Seon Min Lee

Nonmotor Symptoms and Cognitive Decline in de novo Parkinson's Disease.

BACKGROUND Cognitive impairments are common in Parkinsons disease (PD). Despite its clinical importance, the development of dementia is still difficult to predict. In this study, we investigated the possible associations between non-motor symptoms and the risk of developing dementia within a 2-year observation period in PD. METHODS A total of 80 patients with PD participated in this study. Nonmotor symptoms (the Nonmotor Symptoms Questionnaire), PD status (Unified Parkinsons Disease Rating Scale), depression (Geriatric d Depression Scale or Montgomery-Asberg Depression Scale), stereopsis and severity of nonmotor symptoms (Non-motor symptoms scale) were assessed. Global cognitive function (Mini-Mental State Examination) were evaluated at baseline and 2 years later. RESULTS Presence of depression, vivid dreaming, REM sleep behavior disorders, hyposmia, abnormal stereopsis, non-smoking and postural instability/ gait disturbance phenotype were associated with a significantly more rapid decline of Mini-Mental State Examination. Logistic regression analyses demonstrated that depression (odds ratio=13.895), abnormal stereopsis (odds ratio=10.729), vivid dreaming (odds ratio=4.16), REM sleep behavior disorders (odds ratio=5.353) and hyposmia (odds ratio=4.911) were significant independent predictors of dementia risk within 2 years. Postural instability/ gait disturbance phenotype and age >62 years were also independent predictors of dementia risk (odd ratio=38.333, odds ratio=10.625). CONCLUSIONS We suggest that depression, vivid dreaming, REM sleep behavior disorders, hyposmia and abnormal stereopsis are closely associated with cognitive decline, and that presence of these nonmotor symptoms predict the subsequent development of Parkinsons disease dementia.

Nonmotor symptoms in essential tremor: Comparison with Parkinson's disease and normal control.

BACKGROUND Recently, the definition of essential tremor (ET) has evolved to have two different meanings. One refers to classic ET, a benign mono-symptomatic disorder, and the other refers to a heterogeneous neurodegenerative disorder. The aim of this study was to categorize nonmotor symptoms according to ET phenotype, and compare them, along with autonomic function, in people with Parkinsons disease (PD) and normal controls. METHODS We divided patients with ET into 3 subtypes according to their motor features: 23 Pure-ET, 25 Cerebellar-ET, and 12 Parkinsonism-ET. Comparisons were made between 30 PD subjects and 22 normal controls, and 60 subjects with ET. The following assessments were conducted: the Nonmotor Symptoms Scale, the Mini-Mental State Exam, Montreal Cognitive Assessment, the Montgomery-Asberg Depression Rating Scale, Neuropsychiatric Inventory Questionnaire, Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Scales for Outcomes in Parkinsons Disease-Autonomic. RESULTS There were significant differences in the Nonmotor Symptoms Scale total scores of the ET, PD, and control groups (ET: 25.500 ± 2.346; PD: 27.960 ± 3.267; CONTROL 3.328 ± 3.796.). There were no significant differences in terms of each ET phenotype. ET patients had significant cognitive dysfunction, neuropsychiatric problems including depression and have complained about significant autonomic dysfunction and excessive daytime somnolence compared to normal controls. CONCLUSIONS Patients with ET have several nonmotor symptoms similar to those of patients with PD, which have a similar impact on their quality of life. Therefore, nonmotor symptoms should be considered in the clinical evaluation and management of ET.

The interrelationship between non-motor symptoms in Atypical Parkinsonism

BACKGROUND Atypical Parkinsonism is less common and has more severe symptoms than Parkinsons disease (PD). Little is known about the non-motor symptom (NMS) characteristics of multiple systemic atrophy (MSA) or progressive supranuclear palsy (PSP). We report the interrelationship of NMS in MSA, PSP, and PD. METHODS We studied 117 cases of PD and 57 of Atypical Parkinsonism. Out of the 57 patients, 31 had multiple systemic atrophy parkinsonian subtype (MSA-P), 14 had multiple systemic atrophy cerebellar dysfunction subtype (MSA-C), and 12 had PSP. We assessed the condition of the patients using the United Parkinsons Disease Rating Scale part III (UPDRS-III), the modified Hoehn & Yahr scale (H&Y), the non-motor symptom scale (NMSS), and the Parkinsons Disease Questionnaire (PDQ-39). RESULTS In Atypical Parkinsonism, the NMSS scores significantly correlated with PDQ-39 scores, but not with UPDRS-III. In the MSA-P group, the mood/cognitive domain significantly correlated with both the urinary and sleep/fatigue domains. In the MSA-C group, the sleep/fatigue domain correlated with the mood/cognition and cardiovascular domains. Finally, in the PSP and PD groups, the attention/memory domain significantly correlated with the sleep/fatigue and mood/cognition domains. DISCUSSION These results suggest that, with respect to cognitive function, dysautonomia and sleep/fatigue are detrimental factors in MSA and PSP, respectively.

