Showing posts with label Parkinsonaposs. Show all posts
Showing posts with label Parkinsonaposs. Show all posts

Saturday, June 22, 2013

Parkinson's Effect on Speech Fosters Isolation (CME/CE)

By Ed Susman, Contributing Writer, MedPage Today Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.This small study of patients with Parkinson's disease and familial controls demonstrated significant deficits in speech and communication among the affected participants.

SYDNEY -- A new study demonstrated that subtle changes in speech can impact the ability of Parkinson's patients to communicate and may result in further isolation from the community, researchers said here.

Patients participating in the Factors Affecting the Speech of People with Parkinson's Disease Study scored an average 14.8 percentage points lower in their ability to communicate intended emotions compared with controls (P=0.02), Maxwell Barnish, a PhD candidate at University of East Anglia in Norwich, England, and colleagues found.

In his poster presentation at the International Congress on Parkinson's Disease and Movement Disorders, Barnish noted that the communication and emotional conveyance were both predicted by patients' cognitive status as measured by the Montreal Cognitive Assessment.

"Cognitive impairment significantly affects speech and communication in Parkinson's disease," he said. "This leads to reduced communicative participation."

Parkinson's patients were stratified by the median score on the test, and those who scored lower than or equal to 23 also measured 16.7 percentage points lower, on average, in their ability to convey emotion, he told MedPage Today. Cognitive status predicted 19% of the variance in communicative participation, which was statistically significant (P<0.05), he said.

For the study, the researchers recruited 45 people with Parkinson's disease and 29 people who were friends or relatives of the patients. All were from various areas of the U.K. and all were white. The patients were about 70 years of age, and ranged from 48 to 93 years.

The group was not gender-balanced, with a predominance of men in the patients and a predominance of women among the controls. The difference was controlled for in the analysis, Barnish said.

"The majority of Parkinson's patients in this study had mild speech impairments, but this impairment had a substantial impact on everyday communication tasks," Barnish explained. "The qualitative analysis we performed indicated that patients were anxious about their speech and that voices sounded different."

Barnish suggested that their anxiety and perceived voice change might lead to them become less outgoing.

Previous research had not focused on the relationship between cognitive status and everyday communication, hence Barnish attempted to define these relationships.

"Further research is required to determine how these findings can be applied in speech and language therapy for Parkinson's disease," he added.

Alison Yarnall, MD, of the University of Newcastle in England, told MedPage Today, "This is an interesting area of study. Obviously speech and communication are important aspects of daily living that can be interrupted by Parkinson's disease."

"Drugs in Parkinson's disease are well studied with big randomized clinical trials, but things like speech therapy and physical therapy, which can make a massive difference to patients, are often not well studied," she said. Yarnall said she was interested in seeing how further research in the field could impact treatment decisions and resource implementation.

Barnish and Yarnall had no disclosures.

Primary source: Movement Disorder Society
Source reference:
Barnish M, et al "Relationships between cognitive status, speech characteristics and communicative participation in Parkinson's disease" MDS 2013.

Depression Tied to Mental Loss in Parkinson&apos;s (CME/CE)

By Ed Susman, Contributing Writer, MedPage Today Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Note that this study of patients with Parkinson's disease and healthy controls demonstrated a strong association between mild cognitive impairment and worse scores on standardized tests for depression and anxiety.Be aware that the cross-sectional nature of the study precludes a formal assessment of causality.

SYDNEY -- Nonmotor symptoms such as depression and anxiety appear to be more frequent among patients with Parkinson's disease who also are diagnosed with mild cognitive impairment, researchers reported here.

In comparing scores on the Beck Depression Inventory II, patients with Parkinson's disease and mild cognitive impairment registered a mean score of 14.6; those patients with Parkinson's disease but without mild cognitive impairment scored 8.6, while healthy controls scored 5.3 (P<0.05 for all comparisons), said Sabrina Diab, MS, a PhD candidate at the Center for Advanced Research in Sleep Medicine at the Hôpital du Sacre-Coeur in Montreal.

In addition, patients with Parkinson's disease and mild cognitive impairment scored an average of 14.1 on the Beck Anxiety Index, which was statistically significant compared with Parkinson's disease patients without mild cognitive impairment (5.9) and controls (4.1) (all comparisons, P<0.05), Diab said at her poster presentation at the International Congress on Parkinson's Disease and Movement Disorders.

The 5.9 score is below the cut-off for clinical anxiety, Diab said, so while it is statistically significant, it might not be clinically meaningful. She noted the results were significant despite small numbers of patients in each group.

"What we found is that patients who have Parkinson's disease and mild cognitive impairment scored higher on those scales of depression and anxiety versus patients with Parkinson's disease and without mild cognitive impairment, and versus the control group as well," she said. "We think that if you are treating a Parkinson's disease patient with mild cognitive impairment, that person is more likely to have depression and anxiety."

For the study, Diab and colleagues recruited 36 patients with Parkinson's disease who were taking only dopaminergic medications. They diagnosed 16 of those patients with mild cognitive impairment. The patients with Parkinson's disease were compared with 36 healthy controls.

Most of the participants in the trial were men, and their average age was about 65 years. Disease duration was 6.4 years in the Parkinson's patients with mild cognitive impairment compared with 4.3 years for those without cognitive impairment, but that difference was not statistically significant.

