research paper on parkinsons disease

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Research paper on parkinsons disease

Motor symptoms are often accompanied with fatigue, depression, pain and cognitive problems. Research 17 July Open Access. Research 16 July Open Access. Research 15 July Open Access. Research 08 July Open Access.

Research 08 July Which brain circuits are causally involved in depression? Using the human connectome as a wiring diagram, Siddiqi et al. Results of a new study have identified an association between risk of incident Parkinson disease and exposure to NO 2 , which is released into the atmosphere as a result of burning fuels.

Parkinson disease has a long prodromal phase, so these findings suggest an opportunity to apply early prevention strategies. Research Highlights 29 June Research Highlights 03 June Research Highlights 13 May Research Highlights 12 April Biomarkers that predict conversion from isolated REM sleep behaviour disorder to Parkinson disease are urgently needed.

Multiple logistic regression analyses revealed that the DRS-2 Conceptualization subscale, other compulsive behaviors, and smoking habits remained statistically associated with central parkinsonian pain even when other significant covariates were considered. Only patients with pain, regardless of type, had a gambling disorder.

The study results provide further evidence that pain revealed that patients with central parkinsonian pain are more likely to present compulsive or addictive behaviors, despite having more preserved cognitive performance. Patients with central parkinsonian pain appear to have a distinct phenotype of PD.

It is a chronic, disabling, and progressive disease, and no treatment stops its progression. Rating scales are utilized to quantify PD progression and severity. An analytical investigation into the use and meaning of these clinical scale scores was conducted to determine if gaps exist in quantifying disease progression and severity.

A series of discrepancies were identified including confusion among patients regarding the score meaning and misuse of the scores among clinicians and researchers to define disease progression. The scales are of an ordinal type and hence the resulting scores are ordinal, not providing a quantifiable progression nor severity level, but a categorical value and survey total.

The knowledge that the scores are ordinal and the scales are subjective is mentioned in very limited publications, not the focus of these papers, but a brief introduction and a thoroughly researched, analytical investigation into the scales and scores have not been found.

Therefore, the continuous misunderstanding and misuse of these scales and resulting scores warrant a comprehensive assessment and evaluation of these scales and scores to identify the gaps. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview.

Special Issues. Journal metrics. Submission to final decision 75 days. Acceptance to publication 35 days. CiteScore 3. Impact Factor 2. About this journal. Editor spotlight Parkinson's Disease maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

Meet the editorial board. Special Issues We currently have a number of Special Issues open for submission. Special Issues highlight emerging areas of research within a field, or provide a venue for a deeper investigation into an existing research area. Submit to Special Issue. Latest Articles More articles Research Article. Samaneh Reiszadeh Jahromi S. Mohammad Haddadi. Read the full article. Research Article. Angeline S. Andrew Faith L.

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Parkinson disease has a long prodromal phase, so these findings suggest an opportunity to apply early prevention strategies. Research Highlights 29 June Research Highlights 03 June Research Highlights 13 May Research Highlights 12 April Biomarkers that predict conversion from isolated REM sleep behaviour disorder to Parkinson disease are urgently needed.

Advanced search. Skip to main content Thank you for visiting nature. Atom RSS Feed Parkinson's disease Definition Parkinson's disease is a progressive neurodegenerative disorder, which is characterized by motor symptoms such as tremor, rigidity, slowness of movement and problems with gait. Research 08 July Brain stimulation and brain lesions converge on common causal circuits in neuropsychiatric disease Which brain circuits are causally involved in depression?

Nature Human Behaviour , Nature Reviews Neurology , Research Highlights 12 April Could perampanel treat Parkinson disease? Heather Wood Nature Reviews Neurology 17 , Nature Reviews Neurology 17 , Variables were standardised separately within each cohort to ensure that each variable had the same weighting within the k-means analysis.

Further details are described in our previous publication. These predicted clusters were compared with the k-means clusters in the Discovery cohort to determine the stability of our approach. We used the kappa statistic to compute the extent of agreement and adopted accepted guidelines 13 to determine the strength of this agreement. A sensitivity analysis using pattern-mixture models was carried out to determine whether patients lost to follow-up may potentially have biased our disease progression estimates.

The disease duration from diagnosis was on average 1. Demographic and clinical characteristics at baseline for the patients in the two studies. In our factor analysis, we found two factors: a psychological well-being and a non-tremor motor factor table 2 , as we reported previously. Using the statistics in web supplementary table 1 helped us decide that four clusters gave us an optimal solution. In general, the cluster patterns between the cohorts were fairly similar but with some differences see below.

Details of the clusters are available in web supplementary table 2 , which shows all the scores from the different tests included in the cluster analysis and categorised scores using standard cut-points from the literature for easier clinical interpretation. More details of the factor and the cluster analysis can be found in the online supplementary e-appendix.

