Background. There are still no clearly proven methods to slow down or stop the progression of Parkinson’s disease (PD). Thus, improving the quality of life (QoL) of patients with PD becomes of primary importance. Autonomic dysfunction and its symptoms are known to worsen the quality of life in PD, but the degree of this influence is underinvestigated. Particularly, impacts of the separate significant gastrointestinal symptoms, such as dyspepsia, constipation, and abdominal pain, in PD should be more precisely evaluated with the help of specific scales. Objective. To assess the impacts of gastrointestinal dysfunction and its symptoms on PD patient’s QoL using PDQ-39. Methods. 111 PD patients in the I-III Hoehn and Yahr (H&Y) stage were enrolled in the study. The following scales were applied: UPDRS III, PDQ-39, GSRS, GDSS, MMSE, BDI, STAI-S, and STAI-T. Results. The linear regression model showed that the PDQ-39 SI depended on summary assessments GSRS-SI (β = 0.333, p < 0.001 ), BDI (β = 0.463, p < 0.001 ), and UPDRS III (β = 0.163, p < 0.05 ). The use of the stepwise method, adding GSRS-SI and UPDRS III scores to the BDI predictor, improved the model (R2 increased from 0.454 to 0.574). The investigation of GSRS domain’s influence revealed that PDQ-39 SI had a significant correlation with almost all of them, but the regression analysis showed significant QoL impacts of only two factors: constipation and abdominal pain (β = 0.288, p < 0.01 and β = 0.243, p < 0.05 accordingly). Conclusions. Our results suggest a considerable negative influence of depression and gastrointestinal dysfunction (especially constipation and abdominal pain) on QoL of patients with PD. Their impact on QoL in patients with I-III H&Y stages of PD is more significant than that of motor symptoms. Therefore, the correction of depression and gastrointestinal dysfunction should be prioritized in PD therapy.
Витамины – это группа органических соединений, которые необходимы для нормального физиологического функционирования, но не синтезируются организмом эндогенно и поэтому должны в небольших количествах поступать из окружающей среды. Роль витаминов группы В в функционировании клеток чрезвычайно важна: они действуют как коферменты в широком спектре катаболических и анаболических ферментативных реакций. Их эффекты тесно взаимосвязаны и особенно значимы для функционирования нервной системы, включая производство энергии, синтез и восстанов-ление ДНК или РНК, геномное и негеномное метилирование, синтез многочисленных медиаторов и прочих нейрохимических и сигнальных молекул. Данные эпидемиологических исследований показывают, что значительная часть населения развитых стран страдает от дефицита одного или не-скольких витаминов группы В и что в отсутствие оптимальной диеты введение в рацион питания комплекса витаминов группы В в адекватных дозах является рациональным подходом к сохранению здоровья мозга и организма в целом. Генетические дефекты метаболизма витаминов и ви-таминодефицитные состояния являются безусловными показаниями к терапии витаминами группы В. Однако наиболее распространенной причиной их назначения служит ряд неврологических заболеваний, при которых дефицит витаминов группы В отсутствует. Так, одним из самых частых по-казаний к назначению витаминов группы В является болевой синдром при заболеваниях опорно-двигательного аппарата и при невропатиях. Счи-тается, что витамины группы В способны влиять на ноцицептивные и нейропатические боли, обладают собственным анальгетическим и противо-воспалительным действием. Комбинированное применение витаминов В1 + В6 + В12 в большинстве случаев более предпочтительно, чем монотерапия, поскольку эти витамины выполняют синергичные биохимические роли в нервной системе, т.е. действуют сообща, и ни один из них не может заме-нить другой. Экспериментальные и клинические данные свидетельствуют об эффективности комплексной терапии витаминами группы В ряда за-болеваний периферической и центральной нервной системы. Относительно терапии болевых синдромов можно сделать следующие выводы: вита-мины группы В обладают анальгетической активностью, их совместное применение более эффективно, чем монотерапия В1, В6 и В12, в лечении острых болей, комбинация витаминов В с нестероидными противовоспалительными препаратами более эффективна и безопасна, чем монотерапия последними. В будущем, скорее всего, показания к применению витаминов группы В будут только расширяться. Ключевые слова: болевой синдром, боль в спине, дорсалгия, невропатия, витамины группы В, Нейромультивит. Для цитирования: Пилипович А.А. Применение витаминов группы В в практике врача-невролога. Consilium Medicum. 2020; 22 (9): 82–86. DOI: 10.26442/20751753.2020.9.200438
