Amin Cervantes-Arriaga

Impulse control and related disorders in Mexican Parkinson's disease patients

BACKGROUND Impulse control disorders (ICDs) are a relatively recent addition to the behavioral spectrum of PD-related non-motor symptoms. Social and economic factors may play a role on the ICD phenotype of PD patients. OBJECTIVE The aim of this study is to determine the prevalence and characterize the clinical profile of ICDs in a sample of low-income, low-education PD patients with no social security benefits from a Latin American country. METHODS We included 300 consecutive PD patients and 150 control subjects. The presence of ICD and related disorders was assessed using a structured interview. After the interview and neurological evaluation were concluded, all subjects completed the Questionnaire for Impulsive-compulsive Disorders in Parkinsons Disease-Rating Scale (QUIP-RS). RESULTS Regarding ICDs and related disorders (hobbyism-punding), 25.6% (n = 77) of patients in the PD group and 16.6% (n = 25) in the control group fulfilled criteria for at least one ICD or related disorder (p = 0.032). There was a statistically significant difference in the QUIP-RS mean score between PD and control subjects (5.6 ± 9.7 and 2.7 ± 4.21, p = 0.001). The most common ICD was compulsive eating for both PD (8.6%) and control (2.6%) groups. CONCLUSIONS The results of this study confirm that for this population, symptoms of an ICD are significantly more frequent in PD subjects than in control subjects. Nevertheless, socioeconomic differences may contribute to a lower overall frequency and distinct pattern of ICDs in PD patients compared with what has been reported in other countries.

Clinical Determinants of Health-related Quality of Life in Mexican Patients with Parkinson’s Disease

BACKGROUND AND AIMS Parkinsons disease (PD) is the second most common chronic neurodegenerative disorder. PD is clinically characterized by a constellation of motor and nonmotor symptoms that may have a direct effect on daily activities as well as in the quality of life of the patient. Identifying the symptoms more closely associated with a poor quality of life is central on improving the medical care of the patient. We undertook this study to identify and describe the clinical and demographic factors that predict health-related quality of life among Mexican patients with PD. METHODS One hundred seventy-seven patients with Parkinsons disease were included. Patients were evaluated using the following clinimetric instruments: motor subscale of the Unified Parkinsons disease rating scale, Hoehn and Yahr stage, Non-motor Symptoms Questionnaire, Parkinsons disease Questionnaire (PDQ-39) and the Mini Mental Status Examination. RESULTS Multivariate analysis showed that the main factors associated with a poor quality of life were motor impairment (β = 0.27, p <0.001) and the number of nonmotor symptoms (β = 2.17, p <0.001). The main nonmotor domains impacting on the quality of life were depression/anxiety (β = 6.36, p <0.001), cardiovascular (β = 5.39, p = 0.001), memory (β = 4.64, p <0.001) and miscellaneous (β = 3.15, p = 0.001). CONCLUSIONS Both motor and mainly nonmotor symptoms are negatively associated with health-related quality of life in patients with PD and should be appropriately attended in order to improve patient care.

Overweight is more prevalent in patients with Parkinson's disease

Underweight and malnutrition are well documented in Parkinsons disease (PD), while overweight has been less reported. We carried out a cross-sectional study including 177 healthy controls and 177 PD patients attending a tertiary care center. We recorded weight and height for all participants. A statistically significant difference was found in body mass index (BMI) between controls and PD patients (29.1±5.4 versus 27.2±4.7, p<0.001). In the PD Group, two patients were underweight, 32.7% were within normal range, 46.9% had overweight, and 19.2% were obese. Overweight and normal weight were more prevalent in the PD Group (p=<0.01 and <0.001, respectively) when compared to controls. In conclusion, overweight/obesity are common among patients with PD, while underweight is almost negligible.

Use of smell test identification in Parkinson's disease in Mexico: A matched case-control study

Smell tests can be useful in the differential diagnosis of Parkinsons disease (PD) but are affected by cultural factors. Currently there is no smell test tailored for the Mexican population but the brief smell identification test (B‐SIT) was created as a cross‐cultural SIT. We have created a translation of this test into Spanish adapted to the Mexican population and have applied it to 70 PD patients and 70 age‐ and gender‐matched controls. The B‐SIT differentiated PD and controls with 71.4% sensitivity and 85.7% specificity, when subjects were divided into two age groups.

