Shirley Coleman

Characterizing mild cognitive impairment in incident Parkinson disease: The ICICLE-PD Study

Objective: To describe the frequency of mild cognitive impairment (MCI) in Parkinson disease (PD) in a cohort of newly diagnosed incident PD cases and the associations with a panel of biomarkers. Methods: Between June 2009 and December 2011, 219 subjects with PD and 99 age-matched controls participated in clinical and neuropsychological assessments as part of a longitudinal observational study. Consenting individuals underwent structural MRI, lumbar puncture, and genotyping for common variants of COMT, MAPT, SNCA, BuChE, EGF, and APOE. PD-MCI was defined with reference to the new Movement Disorder Society criteria. Results: The frequency of PD-MCI was 42.5% using level 2 criteria at 1.5 SDs below normative values. Memory impairment was the most common domain affected, with 15.1% impaired at 1.5 SDs. Depression scores were significantly higher in those with PD-MCI than the cognitively normal PD group. A significant correlation was found between visual Pattern Recognition Memory and cerebrospinal β-amyloid 1–42 levels (β standardized coefficient = 0.350; p = 0.008) after controlling for age and education in a linear regression model, with lower β-amyloid 1–42 and 1–40 levels observed in those with PD-MCI. Voxel-based morphometry did not reveal any areas of significant gray matter loss in participants with PD-MCI compared with controls, and no specific genotype was associated with PD-MCI at the 1.5-SD threshold. Conclusions: In a large cohort of newly diagnosed PD participants, PD-MCI is common and significantly correlates with lower cerebrospinal β-amyloid 1–42 and 1–40 levels. Future longitudinal studies should enable us to determine those measures predictive of cognitive decline.

The case for ISO 9000

Summarizes the arguments for and against the ISO 9000 standard and examines the perceived advantages and disadvantages of implementing it. Reports the results of a survey of over 100 quality managers/representatives of ISO 9000‐certified organizations in the service and manufacturing sectors of UK industry. Too many ISO 9000 surveys in the past have sought the opinions of organizational managers who have had little or no operational experience of the standard on a day‐to‐day basis. This paper aims to redress this anomaly. Survey results indicate quite conclusively that most quality professionals are content with ISO 9000’s contribution to quality improvement, dismissing many of the past criticisms of the standard as inappropriate. These results can form the basis of a case for the implementation of the standard for those organisations currently trying to decide whether to implement it or not.

Health-Related Quality of Life in Early Parkinson's Disease: The Impact of Nonmotor Symptoms

Nonmotor symptoms (NMS) are common in patients with established Parkinsons disease (PD) and have a major impact upon quality of life. We investigated the significance of NMS in relation to health‐related quality of life (HRQoL) in patients with newly diagnosed PD. Patients and healthy controls were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinsons Disease Study. Prevalence of NMS was determined with the Non‐Motor Symptom Questionnaire. HRQoL was recorded with the 39‐item Parkinsons Disease Quality of Life Questionnaire (PDQ‐39). Further assessments included measures of motor disability, depression, sleep, and cognition. One hundred and fifty‐eight patients with newly diagnosed PD and 99 controls participated in this cross‐sectional study. Patients reported greater numbers of NMS than controls (mean 8.3 ± 4.3 versus 2.8 ± 2.5 symptoms; P < 0.001). Patients reported lowest HRQoL in the domains assessing bodily discomfort, mobility, and activities of daily living. Motor and nonmotor symptoms impacted negatively upon HRQoL scores. Patients with the postural instability and gait difficulty motor subtype reported worse HRQoL, compared with those with tremor‐dominant disease. Depression (P < 0.001), incomplete bowel emptying (P < 0.001), anxiety (P < 0.001), impaired concentration (P < 0.001), memory complaints (P < 0.001), and insomnia (P = 0.001) had the greatest negative impact upon HRQoL. NMS are common in patients with early PD and represent a significant cause of poorer health‐related quality of life. Cognitive, neuropsychiatric, and sleep disturbances are particularly associated with reduced well‐being. Screening and management of these symptoms should be prioritized at the time of diagnosis.

Where next for ISO 9000 companies

Many organisations take their quality improvement initiatives no further than ISO 9000. Others try to achieve TQM and fail, while others successfully make the transition. This may be because the requirements for TQM are not clear. However, the requirements for implementing the EFQM model criteria are clear and therefore may allow an organisation’s senior management to help drive their company towards excellence, perhaps with some external assistance. This paper investigates what happens with regard to quality management after an organisation has achieved ISO 9000. In particular, the extent of adoption of the EFQM excellence model is examined, as is the use of proven quality improvement tools and techniques such as statistical process control (SPC). Associated with these improvement techniques, the importance and standard of external assistance in implementing them are examined. The paper concludes that training, the use of SPC and working to the EFQM model criteria are all significant factors if an organisation is to be perceived as successful.