Is reduced arm and leg swing in Parkinson's disease associated with rigidity or bradykinesia?

BACKGROUND AND PURPOSE Arm and leg swings during gait are reduced and asymmetric in Parkinsons disease (PD). Although rigidity and bradykinesia are interconnected with each other, and related with gait hypokinesia including arm and leg swing alteration, it remains uncertain which factor is more responsible for the decrease of arm and leg swings. The study aimed to uncover which factor between rigidity and bradykinesia is more associated with the reduction of arm and leg swings during gait. METHODS Patients with PD were selected and divided into a concordance group (21 patients) representing a match of both symptoms and a discordance group (nineteen patients) exhibiting a mismatch of pronounced rigidity and bradykinesia. Visual inspections of video clips for asymmetric features of gait and posture including arm swing, leg swing, shoulder position, external foot rotation were analyzed and accessed by two independent neurologists blindly. RESULTS The side of more pronounced rigidity was significantly and moderately related with the side of more decreased arm and leg swings (p<0.001, κ=0.592 in arm swing; p=0.011, κ=0.432 in leg swing, respectively), but the side of more dominant bradykinesia was associated with neither arm nor leg swing asymmetry (p=1, κ=0.014 in arm swing; p=1, κ=-0.036 in leg swing). In addition, asymmetric posturing including shoulder position and a laterally rotated foot showed no relationship with rigidity or bradykinesia. CONCLUSION The reduction of arm and leg swings during gait in PD was associated with rigidity, but not with bradykinesia.

Comparison of motor and non-motor features between essential tremor and tremor dominant Parkinson's disease.

BACKGROUND Differential diagnosis of tremor disorders, including essential tremor (ET) and Parkinsons disease-tremor dominant type (PD-TDT), requires further investigation. Therefore, the current study aimed to compare non-motor and tremor features in order to differentiate between ET and PD-TDT. METHODS Twenty-eight patients with classic ET and 24 patients with typical PD-TDT were retrospectively enrolled in a multi-stage investigation process. Tremor features including surface electromyogram (EMG) were analyzed in detail. For non-motor symptom analyses, the global cognition test, frontal function test, and non-motor symptoms scale (NMSS) were administered, in addition to collecting patient history data. RESULTS Patients with PD-TDT presented with more asymmetric tremor, whereas patients with ET presented with more symmetric tremor. Leg tremor was observed only in patients with PD-TDT. Surface EMG analyses of arm tremor demonstrated considerable overlaps in tremor type, tremor frequency, and contractive patterns. However, patients with PD-TDT were significantly more likely to exhibit resting tremor, and experienced alternative contraction patterns only for kinetic tremor, which was in contrast to patients with ET. For non-motor symptom analyses, patients with PD-TDT had more non-motor symptoms compared to patients with ET (mean=5.0 vs. 2.6; P=0.002). Specifically, patients with PD-TDT exhibited higher frequencies of hyposmia, REM sleep behavior disorder (RBD)-like symptom, urinary frequency, and memory disturbance. Age- and gender- matched analyses for the severity of NMSS scores did not indicate significant differences. However, patients with PD-TDT displayed slightly lower scores of frontal function test compared to patients with ET. CONCLUSIONS Careful and detailed evaluations of both tremor features and non-motor symptoms are required in order to distinguish between ET and PD-TDT.

A practical method for the detection of freezing of gait in patients with Parkinson’s disease

Purpose Freezing of gait (FOG), increasing the fall risk and limiting the quality of life, is common at the advanced stage of Parkinson’s disease, typically in old ages. A simple and unobtrusive FOG detection system with a small calculation load would make a fast presentation of on-demand cueing possible. The purpose of this study was to find a practical FOG detection system. Patients and methods A sole-mounted sensor system was developed for an unobtrusive measurement of acceleration during gait. Twenty patients with Parkinson’s disease participated in this study. A simple and fast time-domain method for the FOG detection was suggested and compared with the conventional frequency-domain method. The parameters used in the FOG detection were optimized for each patient. Results The calculation load was 1,154 times less in the time-domain method than the conventional method, and the FOG detection performance was comparable between the two domains (P=0.79) and depended on the window length (P<0.01) and dimension of sensor information (P=0.03). Conclusion A minimally constraining sole-mounted sensor system was developed, and the suggested time-domain method showed comparable FOG detection performance to that of the conventional frequency-domain method. Three-dimensional sensor information and 3–4-second window length were desirable. The suggested system is expected to have more practical clinical applications.

