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ON-OFF fluctuations predict the re-emergence of fatigue in Parkinson's disease
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Abstracts / Parkinsonism and Related Disorders 22 (2016) e29ee75
P 1.051. ON-OFF FLUCTUATIONS PREDICT THE RE-EMERGENCE OF FATIGUE IN PARKINSON'S DISEASE Tiziano Tamburini, Davide Massucco, Giovanni Abbruzzese. Department of Neurology, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Genoa, Italy Objectives: Fatigue is one of the most disabling non motor symptoms in PD [1], but it is still debated whether is correlated with motor conditions, dopaminergic therapy or other comorbid issues such as sleep disturbances, depression and cognitive decline [2]. We aimed to evaluate whether the presence and severity of fatigue is correlated with motor fluctuations in a cohort of patients with H&Y stage II PD. Methods: We recruited 40 patients with bilateral PD without postural instability taking L-DOPA. Fatigue was assessed using the PFS-16 and the presence of wearing-off by the WOQ-19.The motor state and the impact of motor complications were evaluated with the MDS-UPDRS parts III and IV. Sleep was assessed using the PDSS and mood with the BDI. Cognitive performances were screened using the MOCA. Results: A logistic regression using the PFS-16 score as binary dependent variable (value 1 when mPFS2.95) showed that only the presence of wearing-off (WOQ-19 score2) significantly increased the odds of having fatigue in our PD patients (OR¼19.06, p¼.022). Fatigue severity (mPFS) was correlated with the frequency (number of daily OFFs, r¼0.7) and impact of
visuoconstructive and visuoperceptive functioning in subjects with PD. Methods: Consecutive subjects with PD were included. The following examinations were performed: CASI, MiniMental, MoCA, Lanthony Desaturated D-15 Test, Ret-Osterrieth Complex Figure Test, ClockDrawing Test, Benton Visual Retention Test and Motor-Free Visual Perception Test. Motor disease severity was classified according to Hoehn and Yahr (HY) stages (Mild 1-2; Moderate 3 and Severe 4-5). Results: A total of 45 consecutive patients (64.4% male) with PD were enrolled. The mean age of the sample was 62.22±10.38 years. The mean disease duration was 5.15 ± 5.04 years. The comparison between mean scales scores and the disease severity is shown in Table 1. Patients scored worse in the MoCA test from mild to severe disease (26.06±2.34 vs 21.00±3.83, respectively; p¼0.003) and from moderate to severe disease (25.02±2.91 vs 21.00±3.83, respectively; p¼0.032). Lower scores were obtained for Rey-Osterrieth Complex Figure when comparing mild to severe disease (29.81±6.26 vs 17.75±7.14, respectively; p¼0.007). Although mean scores for CASI, Clock-Drawing Test, Benton Visual Retention Test and Motor-Free Visual Perception Test were worse as the severity increased, no statistically significant differences were found. Conclusions: Visuoconstructive functioning is worse in more severe disease stages; while no differences were found in visuospatial, visuoperceptive and color discrimination. MiniMental and MoCA scores also were associated with disease severity, although these instruments assess general cognition.
