No abstract

BACKGROUND In a combined animal and human study, we have previously found that a five-day treatment that enhances cortical plasticity also facilitates brain-derived neurotrophic factor (BDNF)-tyrosine receptor kinase B (TrkB) signaling and increases activated TrkB and N-methyl-D-aspartate receptor (NMDAR) association in both the cortex and the peripheral lymphocytes. Patients with Parkinson’s disease (PD) in general show decreased cortical plasticity, as demonstrated by electrophysiological and behavioral studies. Here we test the hypothesis that an exercise program that improves motor function and seems to slow down symptoms’ progression can enhance BDNF-TrkB signaling in lymphocytes. METHODS Sixteen patients with PD underwent a four-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT), which included aerobic training, physical and occupational therapy. Blood was collected before, after two- and four-week MIRT. Lymphocytes were isolated to examine BDNF-TrkB signaling induced by incubation with recombinant human BDNF. TrkB signaling complexes, extracellular-signal-regulated kinase-2 and protein-kinase-B were immunoprecipitated; content of immunocomplexes was determined by Western blotting. RESULTS After MIRT, all patients showed improvement in motor function. TrkB interaction with NMDAR and BDNF-TrkB signaling increased in peripheral lymphocytes at receptor, intracellular mediators and downstream levels. The decrements in UPDRSII and total scores were significantly correlated with the increases in TrkB signaling at receptor, intracellular mediators and NMDAR interaction levels. CONCLUSIONS The significant correlation between reduced UPDRS scores and the changes in lymphocytes’ activity suggest that enhanced BDNF-TrkB signaling in lymphocyte and reduced severity of PD symptoms may be related.

BackgroundSleep disturbances are among the most common non-motor symptoms of Parkinson’s disease (PD), greatly interfering with daily activities and diminishing life quality. Pharmacological treatments have not been satisfactory because of side effects and interactions with anti-parkinsonian drugs. While studies have shown that regular exercise improves sleep quality in normal aging, there is no definitive evidence in PD.MethodsIn a retrospective study, we determined whether an intense physical and multidisciplinary exercise program improves sleep quality in a large group of patients with PD.We analyzed the scores of PD Sleep Scale (PDSS), which was administered twice, 28 days apart, to two groups of patients with PD of comparable age, gender, disease duration and pharmacological treatment. The control group (49 patients) did not receive rehabilitation, The treated group (89 patients) underwent a 28-day multidisciplinary intensive rehabilitation program (three one-hour daily sessions comprising cardiovascular warm-up, relaxation, muscle-stretching, balance and gait training, occupational therapy to improve daily living activities).ResultsAt enrolment, control and treated groups had similar UPDRS and PDSS scores. At re-test, 28 days later, UPDRS and total PDSS scores improved in the treated (p < 0.0001) but not in the control group. In particular, the treated group showed significant improvement in PDSS scores for sleep quality, motor symptoms and daytime somnolence. The control group did not show improvement for any item.ConclusionsThese results suggest that multidisciplinary intensive rehabilitation treatment may have a positive impact on many aspects of sleep in PD.

Balance dysfunction (BD) in Parkinson's disease (PD) is a disabling symptom, difficult to treat and predisposing to falls. The dopaminergic drugs or deep brain stimulation does not always provide significant improvements of BD and rehabilitative approaches have also failed to restore this condition. In this study, we investigated the suitability of quantitative posturographic indicators to early identify patients that could develop disabling BD. Parkinsonian patients not complaining of a subjective BD and controls were tested using a posturographic platform (PP) with open eyes (OE) and performing a simple cognitive task [counting (OEC)]. We found that patients show higher values of total standard deviation (SD) of body sway and along the medio-lateral (ML) axis during OE condition. Furthermore, total and ML SD of body sway during OE condition and total SD of body sway with OEC were higher than controls also in a subgroup of patients with normal Berg Balance Scale. We conclude that BD in Parkinsonian patients can be discovered before its appearance using a PP and that these data may allow developing specific rehabilitative treatment to prevent or delay their onset.