Positive above the dotted line is worse than average and negative better than average. For laterality, positive is more bilateral than average and negative more unilateral than average. Note that hallucinations, constipation and urinary are categorical variables and were standardised using a slightly different method see online supplementary appendix 1.

BP, blood pressure; RBD, rapid eye movement sleep behaviour disorder. The fast motor progression 1 cluster had less advanced motor features and psychological well-being but worse than average non-motor features such as blood pressure postural drop, olfaction and cognition with more symmetrical motor disease. However, within the Discovery cohort, the non-tremor motor was worse, rather than better than average, for this cluster. The mild motor and non-motor disease 2 cluster showed a milder form of the disease being better in most domains and was similar in the Discovery cohort analysis.

The severe motor disease, poor psychological well-being and poor sleep 3 cluster was similar in the two cohorts and showed a more severe form of PD, especially in non-tremor motor features particularly bradykinesia and postural scores, worse psychological well-being and poor sleep and excessive daytime somnolence.

This reveals an overall agreement of We found a modest difference in disease duration since diagnosis maximum average difference 3. The mild motor and non-motor disease 2 cluster had the highest proportion of women and youngest age at diagnosis, while the fast motor progression 1 cluster had the highest age at diagnosis.

The severe motor disease, poor psychological well-being and poor sleep 3 cluster had the highest proportion with the postural instability gait difficulty PIGD phenotype while the slow motor progression 4 cluster had the highest proportion of tremor-dominant disease at baseline. The LEDD at baseline was highest in the severe motor disease, poor psychological well-being and poor sleep 3 cluster, which also had the smallest proportion of untreated patients.

Association of clusters with variables not used in the cluster analysis, along with a p value derived from a hypothesis test that the variable is equally distributed ie, same mean or same proportion among the four clusters. Cluster 1 is fast motor progression ; cluster 2 is mild motor and non-motor disease ; cluster 3 is severe motor disease, poor psychological well-being and poor sleep ; cluster 4 is slow motor progression.

In the Discovery cohort, only The change was highest in the mild motor and non-motor disease 2 cluster and slightly lower than average in the slow motor progression 4 cluster within both cohorts. In Discovery, All of the progression rates by cluster and cohort are shown in table 4. The same pattern of was seen in both cohorts. The fast motor progression 1 cluster had the fastest progression: 3.

Comparison of per-year progression rates within the two cohorts using the two approaches: multilevel random slope and intercept models MLMs versus pattern-mixture models PMMs. Observed data were split into yearly bins 0—1, 1—2, 2—3, 3—4 and 4—5 years and the means plotted. Repeating our analyses using pattern-mixture models showed little difference in progression rate estimates table 4 , providing evidence that withdrawal has not biased our estimates.

Our analysis has taken into account the five points recommended for studies using cluster analysis. Our previous paper reported five clusters in the Discovery cohort. The clusters in our new analysis are qualitatively similar although two of the original clusters a poor psychological well-being, rapid eye movement sleep behaviour disorder and sleep, and b severe motor and non-motor disease with poor psychological well-being have now merged into a single cluster cluster 3.

Our clusters are consistent with other similar studies in PD, which generally find a group with milder symptoms and a younger age at onset 3 5 15—22 our second cluster. Three studies also found a tremor-dominant group 17 18 20 our fourth cluster and most studies find a group with more severe symptoms or rapid disease progression 3 4 15—22 our first and third clusters. Importantly, we have now demonstrated different rates of motor progression across our baseline-defined clusters, with a mean annual deterioration in UPDRS III scores varying significantly from 0.

Interestingly, we also found, in keeping with another study 3 , that poor cognition and postural hypotension predicted faster motor progression. Stratification, or defining different subcategories, is key to better understanding disease mechanisms and kinetics in PD, predicting disease course and ultimately delivering personalised management strategies.

The emerging focus of PD trial design is on early motor disease, including novel immunomodulatory therapies that require intensive and invasive monitoring. Traditionally, little account has been taken of disease heterogeneity in early PD when selecting patients for randomised, placebo-controlled studies. However, our results show that baseline phenotype is associated with variable rates of subsequent motor progression, although confounded by potential medication response effects.

This study has used two of the largest PD incidence cohorts worldwide. In addition, the methods were designed collaboratively with similar variables being collected using almost identical inclusion criteria, though the source of recruitment differed. While this may impact on the frequency of the subtypes of PD, it should not influence the consistency of the clusters or the within-cluster progression rates. We had little missing data and we used imputation methods to reduce any bias.

Levodopa response is also composed of both short-duration and long-duration responses. Also, the long-duration response is typically much larger than the short-duration response. We used non-statistical criteria to help judge the best number of clusters, as the optimal number of clusters can differ depending on which statistic is the primary focus.

