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1.016 Excessive daytime sleepiness and fatigue are not associated features of Parkinson's disease
Meet the Expert Breakfast Seminars Conclusion: Our results support previous findings that depression is associated with more severe clinical progression. Clinician should pay special attention to this group of patients.
1.014 Non-motor symptoms in akinesia dominant versus other phenotypes in Parkinson’s disease (PD): Results from the international PD non-motor symptoms scale study Y. Naidu1° , D. Contrafatto, P. Martinez-Martin, K.R. Chaudhuri United Kingdom
1 London,
Objective: Parkinson’s disease (PD) can be separated to three different motor patterns: Tremor type (TT), Akinetic-Rigid type (ART) and Mixed type (MT). In this study generated from the international validation study of the recently reported PD non motor symptoms scale (NMSS), we report on the burden of non-motor symptoms and health related quality of life (HrQol, using the Parkinson’s disease Questionnaire-8 items (PDQ-8)) in these different subgroups of PD. Method: 239 PD patients (137 male, 102 female) were studied; 44 patients (18.4%) have a TT disease, 71 (48.1%) have an ART and 124 (51.88%) a MT. Subjects completed the nine domains, 30 items NMSS, a grade rating scale (Chaudhuri et al. Mov Disord 2007; DOI: 10.1002/mds.21596). Since the population presented a “non-normal” distribution pattern, non parametric tests were used. Results: Sex (p 0.257) and distribution among the Hoehn–Yahr stages (p 0.135) didn’t significantly differ. No significant differences in PDQ8 score (p 0.124) was found, but there was the trend for ART to have higher PDQ-8 while NMSS total score was borderline significantly higher in ART patients (p 0.04). However, combining the RT and MT patients (n 168, 70.29%) versus the AR subjects, NMSS score was significantly worse in ART (63.81±38.74 vs 53.44±41.14, p 0.016) and additionally, with worse PDQ-8 scores (33.34±19.04 and 28.34±18.57, p 0.045). There were no differences in age, sex, duration of disease and UPDRS although ART patients were older than non ART subjects at the onset of disease (63.28±12.88 and 59.43±12.36 respectively, p 0.03). Conclusion: Our data suggest that the burden of non-motor symptoms complex as a whole is higher in Akinetic type PD patients. This appears to have a negative impact on health related quality of life.
S31
The difference reach statistical significance in multiple domains PD-MCI group (p = 0.03), while the TD subtype was more represented in cognitively intact PD patients (p = 0.05). Conclusion: This cross-sectional study has demonstrated that motor symptoms of non-dopaminergic postural instability gait difficulties are more frequent in the PD-MCI independently of cognitive subtype. Moreover, we found that the change of predominant motor subtype, but not the total motor deterioration correlated with the cognitive deterioration in PDMCI patients. These findings should contribute to better understanding of dementia risk profile in PD.
1.016 Excessive daytime sleepiness and fatigue are not associated features of Parkinson’s disease E. Havlikova1° , J.P. van Dijk, J. Rosenberger, I. Nagyova, B. Middel, Z. Gdovinova, J. Groothoff 1 Kosice, Slovak Republic Objective: Many patients with Parkinson’s disease (PD) report excessive daytime sleepiness (EDS) or fatigue, both negatively influencing the quality of life of PD patients. The aim of our study was to explore the relationship between these two problems, controlled for age, gender, depression and disease duration. Method: The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8±8.7, mean disease duration 7.2±6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale and the Unified Parkinson’s disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data. Results: Sleepiness did not show a significant association with fatigue in all fatigue domains. Depression was significantly associated with all domains of fatigue (p < 0.001). The worse functional status was significantly related to reduced activity, general fatigue, physical fatigue, and mental fatigue (p < 0.001). Conclusion: Fatigue and excessive daytime sleepiness are not related to each other. Depression and poor functional status showed to be more important factors to be associated with fatigue. These results may also lead to improvement of the management of PD patients and their quality of life.
