Lene Wermuth

Applicability and validity of the Major Depression Inventory in patients with Parkinson's disease

Since depressive symptoms in patients with Parkinsons disease (PD) fluctuate greatly, two depression questionnaires measuring frequency of symptoms rather than intensity were analyzed in 89 PD patients. Both scales (Zung-SDS and Major Depression Inventory (MDI)) were analyzed for internal validity by means of coefficients of homogeneity and factor analysis. The results showed that the MDI was superior to the Zung-SDS when measuring the dimension of severity of depression in terms of both homogeneity coefficients and factor analysis. The intercorrelation between the two scales was 0.75 (Spearman coefficient). When the scores of MDI were used for diagnosing depression, 11% of the patients had moderate depression by the ICD-10 and 13% of the patients had major depression by the DSM-IV.

Diabetes and the Risk of Developing Parkinson’s Disease in Denmark

OBJECTIVE Insulin contributes to normal brain function. Previous studies have suggested associations between midlife diabetes and neurodegenerative diseases, including Parkinson’s disease. Using Danish population registers, we investigated whether a history of diabetes or the use of antidiabetes drugs was associated with Parkinson’s disease. RESEARCH DESIGN AND METHODS From the nationwide Danish Hospital Register hospital records, we identified 1,931 patients with a first-time diagnosis of Parkinson’s disease between 2001 and 2006. We randomly selected 9,651 population control subjects from the Central Population Registry and density matched them by birth year and sex. Pharmacy records comprising all antidiabetes and anti-Parkinson drug prescriptions in Denmark were available. Odds ratios (ORs) were estimated by logistic regression models. RESULTS Having diabetes, as defined by one or more hospitalizations and/or outpatient visits for the condition, was associated with a 36% increased risk of developing Parkinson’s disease (OR 1.36 [95% CI 1.08–1.71]). Similarly, diabetes defined by the use of any antidiabetes medications was associated with a 35% increased Parkinson’s disease risk (1.35 [1.10–1.65]). When diabetes was defined as the use of oral antidiabetes medications, effect estimates were stronger in women (2.92 [1.34–6.36]), whereas when diabetes was defined as any antidiabetes drug prescription, patients with early-onset Parkinson’s disease were at highest risk (i.e., Parkinson’s disease diagnosed before the age of 60 years; 3.07 [1.65–5.70]). CONCLUSIONS We found that a diagnosis of, or treatment received for, diabetes was significantly associated with an increased risk of developing Parkinson’s disease, especially younger-onset Parkinson’s disease. Our results suggest a common pathophysiologic pathway between the two diseases. Future studies should take age at Parkinson’s disease onset into account.

Mortality in patients with Parkinson's disease

Introduction– After the introduction of L‐dopa the mortality rate in Parkinsons disease (PD) patients has changed, but is still higher than in the background population. Material & methods– Mortality, age at death and cause of death in a group of PD patients compared with the background population were studied. The diagnosis on the death certificate were registered. The material consisted of 458 patients who in a period 1.4.1973–31.10.1991 were registered as having PD. Results– Death in the period amounted to 253 patients. Median age of death was 77.29 years for men and 79.11 years for women. In the background population the median age at death was 80.69 years for men and 84.37 years for women. The SMR for men was 1.92 and for women 2.47. Infections, in particular lung infections, and heart diseases were the most common causes of death. Seventy percent of the death certificates had PD as a diagnosis. Conclusion– It is likely that several factors can influence the changed mortality of PD: more effective treatment, changing diagnostic practice, and inter‐disease competition.

Impact of dietary exposure to food contaminants on the risk of Parkinson's disease

This study aimed to investigate the association of Parkinsons disease (PD) with dietary exposure to polychlorinated biphenyls (PCBs) and methylmercury (MeHg) in a community with increased exposure levels. A total of 79 clinically verified idiopathic PD cases and 154 controls matched by sex and age were examined in this case-control study in the Faroe Islands. Blood and hair samples were collected and a questionnaire recorded lifetime information on residence, dietary habits, smoking history, and occupational exposure to solvents, pesticides, and metals. Both unconditional and conditional logistic regression analyses were used to estimate the odds ratio (OR) and 95% confidence interval (CI) in regard to relevant exposure variables. Increased ORs for dietary intakes of whale meat and blubber during adult life were statistically significant. The ORs for occupational exposure to solvents, pesticides and metals also suggested an increased risk for PD. Current serum concentrations of summation operator PCB and related contaminants suggested slightly increased ORs, although only beta-hexachlorocyclohexane (beta-HCH) was statistically significant. Increased intake of whale meat and blubber in adult life was significantly associated with PD, thus suggesting a positive association between previous exposure to marine food contaminants and development of PD.