Table 1 Comparison of several visuospatial, visuoconstructive and visuoperceptive scales with Parkinson's disease severity. Hoehn & Yahr stages
CASI MiniMental MoCA Lanthony RE error score Lanthony LE error score Lanthony BI error scores Rey-Osterrieth complex figure Clock-drawing test Benton visual retention test Motor-free visual perception test
P value
Mild n¼27
Moderate n¼14
Severe n¼4
88.65 ± 6.04 28.59 ± 1.34 26.06 ± 2.34 80.05 ± 79.74 66.12 ± 66.48 53.74 ± 47.18 29.81 ± 6.26 2.44 ± .68 48.37 ± 6.53 28.17 ± 5.12
87.97 ± 6.95 27.36 ± 2.21 25.02 ± 2.91 108.23 ± 145.37 116.24 ± 168.20 64.36 ± 68.53 25.75 ± 8.17 2.38 ± .74 46.79 ± 9.75 28.27 ± 3.99
83.53 ± 10.72 26.25 ± 2.99 21.00 ± 3.83 66.50 ± 64.36 88.00 ± 73.25 76.00 ± 50.70 17.75 ± 7.14 2.00 ± 1.15 39.00 ± 8.98 23.00 ± 6.38
motor fluctuations (UPDRSIV score, r¼0.56) and with higher UPDRS III scores (p¼0.0016). No other differences were found between fatigued and non-fatigued patients. Conclusions: This study shows that only ON-OFF fluctuations are predictive of fatigue in PD patients within the same disease severity stage. Thus we can suggest that the suboptimal control of striatal dopaminergic level is related to the re-emergence of fatigue. References: 1. Friedman JH, Brown RG, Comella C, et al., Fatigue in Parkinson's disease: a review. Mov Disord. 2007;22:297-308. 2. Alves G, Wentzel-Larsen T, Larsen JP. Is fatigue an independent and persistent symptom in patients with Parkinson disease? Neurology. 2004 Nov 23;63:1908-1911. P 1.052. VISUOSPATIAL, VISUOCONSTRUCTIVE AND VISUOPERCEPTIVE FUNCTIONING IN PATIENTS WITH PARKINSON'S DISEASE Mayela Rodriguez-Violante, Genny Arciniega-Martinez, Adib Jorge de Sarachaga, Yaneth Rodriguez-Agudelo, Amin Cervantes-Arriaga, Mireya Chavez-Oliveros. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico Objectives: To assess the effect of disease severity in the visuospatial,
0.376 0.021 0.004 0.653 0.384 0.685 0.006 0.555 0.095 0.141
P 1.053. PARKINSON'S DISEASE, PARKINSONISM, DE NOVO PARKINSON'S DISEASE, ESSENTIAL TREMOR: A COLOR VISION PRELIMINARY ANALYSIS Anna Piro 1, Antonio Tagarelli 1, Giuseppe Nicoletti 1, Angela Lupo 2, Robert Fletcher 3, Aldo Quattrone 1. 1 NRC, Bioimaging and Molecular Physiology Institute, Research Section, Germaneto, Italy; 2 Institute of Neurology, Magna Graecia University, Catanzaro, Italy; 3 The Northampton Institute, City University, London, United Kingdom Objectives: We confirmed the impair color vision is in Parkinson's disease (PD) and the tritan defect at the retinal level as its early diagnostic sign. In this study we wished assess color vision in four different sample groups (essential tremor ET; de novo PD; parkinsonism; idiopathic PD) to eventually confirm the same above role of color vision. Methods: 16 patients (all men; 5 with ET; 3 with parkinsonism; 4 with de novo PD; 4 with idiopathic PD) were enrolled, and underwent Ishihara test, Farnsworth's dichotomous test, 15D, the City University test. The plates were 70 cm distant from the observer, under natural lighting coming back to him and the maximal time of reading for each plate was 5 seconds. We considered each eye separately as well as the more “day to day” binocular use of vision. All patients underwent an ophthalmological and a psychological exams in order trouble out any ocular acquired
Abstracts / Parkinsonism and Related Disorders 22 (2016) e29ee75
P 1.051. ON-OFF FLUCTUATIONS PREDICT THE RE-EMERGENCE OF FATIGUE IN PARKINSON'S DISEASE Tiziano Tamburini, Davide Massucco, Giovanni Abbruzzese. Department of Neurology, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Genoa, Italy Objectives: Fatigue is one of the most disabling non motor symptoms in PD [1], but it is still debated whether is correlated with motor conditions, dopaminergic therapy or other comorbid issues such as sleep disturbances, depression and cognitive decline [2]. We aimed to evaluate whether the presence and severity of fatigue is correlated with motor fluctuations in a cohort of patients with H&Y stage II PD. Methods: We recruited 40 patients with bilateral PD without postural instability taking L-DOPA. Fatigue was assessed using the PFS-16 and the presence of wearing-off by the WOQ-19.The motor state and the impact of motor complications were evaluated with the MDS-UPDRS parts III and IV. Sleep was assessed using the PDSS and mood with the BDI. Cognitive performances were screened using the MOCA. Results: A logistic regression using the PFS-16 score as binary dependent variable (value 1 when mPFS2.95) showed that only the presence of wearing-off (WOQ-19 score2) significantly increased the odds of having fatigue in our PD patients (OR¼19.06, p¼.022). Fatigue severity (mPFS) was correlated with the frequency (number of daily OFFs, r¼0.7) and impact of
