Parkinson's Disease Resource Center

Treatment

Microglial response to aging and neuroinflammation in the development of neurodegenerative diseases

Neural Regeneration Research

This article explores the role of microglia in neurodegenerative diseases, emphasizing their response to aging and chronic inflammation. The review highlights how different states of microglial activation can influence the development of diseases like Alzheimer's, Huntington's, and Parkinson's. Understanding these mechanisms can aid in developing treatments that shift microglia from a neurotoxic to a neuroprotective state. This knowledge could lead to new therapeutic strategies for managing neurodegenerative diseases, improving patient outcomes.

Parkinson’s disease – current treatment

Current Opinion in Neurology

This article reviews recent advancements in the treatment of both motor and non-motor symptoms of Parkinson's disease (PD). It highlights new formulations of levodopa that optimize motor fluctuations and on-demand apomorphine for treating motor off-periods. The article also discusses promising new agents for non-motor symptoms like constipation and sleep disorders, as well as the potential benefits of expiratory muscle strength training for oropharyngeal dysphagia. Additionally, it emphasizes the importance of being familiar with a broad range of treatment options to manage the diverse symptoms of PD effectively.

Predicting Sleep Quality Improvement in Parkinson’s Disease Patients Post-DBS: A Nomogram Approach

Neurosurgery

This article investigates the factors influencing sleep disorder improvement in Parkinson's disease (PD) patients after deep brain stimulation (DBS) of the subthalamic nucleus (STN). The study identifies key predictors such as preoperative medication responsiveness, MMSE scores, and HAMA scores, which can help tailor treatment plans. Additionally, the development of a nomogram model with strong predictive accuracy offers a valuable tool for forecasting sleep quality improvements post-surgery. These insights can enhance patient care and optimize treatment strategies for PD-related sleep disorders.

Rosa moschata ameliorates haloperidol-induced Parkinson’s disease via reduction of neurodegeneration and oxidative stress

Asian Pacific Journal of Tropical Biomedicine

This article investigates the potential neuroprotective effects of Rosa moschata extract on haloperidol-induced Parkinson's disease (PD) in rats. The study shows significant improvements in motor functions and muscle strength, along with increased levels of beneficial neurotransmitters and antioxidants. Additionally, the extract reduced oxidative stress and neurodegeneration markers, suggesting its potential for PD management. These findings provide a basis for further research into the efficacy and molecular mechanisms of Rosa moschata extract, which could lead to new treatment options for PD patients.

Velocity-Based Training Affects Function, Strength, and Power in Persons with Parkinson’s Disease

Journal of Strength and Conditioning Research

This article explores the effects of velocity-based training (VBT) on functional performance, strength, and power in Parkinson's disease (PD) patients. The study demonstrates significant improvements in various physical performance metrics, such as gait speed, sit-to-stand time, and muscle strength, after 12 weeks of supervised VBT. These findings suggest that VBT can be an effective training modality for enhancing physical function in PD patients. Additionally, the study provides insights into the specific protocols and outcomes, helping healthcare providers design better exercise programs for PD management.

Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease

Neurology

This article demonstrates the long-term efficacy of deep brain stimulation of the subthalamic nucleus (STN-DBS) in treating motor complications in Parkinson's disease (PD) patients. The study shows significant reductions in dyskinesia and "off" time, as well as a substantial decrease in dopaminergic drug usage, even 15 years after surgery. Additionally, it highlights improvements in quality of life (QoL) and manageable device-related adverse events. These findings provide valuable insights into the sustained benefits of STN-DBS, helping healthcare providers optimize long-term treatment strategies for PD patients.