The role of exogenous factors in the occurrence of neurodegenerative diseases has been shown in many works: on the effects of radiation, neurotoxicants, pesticides and other organic and inorganic substances. One of the interesting and promising areas for studying the pathogenesis of neurodegeneration is the analysis of the composition and ratio of trace elements in various tissues and organs of a person. The influence of trace elements on the development of neurodegenerative diseases, such as Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's disease, amyotrophic lateral sclerosis, is given special attention, since such patients show multiple disorders in the homeostasis of the main endogenous brain biometals (calcium, magnesium, zinc, iron, manganese, copper, etc.). On the one hand, in a cell or its components, where metals play a key role in biological processes, a metal deficiency can occur, on the other hand, metals can accumulate in pathological proteins, causing cell dysfunction and death. Protein aggregation is a common feature of all neurodegenerative diseases. Specific changes in the concentration of biometals in various environments of the body can be considered as early biomarkers of neurodegenerations. And the identification of reliable biomarkers is considered a paramount task for the development of the direction of early therapy and prevention of the disease, in particular PD. A change in the distribution of metal, cell deficiency and sequestration in pathological proteins are abnormalities that must be addressed during neurodegeneration. Currently, approximately 800 compounds are used or tested for the treatment of PD, of which approximately 250 have the expected or established chelation properties of metals (CuII, CuI, FeII, FeIII, MnII, ZnII) that are involved in dyshomeostasis in PD. Today's knowledge of the pathogenesis of the most common neurodegenerations, such as AD and PD, is still not enough to develop clear recommendations for therapy with biometals and other trace elements, but work in this direction is actively ongoing.
Neck pain is a fairly common complaint when visiting a doctor, its occurrence frequency is 10–21% per year, and neck pain takes the 4th place among the causes of disability; almost 50% of patients continue to experience unpleasant sensations or repeated pain episodes. The elderly people are the most prone to the neck pain, this is associated with the progressive degenerative changes in the facet joints and intervertebral discs. However, reasons of this symptom can be of different kinds. Cervicalgia diagnosis is directed primarily to eliminate symptomatic pains associated with severe somatic pathology, immune diseases, infections and oncology. Comorbid diseases and risk factors can combine with each other causing the polyetiologic pain syndrome. Main steps of the cervicalgia diagnostic algorithm are the following: collection of complaints and anamnesis in detail, physical and neurological examination, and also use of visualization methods. Visualization and electrodiagnostic methods are not always informative for patients with chronic cervicalgia and in the degenerative etiology of the syndrome. MRI and the surgeon consultation must be recommended to patients with deteriorating neurological symptoms or with long-term constant pain. Conservative therapy of cervicalgia implies a combination of non-drug methods (compliance with regime, orthopedic treatment, leaf, physiotherapy, etc.) and pharmacotherapy. The last depends on the presence of a neuropathic component of pain and the duration of pain syndrome. The pain therapy with a nociceptive nature is usually implies a combination of non-steroidal anti-inflammatory remedies, non-opioid analgesics and muscle relaxants. Whereas neuropathic pains first-line preparations are tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, gabapentine. The therapy success depends on the proper individual estimation of the pain factors, pain chronization and possible treatment complications. The therapeutic forecast of the acute nonspecific cervicalgia is usually good, but it becomes less predictable if the pain acquires chronic character.
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