1.015 Relationship between motor symptoms and subtypes of mild cognitive impairment in Parkinson’s disease M. Petrova1° , M. Raycheva, L. Traykov Bulgaria
1 Sofia,
Objective: Parkinson’s disease (PD) is often associated with mild cognitive impairment and dementia, as patients with PD and mild cognitive impairment (PD-MCI) had a higher risk of developing dementia than cognitively intact PD patients. However, the risk factors predicting an increased risk of MCI and eventually dementia in PD are not fully established. The aim of this study was to investigate the relationship between motor symptoms and cognitive impairment in different subtypes of PDMCI patients. Method: We investigated 47 cognitively intact PD patients and 72 patients with PD-MCI and 41 normal controls. All subjects underwent a comprehensive neuropsychological assessment, as well as quantitative ratings of motor symptom severity and functional status. Three subtypes of PD-MCI were defined according to current criteria – amnestic PD-MCI, multiple domains PD-MCI and single nonmemory domain PD-MCI. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), or postural instability gait difficulty (PIGD) subtype, based on defined items in the Unified Parkinson’s disease Rating Scale (UPDRS), subscales II and III. Results: Compared to cognitively intact PD patients, all subtypes of PD-MCI patients showed no significant deterioration in total UPDRS. However the PIGD-subtype was more common in all PD-MCI subgroups.
1.017 Brain acetylcholinesterase changes in Dementia with Lewy Bodies and Parkinson’s disease with Dementia demonstrated by PET H. Shimada1° , H. Shigeki, S. Hitoshi, A. Masato, S. Kouichi, T. Noriko, O. Tsuneyoshi, F. Kiyoshi, S. Tetsuya, H. Takamichi, I. Toshiaki 1 Chiba, Japan Objective: To investigate alterations of brain cholinergic function in patients with Dementia with Lewy Bodies (DLB) and Parkinson’s disease with Dementia (PDD) by measurements of brain acetylcholinesterase (AChE) activity in vivo. Method: Participants were 10 patients with DLB (mean age: 75±4 years; male/female: 5/5; MMSE: 19±5), 10 patients with PDD (mean age: 75±4 years; male/female: 4/6; MMSE: 18±6), 9 patients with PD (mean age: 66±6 years; male/female: 6/3; MMSE: 28±2) and age-matched 27 healthy controls (mean age: 64+-10 years; male/female: 14/13; MMSE: 29±1). We performed N-[11 C]-methyl-4-piperidyl acetate (MP4A) PET scan for 40 minutes with arterial blood sampling, and the regional brain AChE activities were estimated in the three-compartment model. Brain AChE activities were compared between DLB group and healthy control group by voxel-based analysis using the two sample t-test in statistical parametric mapping 2 (SPM), and AChE activities of the whole cerebral cortex were also compared. Same statistical analyses were performed between PDD and controls, and between PD and controls.
1.014 Non-motor symptoms in akinesia dominant versus other phenotypes in Parkinson’s disease (PD): Results from the international PD non-motor symptoms scale study Y. Naidu1° , D. Contrafatto, P. Martinez-Martin, K.R. Chaudhuri United Kingdom
1 London,
Objective: Parkinson’s disease (PD) can be separated to three different motor patterns: Tremor type (TT), Akinetic-Rigid type (ART) and Mixed type (MT). In this study generated from the international validation study of the recently reported PD non motor symptoms scale (NMSS), we report on the burden of non-motor symptoms and health related quality of life (HrQol, using the Parkinson’s disease Questionnaire-8 items (PDQ-8)) in these different subgroups of PD. Method: 239 PD patients (137 male, 102 female) were studied; 44 patients (18.4%) have a TT disease, 71 (48.1%) have an ART and 124 (51.88%) a MT. Subjects completed the nine domains, 30 items NMSS, a grade rating scale (Chaudhuri et al. Mov Disord 2007; DOI: 10.1002/mds.21596). Since the population presented a “non-normal” distribution pattern, non parametric tests were used. Results: Sex (p 0.257) and distribution among the Hoehn–Yahr stages (p 0.135) didn’t significantly differ. No significant differences in PDQ8 score (p 0.124) was found, but there was the trend for ART to have higher PDQ-8 while NMSS total score was borderline significantly higher in ART patients (p 0.04). However, combining the RT and MT patients (n 168, 70.29%) versus the AR subjects, NMSS score was significantly worse in ART (63.81±38.74 vs 53.44±41.14, p 0.016) and additionally, with worse PDQ-8 scores (33.34±19.04 and 28.34±18.57, p 0.045). There were no differences in age, sex, duration of disease and UPDRS although ART patients were older than non ART subjects at the onset of disease (63.28±12.88 and 59.43±12.36 respectively, p 0.03). Conclusion: Our data suggest that the burden of non-motor symptoms complex as a whole is higher in Akinetic type PD patients. This appears to have a negative impact on health related quality of life.
