Nonmotor fluctuations in Parkinson’s disease

Witjas, Tatiana; Kaphan, Elsa; Azulay, J.-P.; Blin, Olivier; Ceccaldi, M.; Pouget, Jean; Poncet, M; Chérif, A. Ali

doi:10.1212/wnl.59.3.408

Cited by 584 publications

(461 citation statements)

References 33 publications

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“…Most patients with PD include fatigue as one of their three most prominent symptoms, and claim that it substantially impacts quality of life [1][2][3][4], yet neurologists tend to underdiagnose fatigue as a presenting symptom of PD [5]. Clinically, fatigue can be described as an "overwhelming sense of tiredness, lack of energy, or feeling of exhaustion" [6].…”

Section: Introductionmentioning

confidence: 99%

Perceptions of effort during handgrip and tongue elevation in Parkinson's disease

Solomon

Robin

2005

Parkinsonism & Related Disorders

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Background-Fatigue and the accompanying perception of effort are often heightened in Parkinson's disease.Objectives-To compare performance on three sense-of-effort tasks between patients with PD and matched neurologically normal control subjects.Methods-Sixteen PD subjects and 16 normal subjects performed three tasks to assess sense of effort: self-ratings of effort using direct-magnitude estimation, generating pressures at various levels of effort, and sustaining a submaximal level of effort. The latter two tasks were done with handgrip and tongue elevation.Results-Two of the three tasks successfully differentiated the groups. Subjects with PD provided significantly higher ratings of effort for general daily activities and for speech. During the constant-effort task, pressure curves decayed more rapidly for the PD subjects.Conclusions-Performance by PD subjects on the constant-effort task resembled that by normal adults who were pre-fatigued in previous experiments. Results support greater than normal senseof-effort related to fatigue in PD, and provide preliminary validation of a performance-based physiologic task to assess abnormal sense of effort in this population.

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Section: Introductionmentioning

confidence: 99%

Perceptions of effort during handgrip and tongue elevation in Parkinson's disease

Solomon

Robin

2005

Parkinsonism & Related Disorders

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“…Levodopa response fluctuations are not limited to motor symptoms, and most patients with motor fluctuations also experience NMS fluctuations (NMS which worsen in OFF episodes) [66]. Recently, the EuroInf study clearly demonstrated that improvements in dopaminergic responsive NMS (with levodopa and apomorphine infusion) lead to robust improvements in quality of life [67].…”

Section: Management Of Non-motor Complicationsmentioning

confidence: 99%

Unmet needs in Parkinson's disease: New horizons in a changing landscape

Bhidayasiri

Laar

2016

Parkinsonism & Related Disorders

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a b s t r a c tThe success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.

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“…Under blind conditions, a placebo causes no similar mood effect (Maricle et al, 1995b). The extent of mood change does not correlate tightly with the extent of motor improvement or with baseline severity of motor signs (Maricle et al, 1995a(Maricle et al, , 1998Witjas et al, 2002). Finally, patients with rheumatoid arthritis and similar fluctuations in motor disability have significantly less severe fluctuations of mood (Cantello et al, 1986).…”

Section: Introductionmentioning

confidence: 97%

“…Patients consider mood symptoms more disabling than their motor deficits, and caregivers consider them more stressful (Witjas et al, 2002;Carter et al, 2002). Patients with clinically significant mood fluctuations tend to have severe PD, with early onset, long duration of illness, and extremely high rates of psychiatric comorbidity including dementia, prior (nonfluctuating) depression, and drug-induced psychosis (Racette et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Levodopa Challenge Neuroimaging of Levodopa-Related Mood Fluctuations in Parkinson's Disease

Black

Hershey

Hartlein

et al. 2004

Neuropsychopharmacol

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Some patients with advanced Parkinson's disease (PD) develop dose-related fluctuations in mood. This may reflect alterations in dopamine-influenced brain circuits that mediate emotion. However, there is no available information to localize which dopamineinfluenced neurons may be most affected. Eight patients with PD and clinically significant levodopa-related mood fluctuations (mania, depression, or anxiety) were compared to 13 patients with similarly severe PD and fluctuations of motor function but not of mood. Regional cerebral blood flow (rCBF) was measured with positron emission tomography before and after levodopa (in the presence of carbidopa). The rCBF response to levodopa in medial frontal gyrus and posterior cingulate cortex (PCC) significantly differed between mood fluctuators and control patients (corrected po0.02). Other regions with uncorrected po0.001 in this comparison were cortical Brodmann areas 22, 40, 13, 11, and 28, hippocampus, and claustrum. The levodopa activation paradigm detected group differences not evident in a comparison of resting rCBF. Abnormalities of dopamine innervation may produce mood fluctuations via effects on PCC, an area strongly linked to mood and anxiety and with known rCBF responsiveness to levodopa or D2-like dopamine receptor agonists. We speculate that mood fluctuations may arise in parkinsonian patients who have abnormal dopaminergic modulation of caudate nucleus, anterior cingulate cortex, or orbital frontal cortex, all of which innervate PCC. The findings require confirmation in larger and bettermatched groups.

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Nonmotor fluctuations in Parkinson’s disease

Abstract: Nonmotor fluctuations are frequent and debilitating in PD.

Cited by 584 publications

References 33 publications

Perceptions of effort during handgrip and tongue elevation in Parkinson's disease

Perceptions of effort during handgrip and tongue elevation in Parkinson's disease

Unmet needs in Parkinson's disease: New horizons in a changing landscape

Levodopa Challenge Neuroimaging of Levodopa-Related Mood Fluctuations in Parkinson's Disease

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