Laura Iorio

Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson's disease outpatients hospitalised on a scheduled basis

Dysautonomia symptoms of nutritional interest may often occur in Parkinsons disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Malnutrition Universal Screening Tool. Presence of dysautonomia symptoms (dysphagia, sialorrhoea and constipation) was investigated using clinical rating scales. In our population, prevalence of nutritional risk was 17·2 (95 % CI 12·1, 24·0) % and relied mainly on unintentional weight loss. Sialorrhoea, dysphagia, dysphagia to liquids and constipation were observed in 10·6, 11·0, 14·4 and 59·6 % of the patients, respectively. Nutritional risk was independently associated with the number of dysautonomia symptoms (OR 1·39 (95 % CI 1·00, 1·96); P= 0·048) but not with single symptoms. An independent association was also found with the severity of motor symptoms (Hoehn-Yahr stage, OR 1·48 (95 % CI 1·00, 2·55); P= 0·049) and levodopa dose (OR 1·16 (95 % CI 1·04, 1·31) mg/kg per d; P= 0·009). Nutritional risk in PD outpatients appears to depend mainly on dysautonomic syndrome, disease severity and levodopa dosage. Implications for outcome deserve further investigation. The assessment of nutritional status and of gastrointestinal dysautonomia symptoms should be part of the routine work-up of a PD patient.

Probiotics and prebiotic fiber for constipation associated with Parkinson disease An RCT

Objectives: Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation. Methods: We conducted a tertiary setting, randomized, double-blind, placebo-controlled trial in patients with PD with Rome III–confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4. Results: For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval [CI] 0.8–1.6) than placebo (0.1, 95% CI −0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4–1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics–prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1–5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8–8.1) during weeks 3 and 4. Conclusions: The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD. ClinicalTrials.gov identifier: NCT02459717. Classification of evidence: This study provides Class I evidence that for patients with PD who have constipation, fermented milk containing probiotics and prebiotics increases the frequency of CBMs.

Nutritional status and dietary habits in Parkinson's disease patients in Ghana.

OBJECTIVE Dietary treatment is important for the management of Parkinsons disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country. METHODS Fifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia). RESULTS The mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively. CONCLUSION This study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.

Endothelial progenitor cells: Cardiovascular protection in Parkinson's disease?

Parkinsons disease (PD) is characterized by reduced dopaminergicactivityandpreviousanimal-modelstudieshaveshownthattheneuro-transmitter dopamine modulates EPC function and mobilization fromthebonemarrow[1].Inapilotstudy,wehaveobservedthatPDpatientshave significantly higher EPC levels than controls [2]. However, thestrength of the evidence was hampered by the small sample size, themethod used for EPC determination and the potential confoundingeffect of dopaminergic treatment. Furthermore, we did not take intoaccount the role of important confounders, such as cardiovascular(CV) risk factors and related treatments. Conversely, another studyhas reported no difference in circulating EPCs between PD patientsand controls [3].Therefore,weinvestigatedwhetherdifferencesincountsofcirculat-ing EPCs occur between PD patients and controls, and, if so, whethersuch counts are modified by dopamine-replacement therapy.We studied:– de novo (drug naive) PD patients (DPD) having at least a one-yearfollow-up;

Protein-redistribution diet in a case of tyrosine hydroxylase enzyme deficiency: Cassani et al

Tyrosine hydroxylase deficiency (THD) is a recessive autosomal hereditary disease that blocks the transformation of tyrosine into levodopa, resulting in dystonia and parkinsonism in children (OMIM #605407). Treatment consists of L-dopa, which has variable efficacy. In Parkinson’s disease (PD) patients, a protein-redistribution diet (PRD; normal protein content, including both animal and vegetable proteins, exclusively for dinner) may reduce the competition between L-dopa and dietary amino acids. We report on the case of a patient with THD whose response to L-dopa improved significantly with a PRD and the consumption of special low-protein foods (LPP).