Therapeutic potential of Glycyrrhiza glabra L. in managing oxidative stress-induced disorders

Journal of Drug Research in Ayurvedic Sciences

This article reviews the therapeutic potential of Glycyrrhiza glabra (licorice) in managing oxidative stress-related conditions. The review highlights key bioactive molecules like glycyrrhizin and isoliquiritin, which modulate antioxidant enzyme activities and inhibit free radical production. These findings suggest that licorice could be beneficial in treating diseases such as cancer, neurodegenerative disorders, and inflammatory conditions. Additionally, the article identifies gaps in current knowledge and calls for further research to fully exploit the medicinal benefits of G. glabra, offering valuable insights for future therapeutic applications.

A Systematic Review and Meta-analysis of the Effect of Apomorphine in Patients with Parkinson’s Disease

Journal of Advanced Trends in Medical Research

This article is important because it offers a comprehensive analysis of the efficacy of apomorphine in treating Parkinson's disease (PD). The systematic review and meta-analysis provide robust evidence on the effectiveness of apomorphine in improving motor symptoms and reducing OFF time in PD patients. Additionally, the study highlights the safety profile of apomorphine, which is crucial for making informed treatment decisions. Understanding these findings can help healthcare providers optimize treatment strategies and improve patient outcomes in PD management.

Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease

Neurology

This article is important because it offers valuable insights into the efficacy of changing or combining advanced therapies (ATs) for Parkinson's disease (PD) patients. The study, based on data from 22 PD centers in Germany, shows significant improvements in clinical outcomes and reduced side effects with AT modifications. It highlights the importance of tailoring ATs to individual patient needs, depending on dominant symptoms and adverse effects. Additionally, the findings suggest that combining ATs can be as beneficial as introducing the first AT, providing a strong basis for optimizing treatment strategies.

Parkinson's Disease Diagnosis and Treatment

Research

Parkinson’s disease – genetic cause

Current Opinion in Neurology

This article offers a comprehensive overview of the genetic factors underlying Parkinson's disease (PD). It highlights key mutations in both autosomal dominant and recessive genes that contribute to PD, providing insights into the genetic complexity of the disease. The article also introduces new putative disease-causing genes, which could influence future diagnostic and therapeutic strategies. Understanding these genetic aspects can help healthcare providers predict and manage PD more effectively, paving the way for precision medicine in treating this condition.

Roles of neuronal lysosomes in the etiology of Parkinson’s disease

Neural Regeneration Research

This article delves into the molecular etiology of Parkinson's disease (PD), focusing on the role of the autophagy-lysosome system. The review highlights how genetic and genomic advancements have identified key proteins and cellular processes involved in PD, particularly those related to lysosome function. Understanding these mechanisms can aid in developing targeted therapies that modify disease progression. Additionally, the article discusses the potential risks of indiscriminately enhancing autophagy, emphasizing the need for precise adjustments in lysosome functionalities to improve neuronal and glial cell functions.

Imaging-Guided Subthalamic Nucleus Deep Brain Stimulation Programming for Parkinson Disease

Neurology

This article compares two programming methods for deep brain stimulation (DBS) in Parkinson's disease (PD) patients, highlighting their efficacy and patient burden. The study shows that both conventional ring-mode programming (CP-RM) and image-guided volume of tissue activated (IG-VTA) programming provide similar improvements in motor function. However, IG-VTA programming is associated with shorter hospital stays and fewer hospitalizations, reducing the burden on patients and clinicians. These findings can help healthcare providers optimize DBS programming methods to enhance patient outcomes and streamline care.

Off-time Treatment Options for Parkinson’s Disease

PubMed

This article offers a comprehensive overview of treatment options for managing motor fluctuations (MF) in Parkinson's disease (PD). It discusses both pharmacological and advanced therapies, including new once-a-daily compounds and on-demand rescue therapies, providing insights into their efficacy and application. The article also addresses complex therapies like deep brain stimulation and device-aided treatments, highlighting their potential benefits when oral/on-demand options are insufficient. Additionally, it emphasizes the importance of personalized treatment decisions based on patient preferences, symptoms, and socio-economic factors, which is crucial for optimizing patient care.

