education, duration motor symptoms. The k-means cluster analysis used group. Correlation cognition analyzed partial correlations. Results: showed significantly poorer (MoCA, p < 0.001), frontal lobe (FAB, = 0.015), attention memory (SDMT, 0.001) (SIE, 0.038) than nFOG group divided into two clusters analysis, which 1 exhibited worse older lower improvement rate, higher FOGQ3 score, proportion levodopa-unresponsive 2. Further, group, correlated MoCA (r −0.382, 0.021), Stroop-C 0.362, 0.030) SIE 0.369, 0.027). Conclusions: This study demonstrated that impairments mainly reflected by function, memory. There be Additionally, severity.

Язык: Английский

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Parkinson’s disease patients benefit from bicycling - a systematic review and meta-analysis

npj Parkinson s Disease, Год журнала: 2021, Номер 7(1)

Опубликована: Сен. 24, 2021

Abstract Many Parkinson’s disease (PD) patients are able to ride a bicycle despite being severely compromised by gait disturbances up freezing of gait. This review [PROSPERO CRD 42019137386] aimed find out, which PD-related symptoms improve from bicycling, and type bicycling exercise would be most beneficial. Following systematic database literature search, peer-reviewed studies with randomized control trials (RCT) non-randomized (NRCT) investigating the interventional effects on PD were included. A quality analysis addressing reporting, design possible bias studies, as well publication test was done. Out 202 references, 22 eligible 505 analysed. An inverse variance-based revealed that primary measures, defined motor outcomes, benefitted significantly more than cognitive measures. Additionally, secondary measures balance, walking speed capacity, PDQ-39 ratings improved bicycling. The interventions varied in durations, intensities target cadences. Conclusively, is particularly beneficial for performance patients, improving crucial features Furthermore, our findings suggest improves overall quality-of-life patients.

Язык: Английский

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