When the researchers scrutinized results on measures of sleep, Diab said, "What we have also seen is that patients with Parkinson's disease and mild cognitive impairment, and Parkinson's disease without mild cognitive impairment, scored higher on the Epworth Sleepiness Scale and the Insomnia Severity Index versus the control group.

"For now, we think that mood symptoms are more related to cognitive impairment, and sleeping complaints are more related to Parkinson's disease."

The researchers did not evaluate the type or severity of the depression or of the anxiety disorder.

Alison Yarnall, MD, of the University of Newcastle in England, told MedPage Today, "This is an interesting pilot study, but we need more information. The numbers in this study are small and only 16 of the patients have mild cognitive impairment."

"Anxiety and depression can impact the tests we do for cognitive impairment, so we should take these results with a pinch of salt because it is kind of chicken or egg," commented Yarnall, who did not participate in the study. "Do people with mild cognitive impairment have more depression and anxiety or is their depression and anxiety impairing their testing abilities? We need a larger study to help us tease out what is really happening with these patients."

Diab and Yarnall had no disclosures.

Primary source: Movement Disorders Society
Source reference:
Diab S, et al "Non-motor symptoms in Parkinson's disease with mild cognitive impairment" MDS 2013.

Friday, June 21, 2013

Curing H. Pylori Cuts Parkinson&apos;s Symptoms (CME/CE)

By Ed Susman, Contributing Writer, MedPage Today Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Note that this cohort study of patients with Parkinson's disease and H. pylori infection demonstrated improved levodopa efficacy following H. pylori eradication.Be aware that, as there was no control group, placebo effects cannot be ruled out.

SYDNEY -- Parkinson's disease patients showed improvement in multiple symptoms of the disease after being treated for Helicobacter pylori infection, researchers reported here.

At 12 weeks post eradication, levodopa 'onset' time was significantly reduced (P=0.023), and "ON" time duration was increased (P=0.023), Norlinah Mohamed Ibrahim, MBBCH, chief of medicine at the National University of Malaysia in Kuala Lumpur, told MedPage Today.

"We believe that H. pylori infection is making it more difficult for Parkinson's disease drugs to work, so by eradicating the infection, we appear to be speeding up the drugs' activity," she explained at her late-breaker poster presentation at the International Congress on Parkinson's Disease and Movement Disorders.

"We also think that H. pylori may play a role in the pathogenesis and severity of Parkinson's disease and we are continuing to research that question." Mohamed Ibrahim said.

In her study, 76 consecutive Parkinson's disease patients were tested for H. pylori infection using the C-urea breath test; 27 patients who were positive for H. pylori underwent a 1-week antibiotic therapy that included oral clarithromycin, amoxicillin, and esomeprazole. The trial was conducted as an open-label single arm study. Mohamed Ibrahim said it would have been medically unethical to have established a placebo arm once it had been determined that patients had the infection known to cause ulcers and other diseases.

However, at baseline, the researchers were able to see differences between those with H. pylori infection and those who were not infected. The average score of the infected patients on the Unified Parkinson's Disease Rating Scale was 85.05 compared with a mean score of 63.98 for those without infection (P=0.005). On the Parkinson Disease Questionnaire scores, those with infection scored 50.98 compared with a score of 32.55 for those free of infection (P<0.001).

There were no significant differences at baseline between those with infection and those H. pylori-negative in "onset" or "ON" times.

Patients who were H. pylori positive were re-tested at 6 weeks post eradication and at 12-weeks post eradication.

Mohamed Ibrahim reported that in these patients: Total Unified Parkinson's Disease Rating Scale scores declined from 85.05 at baseline to 72.05 at 6 weeks and to 66.71 at 12 weeks (P<0.001).In the subdomains, activities of daily living scores decreased from a baseline score of 21.67 to 19.14 at 6 weeks and to 18.43 at week 12 (P=0.001)In motor examination, the baseline score of 50.62 decreased to 41.43 at 6 weeks and to 37.00 at 12 weeks (P<0.001).In the complications of therapy domain, the baseline score of 7.86 was reduced to 6.76 at 6 weeks and to 6.38 at baseline (P=0.009).

In the Parkinson's Disease Questionnaire, treatment was associated with significant score declines in most domains.

"Screening and eradication of H. pylori in Parkinson's disease patients should be recommended particularly in those with erratic response to oral levodopa as part of the current practice guidelines for Parkinson's disease management," Mohamed Ibrahim said.

"This is a very interesting study that should be considered in patients with Parkinson's disease," commented Daan Kamphuis, MD, a neurologist at Reinier de Graaf Hospital in Delft in The Netherlands.

"It would appear that H. pylori is having some form of interaction with drugs such as levodopa and delaying action of the drugs in these people," he told MedPage Today. "I am not sure that H. pylori itself has a causative role in Parkinson's disease. H. pylori remains a widespread infection throughout the developed and undeveloped world."

Approximately two-thirds of the world's population is infected with H. pylori. In the U.S., H. pylori is more prevalent among older adults, African Americans, Hispanics, and lower socioeconomic groups, according to the CDC.

Mohamed Ibrahim and Kamphuis had no disclosures.

Primary source: Movement Disorder Society
Source reference:
Mohamed Ibrahim, N et al, "An open label, single arm study on the effects of H. Pylori eradication in Parkinson's disease" MDS 2013.