Emmanuelle Silva Tavares Sobreira

Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: A case series

Cannabidiol (CBD) is the main non‐psychotropic component of the Cannabis sativa plant. REM sleep behaviour disorder (RBD) is a parasomnia characterized by the loss of muscle atonia during REM sleep associated with nightmares and active behaviour during dreaming. We have described the effects of CBD in RBD symptoms in patients with Parkinsons disease.

Effects of cannabidiol in the treatment of patients with Parkinson’s disease: An exploratory double-blind trial

Introduction: Parkinson’s disease (PD) has a progressive course and is characterized by the degeneration of dopaminergic neurons. Although no neuroprotective treatments for PD have been found to date, the endocannabinoid system has emerged as a promising target. Methods: From a sample of 119 patients consecutively evaluated in a specialized movement disorders outpatient clinic, we selected 21 PD patients without dementia or comorbid psychiatric conditions. Participants were assigned to three groups of seven subjects each who were treated with placebo, cannabidiol (CBD) 75 mg/day or CBD 300 mg/day. One week before the trial and in the last week of treatment participants were assessed in respect to (i) motor and general symptoms score (UPDRS); (ii) well-being and quality of life (PDQ-39); and (iii) possible neuroprotective effects (BDNF and H1-MRS). Results: We found no statistically significant differences in UPDRS scores, plasma BDNF levels or H1-MRS measures. However, the groups treated with placebo and CBD 300 mg/day had significantly different mean total scores in the PDQ-39 (p = 0.05). Conclusions: Our findings point to a possible effect of CBD in improving quality of life measures in PD patients with no psychiatric comorbidities; however, studies with larger samples and specific objectives are required before definitive conclusions can be drawn.

Sleep-Related Eating Disorder in Two Patients with Early-Onset Parkinson's Disease

remember these events the next morning [2, 4] . Finally, SRED may be associated with morning anorexia, sleep disruption, excessive weight gain and other adverse effects from excessive food intake, such as metabolic and dental problems. There is some controversy as to whether SRED and NES are similar disorders situated at opposite ends of a common spectrum of pathophysiology, with different levels of consciousness, or wheth er they are distinct disorders with separate underlying pathophysiologies [1] . Although this diagnostic issue remains unresolved, the International Classification of Sleep Disorders, 2nd Edition, by not including a level of consciousness criterion for the parasomnia SRED, has not definitively distinguished between these two disorders, thus encouraging further research [1] . Herein we describe 2 patients with Parkinson’s disease (PD) with typical symptoms of SRED. They belong to a cohort of 45 PD patients that was prospectively followed at a tertiary outpatient clinic for sleep disorders. The clinical evaluation of both patients was performed by movement disorders and sleep specialists, a psychiatrist and a neuropsychologist. We performed an audio-video polysomnography (PSG) which included extended electroenDear Sir, Nocturnal eating disorders involve nearly nightly feeding episodes during either multiple nocturnal awakenings or during partial arousals from sleep, and are defined as excessive caloric intake with loss of control over consumption [1] . There are two major subtypes, one viewed more as an insomnia disorder, and the other more as a parasomnia. Nocturnal eating syndrome (NES) is characterized by the consumption of 50% or more of daily calories after the evening meal and/or eating after awakenings from sleep, with morning anorexia [1] . NES is considered a circadian delay of food intake with normal circadian timing of sleep onset [2] . Unrestrained binge eating is uncommon with NES, which is viewed as an insomnia disorder, with multiple, modest feedings being considered to occur to help re-induce sleep. Sleep-related eating disorder (SRED) is a parasomnia characterized by recurrent episodes of involuntary binge eating and drinking during the sleep period. The affected individuals often eat peculiar and at times bizarre combinations of high caloric food. Due to diminished or absent consciousness during these episodes, patients may ingest toxic substances or suffer injuries during food preparation (e.g. cutting oneself, burning oneself with very hot food or liquids) [2, 3] . In addition, they may not Received: April 26, 2011 Accepted: May 23, 2011 Published online: August 12, 2011

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised.

OBJECTIVE The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrookes Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinsons disease (PD). METHOD Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. RESULTS There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. CONCLUSION Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease. Methods Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). Results 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. Conclusions All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Executive cognitive tests for the evaluation of patients with Parkinson's disease

Parkinson’s disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic. Methods Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson’s Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span – Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals). Results Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (–0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (–0.407) and WCST categories completed and MDRS Conceptualization (0.382). Discussion The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

High Frequency of Sleep Disorders in Parkinson’s Disease and Its Relationship with Quality of Life

Objectives: To determine the frequency of major sleep disorders in patients with Parkinson’s disease (PD), diagnosed according to the third international classification of sleep disorders, and assess the relationship of those disorders with the quality of life. Methods: A cross-sectional study was performed involving 88 consecutive patients with PD from outpatient clinic. Participants were subjected to clinical interviews, assessment using standardized scales (Epworth Sleepiness Scale, PD Questionnaire, Pittsburgh sleep quality index (PSQI) and, for individuals with a diagnosis of RLS/WED, International RLS/WED grading scale), and video-polysomnography. Results: We observed sleep disorders in 96.5% of the participants, with REM-sleep behavior disorder found in 62.5%, obstructive sleep apnea in 62.5%, insomnia in 55.7%, and restless legs syndrome in 28.4%. We observed a correlation between health-related quality of life with the PSQI and the Epworth sleepiness scale. Conclusion: Patients with PD have a high prevalence of sleep disorders. The quality of sleep and excessive daytime sleepiness significantly affect the quality of life in these individuals.

Rastreio de comprometimento cognitivo em pacientes com doença de parkinson

OBJECTIVE The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrookes Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinsons disease (PD). METHOD Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. RESULTS There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. CONCLUSION Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

Rastreio de comprometimento cognitivo em pacientes com doença de Parkinson: validade diagnóstica das versões brasileiras da Montreal Cognitive Assessment e do Addenbrooke's Cognitive Examination-Revised

OBJECTIVE The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrookes Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinsons disease (PD). METHOD Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. RESULTS There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. CONCLUSION Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.