Prevalence and correlates of sleep disorders in Parkinson’s disease: a polysomnographic study

OBJECTIVE Sleep disorders in Parkinsons disease are very common. Polysomnography (PSG) is considered the gold standard for diagnosis. The aim of the present study is to assess the prevalence of nocturnal sleep disorders diagnosed by polysomnography and to determine the associated clinical factors. METHOD A total of 120 patients with Parkinsons disease were included. All patients underwent a standardized overnight, single night polysomnography. RESULTS Ninety-four (78.3%) patients had an abnormal PSG. Half of the patients fulfilled criteria for sleep apnea-hypopnea syndrome (SAHS); rapid eye movement behavior disorder (RBD) was present in 37.5%. Characteristics associated with SAHS were age (p = 0.049) and body mass index (p = 0.016). Regarding RBD, age (p < 0.001), left motor onset (p = 0.047) and levodopa equivalent dose (p = 0.002) were the main predictors. CONCLUSION SAHS and RBD were the most frequent sleep disorders. Higher levodopa equivalent dose and body mass index appear to be risk factors for RBD and SAHS, respectively.

Factores asociados a la calidad de vida de sujetos con enfermedad de Parkinson y a la carga en el cuidador

INTRODUCTION Parkinsons disease affects the quality of life of the individual with the disease in addition to creating a burden on the caregiver. Factors related to these effects include motor and non-motor aspects of the disease, as well as traits inherent to the caregiver. METHODS We evaluated subjects with Parkinsons disease using the following instruments: Quality of Life Questionnaire PDQ-8, Movement Disorders Society Unified Parkinsons disease Rating Scale part i to iv (MDS-UPDRS), and Hoehn and Yahr staging. The Zarit Burden Inventory was used to assess all primary caregivers. Major demographic and clinical variables were also recorded. RESULTS A total of 250 subjects with Parkinsons disease were included, of whom 201 had a primary caregiver. In the multivariate analysis, predictors of poor quality of life for a subject with Parkinsons disease were the MDS-UPDRS I score (β=.39, P<.001), MDS-UPDRS II score (β=.21, P<.001), and MDS-UPDRS III score (β=.07, P=.004). Regarding caregiver burden, the MDS-UPDRS II score (β=.54, P=.007) was the most influential factor. CONCLUSIONS The present study shows a relationship between quality of life for the subject with Parkinsons disease and the caregivers perceived burden. However, the factors that determine each situation appear to be distinct.

Comparing the accuracy of different smell identification tests in Parkinson’s disease: Relevance of cultural aspects

OBJECTIVE The aim of this study is to determine the usefulness of the University of Pennsylvania smell identification test (UPSIT), sniffin sticks (SS-16) and brief smell identification test (B-SIT) to assess smell identification in the Mexican population and its accuracy in discriminating subjects with Parkinsons disease (PD). METHODS We included 199 nondemented PD subjects and 199 control subjects matched by gender. Smell identification was tested using the UPSIT and SS-16. Our group obtained B-SIT data from a previous report. RESULTS The mean number of UPSIT items correctly identified by controls was 27.3±6; the PD group had a mean score of 19.4±6. UPSIT had a sensitivity of 82% with a specificity of 66% for a cut-off score of ≤25 for detection of PD. The mean number of SS-16 items correctly identified by controls was 10.3±2.2, while the PD group had 7.4±2.8 correct answers. For SS-16, sensitivity was 77.8% and specificity of 71.2% when using a cut-off value of ≤9. Lemon, turpentine and rose had an identification rate below the 25th percentile for all three tests. Odors with an identification rate above the 75th percentile include banana for all three tests, and gasoline, onion and chocolate for UPSIT and B-SIT. CONCLUSION The sensitivity and specificity of the smell tests that were evaluated were lower in comparison to other published reports. Cultural biases and smell familiarity may influence the test results. The development of a true cross-culturally adapted smell identification test is warranted may improve test accuracy.

Prevalence and determinants of depression in Mexican patients with Parkinson's disease.