The Efficacy of Istradefylline for Treating Mild Wearing-Off in Parkinson Disease

Clinical Neuropharmacology

This article examines the efficacy of istradefylline, an adenosine A2A antagonist, in treating mild wearing-off symptoms in Parkinson's disease (PD) patients. The study found that 20 mg/day of istradefylline significantly improved motor functions over 12 weeks, as evidenced by reductions in ON-UPDRS-III scores. The results suggest that istradefylline can be effective for PD patients with shorter daily OFF times, providing valuable insights for healthcare providers on optimizing treatment strategies. Additionally, the article highlights the dose-dependent effects of A2A antagonists in relation to L-DOPA, which is crucial for tailoring treatment regimens.

Diagnosis

Diagnosis is based on clinical features (rest tremor, rigidity, bradykinesia, postural instability) and response to dopaminergic therapy.
PD is a clinical diagnosis and gold standard for diagnosis are history and neuropathologic exam.
Generally, bradykinesia plus either tremor or rigidity must be present.
Idiopathic rapid eye movement sleep behavior disorder is a possible prodrome for PD.

History

Symptoms are often subtle or attributed to aging.

Decreased emotion displayed in facial features
General motor slowing and stiffness (One or both arms do not swing with walk.)
Resting tremor (often initially one hand)
Speech soft/mumbling
Falls/difficulty with balance; seen with disease progression
Psychiatric symptoms including depression, anxiety, hallucinations, and dementia
Urinary symptoms including increased frequency and urgency; constipation

Physical Exam

Tremor
- Resting tremor (4 to 6 Hz) that is often asymmetric; disappears with voluntary movement; frequently emerges in a hand while walking and may present as pill rolling; may also present in jaw, chin, lips, and tongue
Bradykinesia—generalized slowness of movements
Rigidity: cogwheel (catching and releasing) or lead pipe (continuously rigid), tested by passively manipulating the limbs
Postural instability—decreased ability to prevent falling

Differential Diagnosis

Essential tremor: Bradykinesia is not present; often symmetric and occurs mostly during action or when holding hands outstretched, nonresponsive to levodopa (L-dopa).
Depression can cause psychomotor slowing that may appear similar to bradykinesia in PD.
Dementia with Lewy bodies: characterized clinically by visual hallucinations, fluctuating cognition, and parkinsonism; dementia occurs concomitantly with or before the development of parkinsonism.
Multiple system atrophy: presets with parkinsonism and varying degrees of dysautonomia, cerebellar involvement, and pyramidal signs; poor response to L-dopa.
Progressive supranuclear palsy: impairment in vertical eye movements (particularly down gaze), hyperextension of neck, and early falling; pseudobulbar palsy
Associated neurodegenerative disorders: late stages of Alzheimer disease, Huntington disease, frontotemporal dementia, spinocerebellar ataxias
Secondary parkinsonism (drug induced: reversible; may take weeks/months after offending medication is stopped; often bilateral symptoms): neuroleptics (most common); antiemetics (e.g., prochlorperazine and promethazine), metoclopramide; SSRIs; calcium channel blockers; amiodarone; lithium/valproic acid; amphotericin B; estrogens

Diagnostic Tests & Interpretation

Initial Tests (lab, imaging)

Diagnosis is mainly clinical, and there are no confirmatory physiologic or blood tests.
Reduction in α-synuclein and DJ-1 protein can act as a qualitative feature in PD diagnosis.
MRI of brain is nondiagnostic but can be used to rule out structural abnormalities.

Follow-Up Tests & Special Considerations

Single-photon emission computerized tomography (SPECT) scan might be helpful to differentiate PD from secondary parkinsonism.

Diagnostic Procedures/Other

PET and MR spectroscopy are not recommended.

Test Interpretation

Diagnosis is clinical and no tests are recommended to confirm diagnosis of PD.

From 5-Minute Clinical Consult, Svitlana Zhukivska, Medical Doctor Reviewed 04/2024

Parkinson's Disease Resource Center

Treatment

Research

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