High prevalence of Parkinson's disease in the Faroe Islands

We used several case-findings methods and strict criteria for case ascertainment to diagnose parkinsonism and idiopathic Parkinsons disease(PD) in the Faroe Islands. In the last few years before the prevalence date of July 1, 1995, we searched various registries from pharmacies, hospitals, and general practices, and found 195 patients with suspected parkinsonism out of 43,709 inhabitants. After excluding those who died before the prevalence date or were treated with levodopa (LD) for other diseases, a total of 124 patients remained for study, of whom 122 participated. We found 102 patients with parkinsonism and 82 with PD versus the expected 53 (p < 0.001, age-specific prevalences in the county of Rogaland, Norway). The overall prevalence of PD was estimated to be 187.6 and the age-adjusted prevalence to be 183.3 versus 110.9 per 100,000 inhabitants in the county of Rogaland. Compared to the study from Rogaland, the mean age at onset of PD symptoms, the mean age at the prevalence date, and the duration of PD indicated that the higher prevalence was not due to either an early onset nor to a longer duration of PD. A lower proportion of definite PD, a lower mean score on the Hoehn-Yahr scale, and a lower average dose of LD suggest that the high prevalence may be due to early diagnosis and a higher ascertainment of cases with mild disease. However, a high incidence cannot be excluded.

Sexual problems in young patients with Parkinson's disease

The purpose of this study was to describe sexual function in a representative group of young patients with Parkinsons disease (PD). Twenty‐five patients (15 men, 10 women; agerange 36‐56 yrs) participated in a structured interview on sexual function. Forty percent of the men and 70% of the women reported changed libido while 33.4% of the men and 80% of the women experienced changed sexual activity after onset of PD. A tendency to changes in libido and sexual function was seen with increasing time of treatment and advanced Hoehn‐Yahr stages. It is concluded that changes in libido and sexual function occur more frequently than previously reported, especially in women, and more attention should be paid to these problems.

Clinical course and long-term prognosis of acute transverse myelopathy.

The clinical characteristics and course of acute transverse myelopathy (ATM) was studied. One patient developed multiple sclerosis. In 1 patient ATM was caused by tumour‐cell embolization of the intramedullar vessels; 30 aged 12–74 years (median 36 years) had ATM of unknown course, of these, 13 had symptoms of a preceding viral‐like infection, 18 had back‐pain and 10 signs of spinal shock. The time from onset of ATM to maximum deficit varied from less than 1 h to 20 days. The thoracic region was the most common level of cord damage. Follow‐up was possible in 29 cases; 2 died (2 and 8 months after onset), of the surviving 27 (follow‐up 1–13 years, median 6 years) one third had a good outcome, one third a fair, while one third remained paraplegic, incontinent with severe sensory deficits. Back‐pain and signs of spinal shock indicated a poor outcome.

Suicide in patients with Parkinson's disease : an epidemiological study

The purpose of this study was to estimate the risk of suicide for patients with Parkinsons disease (PD) in Denmark compared with that in the background population. The study involved 458 patients with a PD diagnosis, 226 men and 232 women. The follow‐up period to either death or end of follow‐up on December 31, 1990 was 0 to 17 years, mean 5.7 years. Deaths in the follow‐up period amounted to 254, 135 men and 119 women. Two women committed suicide. The number of expected suicides was 1.06 for men and 0.55 for women, a total of 1.62. Neither for men nor for women was the difference between expected and observed suicides statistically significant.

Treatment for Helicobacter pylori infection and risk of Parkinson's disease in Denmark

Background and purpose:  It has been speculated that gastrointestinal infection with Helicobacter pylori (HP) contributes to the development of Parkinson’s disease (PD). We used nationwide Danish registers to investigate this hypothesis.

A double-blind, placebo-controlled, randomized, multi-center study of pramipexole in advanced Parkinson's disease.

Pramipexole (SND 919), a potent non‐ergot dopamine agonist, or placebo, was administered to 69 patients with advanced Parkinsons disease (33 received placebo, 36 received pramipexole) in a double‐blind, randomized, multi‐center study in which individually optimized doses of l‐dopa plus a dopa decarboxylase inhibitor were associated with dyskinesia, “on–off” fluctuation, dystonia, akinesia, or end‐of‐dose deterioration. Study medication was titrated over 7 weeks to the maximal tolerated dose or to the maximal dose allowed by the study (5 mg/day in four divided doses). Dosing was maintained for 4 weeks and then tapered during the final week. Total score on the Unified Parkinsons Disease Rating Scale (UPDRS) for the intent‐to‐treat population was significantly improved in the pramipexole‐treated group compared with the placebo‐treated group (16.9 ± 14.9 vs 9.0 ± 16.1; p= 0.0184). By the end of maintenance, the mean reduction in l‐dopa requirement was −150.7 mg for pramipexole‐treated patients compared to −10.6 for placebo‐treated patients. The most common adverse events (> 10%) were dizziness, insomnia, nausea, and postural hypotension. Aggravated parkinsonism occurred only after withdrawal of the study medication. Treatment with pramipexole in doses up to 5 mg/day was safe and well tolerated by patients with advanced Parkinsons disease.