OBJECTIVE To assess the prevalence and associated factors of depression in a Mexican Parkinsons disease (PD) population. BACKGROUND Depressive symptoms are frequent in PD and have been recognized as a major determinant of quality of life. Only two previous studies have partially addressed depression in Mexican PD patients. METHODS One hundred forty-seven non-demented PD patients were recruited at the movement disorder specialist clinic at the National Institute of Neurology and Neurosurgery, Mexico City. The following sociodemographic variables were collected: gender, age, age at onset, disease duration and disease severity in terms of Hoehn and Yahr stage. PDQ-8, NMSQuest and Beck Depression Inventory (BDI) were applied to all participants. RESULTS One hundred forty-seven patients were included (49.7% female). The mean age of the sample was 62.1 ± 11.7 years, the mean age at diagnosis was 55.8 ± 12.3 and the mean duration of the disease was 6.3 ± 5 years. A total of 49 (33.3%) patients were diagnosed with current depression. Depressed patients also scored higher in the NMSQuest even when depression/anxiety items were excluded. Differences were found in gender, UPDRS III score and HY stage, but after the logistic regression analysis was performed only the NMSQuest score and low education remained as statistically significant factors for depression in Mexican PD patients. CONCLUSIONS Depression prevalence in PD Mexican patients is similar to other international reports. The main associated factor was the presence of non-motor symptoms.

Impact of Neuropsychiatric Symptoms on the Quality of Life of Subjects with Parkinson’s Disease

BACKGROUND Neuropsychiatric symptoms in Parkinsons disease (PD) are frequent. Impact of neuropsychiatric symptoms on quality of life has recently become a relevant topic of research due to its potential to develop targeted therapies to improve quality of life. OBJECTIVE To determine the impact of neuropsychiatric symptoms in patients with PD using the Parkinsons Disease Questionnaire Short Form (PDQ-8). METHODS Consecutive patients with PD were evaluated with the Scale for Evaluation of Neuropsychiatric Disorders in Parkinsons disease (SEND-PD) and PDQ-8 scales separately. Association between neuropsychiatric symptoms and quality of life was explored using, means comparisons, correlation coefficients and multiple regression models. RESULTS A total of 492 patients were included for the study. Overall, 44.5% had psychotic symptoms, 76.5% had alterations on mood/apathy domains, and 27% had an impulse control disorder. All neuropsychiatric symptoms had an effect on the PDQ-8 with a moderate to large effect size. Correlation coefficients ranged from 0.17 to 0.63 between neuropsychiatric symptoms and quality of life (p <  0.001, in all cases). The regression model showed that mood/apathy alterations and impulse control disorders, along with MDS-UPDRS III accounted for 49.8% of variance in the PDQ-8 simplified index (F = 122.98; p <  0.001). Mood/apathy alterations showed the highest correlation coefficient (0.63, p <  0.001) and β (0.53, p <  0.001). CONCLUSIONS Both the presence and severity of neuropsychiatric symptoms, in particular mood/apathy alterations,had a significant impact on quality of life in subjects with PD.

Opsoclonus myoclonus syndrome associated with GQ1b antibodies.

Opsoclonus myoclonus syndrome (OMS) is a rare disorder characterized by involuntary, multidirectional, chaotic saccades; head, limb, and trunk action myoclonus; and other associated features including cerebellar ataxia, encephalopathy, postural tremor, and sleep and behavioral disruption. 1 OMS can occur as a paraneoplastic or nonparaneoplastic syndrome. In both cases, an autoimmune pathophysiology has been proposed. 1,2 We report a 37-year-old man who developed an upper respiratory tract infection. Five days later, he developed paroxysms of blurred vision and oscillopsia. He had prominent neck myoclonus that ceased when supine but was provoked by sitting up, standing, or walking. Truncal instability was present, resulting in an inability to walk unassisted. Neurological examination (see Video) revealed eye movements with periodic, rapid, conjugated chaotic ocular oscillations that were independent of eye position and occurred during fixation, regardless of gaze direction, with eyes open or closed. Disabling ataxia of the trunk, limbs, and gait was present with stimulus-sensitive myoclonus. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and unmatched oligoclonal bands. Full blood count, serum chemistry, thyroid profile, cardiolipin, lupus anticoagulant, and dsDNA antibodies, Yo, Hu, Ri antibodies, brain CT and MRI, and