H. Shabtai

Risk factors for dementia, depression and psychosis in long-standing Parkinson's disease

Summary.Objectives. To study the relationships between clinical features of Parkinsons disease (PD) and the development of dementia, depression or psychosis in patients with long-standing disease. Background. The natural history of dementia and depression in PD, and its relation to psychosis in long standing PD, are unclear. Method. 172 consecutive patients (99 men and 73 women, mean age at symptoms onset 58.3 ± 13.2 years) with 5 years or more of PD (mean symptom duration of 11.8 ± 5.6 years) were studied. Clinical data were collected during the last office visit through physical examination, detailed history, review of patient charts and outside documents. Dementia and depression were diagnosed according to DSM-IV criteria, while psychosis was diagnosed if hallucinations or delusions were present. Chi-square and t tests were used to compare the patient characteristics among those with vs. those without mental complications of the disease at different disease stages. Logistic regression was used for the comparison of associations between the presence of dementia or depression (dependent variable) and age at onset of PD, duration of PD and disease staging (explanatory variables). Results. The study population consisted of 45 patients at Hoehn & Yahr (H&Y) stage ≤2.5 (26%), 104 patients at stage 3 (60.5%) and 23 patients at H&Y stage 4–5 (13.5%). Sixty one patients (36%) had dementia, 55 patients had depression (33%) and 50 patients (27%) had psychosis. Dementia and depression were significantly associated with disease severity as reflected in the H&Y scale (P = 0.0003, Z = 3.59; P = 0.006, Z = 3.22, respectively). These associations were significant also for the older age of PD onset (≥59 years n = 89) subgroup (p = 0.001, Z = 3.2 for dementia and p = 0.02, Z = 2.9 for depression), but not for younger onset cases (<59 years n = 83). Dementia was significantly associated with older age of PD onset (β = 0.04, p = 0.009) while depression was inversely associated with age of PD onset (β = −0.04, p = 0.02). The presence of dementia was also significantly associated with depression (β = 1.49, p = 0.0006). Dementia and depression were found to be independent explanatory variables for the development of psychosis (logistic regression, odds ratio (OR) = 26.0, p < 0.0001; OR = 10.2, p < 0.0001, respectively). In patients with younger age of PD onset, depression more than dementia was strongly correlated with the appearance of psychosis. Conclusion. Dementia in PD was related to older age of symptoms onset and old age. Depression was associated with dementia or early age of PD onset. Depression seemed to contribute to the appearance of psychosis even more than dementia, especially in patients with younger age of symptoms onset.

Subjective memory complaints in elders: depression, anxiety, or cognitive decline?

To study the association of subjective memory complaints (SMC) with affective state and cognitive performance in elders.

Rivastigmine (Exelon) for dementia in patients with Parkinson's disease.

Objectives – To study the efficacy of cholinesterase inhibitors in the treatment of dementia in patients with Parkinsons disease (PD).

Antiparkinsonian medication is not a risk factor for the development of hallucinations in Parkinson's disease.

Summary.Background. It was commonly assumed that psychotic phenomena in Parkinson’s disease (PD) are mainly drug related. Accumulating evidence suggests the existence of other risk factors for psychosis in PD. Aims. To evaluate the contribution of the drug profile of patients with PD to emergence of hallucinations. Methods. We compared patients with and without hallucinations, using Cox proportional hazards model, concerning drug profile at the time of hallucinations emergence. Results. Of 422 consecutive patients, 113 had dementia, while 90 patients experienced hallucinations (46 had both dementia and hallucinations). The mean levodopa dose for the group of patients with hallucinations was 650 ± 279 mg/day at the time of hallucinations onset, which was not significantly different from the levodopa dose at last visit for the group without hallucinations (621 ± 326 mg/day). Supplementary treatment with amantadine, selegiline, dopamine agonists, entacapone and anticholinergics did not increase the risk for the development of hallucinations. Conclusions. We did not confirm drug treatment as a risk factor for hallucinations in PD. Our study suggests the existence of “endogenic” factors as substantial contributors in the genesis of PD hallucinations. The clinical implications may be earlier administration of antipsychotic treatment and not as traditionally accepted, dose reduction of antiparkinsonian drugs.

Quality of sexual life in Parkinson's disease

Ninety-one consecutive patients with Parkinsons disease (PD) were asked to grade their general satisfaction from life (GSL) and completed the PDQ-39 and the quality of sexual life questionnaire (QoSL-Q). The reliability of the QoSL-Q was 0.74. Satisfaction from sexual life as reflected by the QoSL-Q significantly decreased with aging (P<0.01) and advanced disease (P<0.05). No correlation was found between the PDQ-39 and the QoSL index. The correlation between the PDQ-39 and GSL (r=-0.334) improved by adding the QoSL-Q, as a 9th dimension to the PDQ-39 (r=-0.405). The QoSL-Q is a reliable tool assessed a unique and important dimension not evaluated by the PDQ-39.