S31
The difference reach statistical significance in multiple domains PD-MCI group (p = 0.03), while the TD subtype was more represented in cognitively intact PD patients (p = 0.05). Conclusion: This cross-sectional study has demonstrated that motor symptoms of non-dopaminergic postural instability gait difficulties are more frequent in the PD-MCI independently of cognitive subtype. Moreover, we found that the change of predominant motor subtype, but not the total motor deterioration correlated with the cognitive deterioration in PDMCI patients. These findings should contribute to better understanding of dementia risk profile in PD.
1.016 Excessive daytime sleepiness and fatigue are not associated features of Parkinson’s disease E. Havlikova1° , J.P. van Dijk, J. Rosenberger, I. Nagyova, B. Middel, Z. Gdovinova, J. Groothoff 1 Kosice, Slovak Republic Objective: Many patients with Parkinson’s disease (PD) report excessive daytime sleepiness (EDS) or fatigue, both negatively influencing the quality of life of PD patients. The aim of our study was to explore the relationship between these two problems, controlled for age, gender, depression and disease duration. Method: The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8±8.7, mean disease duration 7.2±6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale and the Unified Parkinson’s disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data. Results: Sleepiness did not show a significant association with fatigue in all fatigue domains. Depression was significantly associated with all domains of fatigue (p < 0.001). The worse functional status was significantly related to reduced activity, general fatigue, physical fatigue, and mental fatigue (p < 0.001). Conclusion: Fatigue and excessive daytime sleepiness are not related to each other. Depression and poor functional status showed to be more important factors to be associated with fatigue. These results may also lead to improvement of the management of PD patients and their quality of life.
1.015 Relationship between motor symptoms and subtypes of mild cognitive impairment in Parkinson’s disease M. Petrova1° , M. Raycheva, L. Traykov Bulgaria
1 Sofia,
Objective: Parkinson’s disease (PD) is often associated with mild cognitive impairment and dementia, as patients with PD and mild cognitive impairment (PD-MCI) had a higher risk of developing dementia than cognitively intact PD patients. However, the risk factors predicting an increased risk of MCI and eventually dementia in PD are not fully established. The aim of this study was to investigate the relationship between motor symptoms and cognitive impairment in different subtypes of PDMCI patients. Method: We investigated 47 cognitively intact PD patients and 72 patients with PD-MCI and 41 normal controls. All subjects underwent a comprehensive neuropsychological assessment, as well as quantitative ratings of motor symptom severity and functional status. Three subtypes of PD-MCI were defined according to current criteria – amnestic PD-MCI, multiple domains PD-MCI and single nonmemory domain PD-MCI. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), or postural instability gait difficulty (PIGD) subtype, based on defined items in the Unified Parkinson’s disease Rating Scale (UPDRS), subscales II and III. Results: Compared to cognitively intact PD patients, all subtypes of PD-MCI patients showed no significant deterioration in total UPDRS. However the PIGD-subtype was more common in all PD-MCI subgroups.
1.017 Brain acetylcholinesterase changes in Dementia with Lewy Bodies and Parkinson’s disease with Dementia demonstrated by PET H. Shimada1° , H. Shigeki, S. Hitoshi, A. Masato, S. Kouichi, T. Noriko, O. Tsuneyoshi, F. Kiyoshi, S. Tetsuya, H. Takamichi, I. Toshiaki 1 Chiba, Japan Objective: To investigate alterations of brain cholinergic function in patients with Dementia with Lewy Bodies (DLB) and Parkinson’s disease with Dementia (PDD) by measurements of brain acetylcholinesterase (AChE) activity in vivo. Method: Participants were 10 patients with DLB (mean age: 75±4 years; male/female: 5/5; MMSE: 19±5), 10 patients with PDD (mean age: 75±4 years; male/female: 4/6; MMSE: 18±6), 9 patients with PD (mean age: 66±6 years; male/female: 6/3; MMSE: 28±2) and age-matched 27 healthy controls (mean age: 64+-10 years; male/female: 14/13; MMSE: 29±1). We performed N-[11 C]-methyl-4-piperidyl acetate (MP4A) PET scan for 40 minutes with arterial blood sampling, and the regional brain AChE activities were estimated in the three-compartment model. Brain AChE activities were compared between DLB group and healthy control group by voxel-based analysis using the two sample t-test in statistical parametric mapping 2 (SPM), and AChE activities of the whole cerebral cortex were also compared. Same statistical analyses were performed between PDD and controls, and between PD and controls.