Cognition and Gait Show a Selective Pattern of Association Dominated by Phenotype in Incident Parkinson’s Disease

Reports outlining the association between gait and cognition in Parkinson’s disease (PD) are limited because of methodological issues and a bias toward studying advanced disease. This study examines the association between gait and cognition in 121 early PD who were characterized according to motor phenotype, and 184 healthy older adults. Quantitative gait was captured using a 7 m GAITrite walkway while walking for 2 min under single-task conditions and described by five domains (pace, rhythm, variability, asymmetry, and postural control). Cognitive outcomes were summarized by six domains (attention, working memory, visual memory, executive function, visuospatial function, and global cognition). Partial correlations and multivariate linear regression were used to determine independent associations for all participants and for PD tremor-dominant (TD) and postural instability and gait disorder (PIGD) phenotypes, controlling for age, sex, and premorbid intelligence using the national adult reading test. Cognitive and gait outcomes were significantly worse for PD. Gait, but not cognitive outcomes, was selectively worse for the PIGD phenotype compared with TD. Significant associations emerged for two gait domains for controls (pace and postural control) and four gait domains for PD (pace, rhythm, variability, and postural control). The strongest correlation was for pace and attention for PD and controls. Associations were not significant for participants with the TD phenotype. In early PD, the cognitive correlates of gait are predominantly with fronto-executive functions, and are characterized by the PIGD PD phenotype. These associations provide a basis for understanding the complex role of cognition in parkinsonian gait.

Information needs of general day surgery patients

Abstract Information for patients on what to expect in the post-operative period is widely regarded as being important particularly in day-surgery patients when they have limited time to discuss their concerns with clinicians. A literature search was unsuccessful in identifying a systematic attempt to develop post-operative literature and it seems that it is often drawn up with little thought for what patients want to know and is supplemented with anecdotal evidence about what happens to patients during rehabilitation. To compensate for this weakness we designed a two-part study to (i) identify key areas of patient concern and (ii) develop consensus responses for these key concerns. We used Delphi techniques to explore the area further. In the first part we devised, validated, tested and piloted a questionnaire, which was then used to identify key areas of concern for patients in the rehabilitation period following six common general surgical procedures. The key areas were: postoperative pain, wound problems, bathing, stretching and heavy exercise, return to work, driving and sex. These areas of concern were common to all patients regardless of their operation. We then used a similar technique to approach all the consultant general surgeons in the former Northern region to ask what advice they would give in each of the key areas for an idealised ‘normal’ patient. Whilst many surgeons fell within a broad area of agreement, there were some who differed markedly from the others even after the views of peers were taken into account. Examples of this are a range of 7–90 days before patients could undertake vigorous exercise after a hernia repair and 1–60 days for driving after a varicose vein operation.

A European emotional investigation in the field of shoe design

In this paper we report the results of a Kansei Engineering System study. A methodology for the application of Kansei Engineering at the European level has been developed and validated in the field of shoe design by means of the development of experimental studies in two different phases of product design: the information phase in the earliest stages of the design process and the generation and evaluation phase corresponding to the latest stages of the process.

Mild depressive symptoms are associated with gait impairment in early Parkinson's disease

The association between nonmotor characteristics and gait in Parkinsons disease (PD) is well established, particularly the role of cognition. Evidence is emerging that depression, an underrecognized symptom in PD is also associated with gait impairment. This cross‐sectional study examined the association between depressive symptomatology and gait in early PD. Depression was measured with the Geriatric Depression Scale (GDS), disease severity with the Unified Parkinsons Disease Rating Scale III, and cognition with the Mini Mental Status Examination. Gait speed and gait variability were measured using a 7‐m walkway (GAITRite). Linear regression was used to examine the association between depression and gait for PD and controls, controlling for age, cognition, and severity. PD participants who presented with clinically relevant depressive symptoms (GDS ≥ 5) were compared with those who scored < 5. One hundred and twenty‐two people with newly diagnosed PD and 184 controls were assessed. Depression scores were significantly higher for PD patients than for controls (P < .001), although neither group presented with clinically relevant symptomatology (mean [SD] for PD, 2.7 [2.3]; for controls, 1.1 [1.8]). For gait speed there was a main effect for depression (P < .001) and a group × depression interaction that approached significance (P = .054). For gait variability there was a main effect for depression (P < .01). PD participants with GDS scores ≥ 5 had a slower and more variable gait. Very mild depressive symptoms are associated with gait disturbance in early PD. Depression may be a marker for degeneration in nondopaminergic systems in early PD and influence mechanisms of gait disturbance.

Predicting first fall in newly diagnosed Parkinson's disease: Insights from a fall-naïve cohort.

Falls are common and associated with reduced independence and mortality in Parkinsons disease. Previous research has been conducted on falls‐prevalent or advanced disease cohorts.

Apomorphine: A potential modifier of amyloid deposition in Parkinson's disease?

Evidence from clinical and pathological studies suggests a role for both alpha‐synuclein and amyloid‐beta in the pathophysiology of dementia associated with PD. Recent work demonstrated improvement in memory and reduced amyloid‐beta burden in transgenic murine Alzheimers models given subcutaneous apomorphine. The aim of this work was to determine whether antemortem exposure to apomorphine was associated with lower levels of amyloid‐beta in brain tissue in a clinicopathological study of PD.