Clinical characteristics of neuroleptic-induced parkinsonism

Summary. In order to characterize the clinical spectrum of neuroleptic-induced parkinsonism (NIP), we studied a population of consecutive psychiatric in-patients treated with neuroleptics for at least two weeks, who were diagnosed by their psychiatrist as having parkinsonism. Parkinsonism was confirmed by a movement disorders specialist who performed neurological assessment including the motor examination and the activities of daily living (ADL) sections of the Unified Parkinsons Disease Rating Scale (UPDRS), and the Hoehn and Yahr (H&Y) staging.Seventy-five patients (54 males), aged 46 ± 13 years (range 21 to 73 years) were included in the analysis. The mean duration of neuroleptic therapy was 15 ± 12 years, while 61% were treated for more than 10 years. Most of the patients (n = 66, 88%) were scored as H&Y stage 2.5 or less. Rest tremor was present in 44% of the patients, and usually persisted in action. Forty-one patients (61%) had symmetrical involvement. Parkinsonian signs were significantly more common and pronounced in the upper in comparison with the lower limbs (p = 0.0001). Gait disturbances were mild and freezing of gait was very rare (n = 2). Neither age nor duration of therapy or their interaction affected the total motor score or any of the motor sub-scores. In conclusion, NIP differs from PD for more bilateral involvement with relative symmetry, and by affecting upper limbs more often than the lower ones. NIP tends to be associated with the triad of bradykinesia, tremor and rigidity while PD tends to involve gait and posture more often. NIP develops unrelated to duration of neuroleptic treatment or age of the patient, suggesting an individual predisposition to blockage of the dopaminergic receptors.

Effects of rivastigmine on the quantitative EEG in demented Parkinsonian patients

Objectives  – Quantitative electroencephalogram (qEEG) can be used to measure the effects of drugs on the brain. We studied the effects of rivastigmine on the qEEG in Parkinsons disease (PD) patients with dementia.

The effect of botulinum toxin injections to the calf muscles on freezing of gait in parkinsonism : a pilot study

Background Freezing of gait (FOG) is a common and very disabling parkinsonian symptom, which is poorly understood and responds unsatisfactorily to medical treatment. We recently reported a unique patient with Parkinsons disease (PD) who had significant alleviation of FOG shortly after she was injected with botulinum toxin type A (BTX-A) for foot dystonia (Giladi et al. 1997). Objective To assess the effect of BTX-A injections into the calf muscles of parkinsonian patients on FOG. Method BTX-A was injected in an open fashion into the calf muscles of 10 parkinsonian patients (age 55–75 years) with FOG as a predominant symptom. Response of FOG was assessed subjectively by the patient from worsening (–1) to marked improvement (+3). One patient was injected in a single blind fashion with saline or BTX-A after he had an initial good response. Results Seven patients reported different rates of improvement of FOG severity in 15 out of 17 therapeutic sessions. Four patients (40%) reported marked improvement (+3) of FOG in 5 sessions. Two patients reported no effect in two sessions. The mean duration of improvement was 6 weeks (range 1–12 weeks) with definite deterioration afterwards. The patient who was injected in a single blind fashion did not respond to saline injections but improved significantly with BTX-A treatment. Conclusions We observed a clear temporal relationship between BTX-A injections into the calf muscles of parkinsonian patients and improvement of FOG. A double blind placebo controlled prospective study is needed before any conclusions can be drawn about the role of BTX-A injection in FOG.

Cross-Sectional Study of the Prevalence of Parkinson’s Disease in the Kibbutz Movement in Israel

Background: The prevalence of PD in Israel has never been studied. Objective: To study the prevalence of Parkinson’s disease (PD) in a well-defined population of the Kibbutz Movement in Israel. The population which lives in kibbutzim is unique because all these people are under close medical care and the demographic data regarding this population are well defined. Methods: Questionnaires were sent to the medical clinics of 270 kibbutzim in Israel to provide demographic details as well as medical information about all PD patients who have been diagnosed by neurologists. Two subgroups were determined: aged over 40 years and over 60 years. Results: Of the total of 73,767 people studied, PD was diagnosed in 180 patients yielding a cross-sectional prevalence rate of 0.24% for the entire population. Age-adjusted prevalence was 0.94% in the population over 60 years and 0.33% in the population over 40 years. The mean age of disease onset was 66.7 ± 11 years. Topographic location was not found to be a risk factor for the development of PD in Israel. Conclusions: The prevalence of PD in the Israeli kibbutz population is similar to that reported in most other population-based studies. We observed an older age at symptom onset in the Kibbutz Movement than most other epidemiological studies.

Subjective memory decline in healthy community-dwelling elders. What does this complain mean?

Balash Y, Mordechovich M, Shabtai H, Merims D, Giladi N. Subjective memory decline in healthy community‐dwelling elders. What does this complain mean?
Acta Neurol Scand: 2010: 121: 194–197.
© 2009 The Authors Journal compilation