Each cohort has its strengths and weaknesses. The Discovery cohort used fewer clinicians to assess participants and had lower inter-rater variability. Discovery had more disabling disease and slightly worse cognitive function at baseline. Each cohort may have a slightly different mix of patients, but this will also occur in patients recruited for different clinical trials.

The major limitation in this analysis is that most of our data are restricted to the first 3 years of follow-up due to the studies being ongoing and patients not yet reaching 4. We suspect this has reduced our power to detect differences between the clusters. The associations we saw between clusters and progression rates could be due to non-linearity of growth rates; however, non-linearity cannot be tested until the vast majority of patients have four or more observations.

We took a pragmatic perspective where disease progression estimates reflected both pathophysiology and treatment effects. An alternative approach is measurement of the untreated underlying progression of subtypes, which reduces potential confounding effects of dopaminergic therapy in modifying disease progression, and has been applied elsewhere.

We have found four clusters that replicate across two large independent cohorts of newly diagnosed patients with PD and which are associated with different responses to levodopa and motor progression rates. Future work should examine the reasons for these differences, and with longer follow-up and using growth mixture models, we should be able to identify more easily patient groups with different progression rates and how this relates to their baseline characteristics.

This will also allow us to determine the robustness and clinical use of stratifying patients early in the disease course with better defined endpoints. We would like to thank the anonymous reviewers for their useful comments and all patients who have participated in this study. Contributors: ML: analysis and interpretation of the data, writing of the manuscript. YB-S: study concept and design, analysis and interpretation of the data, revision of the manuscript. MTY: analysis and interpretation of the data, revision of the manuscript.

FB: acquisition of data, revision of the manuscript. TRB: acquisition of data, revision of the manuscript. JCK: acquisition of data, revision of the manuscript. DMAS: acquisition of data, revision of the manuscript. NM: acquisition of data, revision of the manuscript.

KAG: study concept and design, acquisition of data, revision of the manuscript. NB: study concept and design, acquisition of data, revision of the manuscript. RAB: study concept and design, acquisition of data, revision of the manuscript. NW: study concept and design, revision of the manuscript. DJB: study concept and design, acquisition of data, revision of the manuscript. TF: study concept and design, acquisition of data, revision of the manuscript.

HRM: study concept and design, acquisition of data, revision of the manuscript. NWW: study concept and design, revision of the manuscript. DGG: study concept and design, acquisition of data, revision of the manuscript. MT-MH: study concept and design, acquisition of data, revision of the manuscript. TF received payment for advisory board meetings for Abbvie and Oxford Biomedica, and honoraria for presentations at meetings sponsored by Medtronic, St Jude Medical, Britannia and Teva pharmaceuticals.

Patient consent: Not required. Provenance and peer review: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. Journal of Neurology, Neurosurgery, and Psychiatry. J Neurol Neurosurg Psychiatry. Published online Jul Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Re-use permitted under CC BY. Published by BMJ. This is an Open access article distributed in accordance with the Creative Commons Attribution 4.

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Research paper on parkinsons disease Write custom academic essay on trump
Research paper on parkinsons disease Three studies also found a tremor-dominant group 17 18 20 our fourth cluster and most studies find a group with more severe symptoms or rapid disease progression 3 4 15—22 our first and third clusters. Brooks, David J. Psychol Methods ; 2 — You are viewing a javascript disabled version of the site. KAG: study concept and design, acquisition of data, revision of the manuscript. Our main goal is to explore effective CAM treatment for PD patients, through an understanding of its molecular mechanisms. We argue that for both clinical care and therapeutic development, these definitions need updating for the molecular age in which we live.
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Write my personal essay on hacking You are viewing a javascript disabled version of the site. Conclusions We have found four novel clusters that replicated well across two independent early PD cohorts and were associated with levodopa response and motor progression rates. In the past years, research has shown that not only does CAM improve behavioral symptoms of PD, but also causes molecular changes in a pathological mechanism associated with PD. Hedeker D, Gibbons RD. Article Type: Review Article Abstract: Neurological disorders are now the leading source of disability globally, and the fastest growing neurological disorder in the world is Parkinson disease.
Buy cheap rhetorical analysis essay on presidential elections Acknowledgments We would like to thank the anonymous reviewers for their useful comments and all patients who have participated in this study. Research 15 July Open Access. Journal metrics. Clinical heterogeneity in newly diagnosed Parkinson's disease. Lang, Anthony E. Research 17 July Open Access. BP, blood pressure; RBD, rapid eye movement sleep behaviour disorder.
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Automotive business plan outline Parkinson's Disease maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study. New clinical subtypes of Parkinson disease and their longitudinal progression: a prospective cohort comparison with other phenotypes. Clinical predictors in Parkinson's disease. Keywords: Alpha-synuclein, prion, constipation, dysautonomia, microbiota, gut-brain-axis. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. DGG: study concept and design, acquisition of data, revision of the manuscript.

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