The Devil Is in the Specificity The Negative Effect of Prediction Specificity on Prediction Accuracy

In the research reported here, we proposed and demonstrated the prediction-specificity effect, which states that people’s prediction of the general outcome of an event (e.g., the winner of a soccer match) is less accurate when the prediction question is framed in a more specific manner (e.g., guessing the score) rather than in a less specific manner (e.g., guessing the winner). We demonstrated this effect by examining people’s predictions on actual sports games both in field and laboratory studies. In Study 1, the analysis of 19 billion bets from a commercial sports-betting business provided evidence for the effect of prediction specificity. This effect was replicated in three controlled laboratory studies, in which participants predicted the outcomes of a series of soccer matches. Furthermore, the negative effect of prediction specificity was mediated by participants’ underweighting of important holistic information during decision making.

The Moderating Effects of Self-Esteem and Self-Efficacy on Responses to Graphic Health Warnings on Cigarette Packages: A Comparison of Smokers and Nonsmokers

ABSTRACT Do graphic pictorial health warnings (GPHWs) on cigarette packaging work better for some people than others? According to the Extended Parallel Process Model (EPPM), fear appeals should heighten positive change only if a person believes he or she is capable of change (i.e., self-efficacy). We exposed 242 smokers and 241 nonsmokers (aged 18–29) in the Republic of Korea to either a GPHW or a text-only warning in a between-subjects experiment. Results indicated that the GPHW increased intentions and motivations to quit smoking (for smokers) and intentions and motivations to not start smoking (for nonsmokers). However, these effects were moderated by self-efficacy related to quitting or not starting smoking. For smokers, a GPHW was especially effective in increasing desires and intentions to quit for people high in self-efficacy and high in self-esteem. However, for nonsmokers, a GPHW was effective only when self-efficacy was high, regardless of self-esteem level. For smokers and nonsmokers, results were mediated by heightened perceived health estimation. Implications for understanding the effectiveness of warning labels on cigarettes, for the introduction of GPHWs in the Republic of Korea, and for the Extended Parallel Process Model, are discussed.

Differential diagnosis of parkinsonism with visual inspection of posture and gait in the early stage

BACKGROUND Parkinsons disease (PD) differs from atypical parkinsonism in many clinical aspects. Principally, posture and gait are distinct features in the early stages of the disease; thus, these differences can be helpful in differential diagnosis. METHODS We analyzed videos of patients with PD or atypical parkinsonism. A total of 76 patients with early PD (n=56) or atypical parkinsonism (n=20) were included. Items related to posture and gait were classified into three categories (standing, gait and associated symptoms) and each sub-item was analyzed. RESULTS Asymmetric arm-swing (p=0.004) and accompanying tremor (p=0.016) were significant indicators of early-stage PD. Staggering gait (p=0.007) and en-bloc turning (p=0.026) were more common in atypical parkinsonism. Characteristics with a high odds-ratio for atypical parkinsonism were en-bloc turning (β=8.475, p=0.032) and normal arm-swing (β=14.6084, p=0.036). CONCLUSIONS Visual inspection of gait and posture provides reliable clues in the differential diagnosis of parkinsonism.

Perceived control and scarcity appeals

We examined how individuals would respond to scarcity appeals when they felt low (vs. high) in personal control. We proposed that scarcity would be an effective way to compensate for loss of control because it symbolizes distinctiveness, stimulates urgency, and offers an opportunity to obtain resources. Results from 2 experiments confirmed our prediction. In Study 1, participants (64 Korean college students) indicated a greater intention to purchase a limited-edition product when they perceived low (vs. high) control. In Study 2, participants (228 Korean college students) who perceived low (vs. high) control chose a larger-sized product more often when the product used an only-time frame than when it did an any-time frame. Our findings contribute to the literature by introducing a compensatory paradigm to scarcity effects and identifying its promotional use as a new mechanism for compensatory control.