visuoconstructive and visuoperceptive functioning in subjects with PD. Methods: Consecutive subjects with PD were included. The following examinations were performed: CASI, MiniMental, MoCA, Lanthony Desaturated D-15 Test, Ret-Osterrieth Complex Figure Test, ClockDrawing Test, Benton Visual Retention Test and Motor-Free Visual Perception Test. Motor disease severity was classified according to Hoehn and Yahr (HY) stages (Mild 1-2; Moderate 3 and Severe 4-5). Results: A total of 45 consecutive patients (64.4% male) with PD were enrolled. The mean age of the sample was 62.22±10.38 years. The mean disease duration was 5.15 ± 5.04 years. The comparison between mean scales scores and the disease severity is shown in Table 1. Patients scored worse in the MoCA test from mild to severe disease (26.06±2.34 vs 21.00±3.83, respectively; p¼0.003) and from moderate to severe disease (25.02±2.91 vs 21.00±3.83, respectively; p¼0.032). Lower scores were obtained for Rey-Osterrieth Complex Figure when comparing mild to severe disease (29.81±6.26 vs 17.75±7.14, respectively; p¼0.007). Although mean scores for CASI, Clock-Drawing Test, Benton Visual Retention Test and Motor-Free Visual Perception Test were worse as the severity increased, no statistically significant differences were found. Conclusions: Visuoconstructive functioning is worse in more severe disease stages; while no differences were found in visuospatial, visuoperceptive and color discrimination. MiniMental and MoCA scores also were associated with disease severity, although these instruments assess general cognition.
Table 1 Comparison of several visuospatial, visuoconstructive and visuoperceptive scales with Parkinson's disease severity. Hoehn & Yahr stages
CASI MiniMental MoCA Lanthony RE error score Lanthony LE error score Lanthony BI error scores Rey-Osterrieth complex figure Clock-drawing test Benton visual retention test Motor-free visual perception test
P value
Mild n¼27
Moderate n¼14
Severe n¼4
88.65 ± 6.04 28.59 ± 1.34 26.06 ± 2.34 80.05 ± 79.74 66.12 ± 66.48 53.74 ± 47.18 29.81 ± 6.26 2.44 ± .68 48.37 ± 6.53 28.17 ± 5.12
87.97 ± 6.95 27.36 ± 2.21 25.02 ± 2.91 108.23 ± 145.37 116.24 ± 168.20 64.36 ± 68.53 25.75 ± 8.17 2.38 ± .74 46.79 ± 9.75 28.27 ± 3.99
83.53 ± 10.72 26.25 ± 2.99 21.00 ± 3.83 66.50 ± 64.36 88.00 ± 73.25 76.00 ± 50.70 17.75 ± 7.14 2.00 ± 1.15 39.00 ± 8.98 23.00 ± 6.38
motor fluctuations (UPDRSIV score, r¼0.56) and with higher UPDRS III scores (p¼0.0016). No other differences were found between fatigued and non-fatigued patients. Conclusions: This study shows that only ON-OFF fluctuations are predictive of fatigue in PD patients within the same disease severity stage. Thus we can suggest that the suboptimal control of striatal dopaminergic level is related to the re-emergence of fatigue. References: 1. Friedman JH, Brown RG, Comella C, et al., Fatigue in Parkinson's disease: a review. Mov Disord. 2007;22:297-308. 2. Alves G, Wentzel-Larsen T, Larsen JP. Is fatigue an independent and persistent symptom in patients with Parkinson disease? Neurology. 2004 Nov 23;63:1908-1911. P 1.052. VISUOSPATIAL, VISUOCONSTRUCTIVE AND VISUOPERCEPTIVE FUNCTIONING IN PATIENTS WITH PARKINSON'S DISEASE Mayela Rodriguez-Violante, Genny Arciniega-Martinez, Adib Jorge de Sarachaga, Yaneth Rodriguez-Agudelo, Amin Cervantes-Arriaga, Mireya Chavez-Oliveros. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico Objectives: To assess the effect of disease severity in the visuospatial,
0.376 0.021 0.004 0.653 0.384 0.685 0.006 0.555 0.095 0.141
P 1.053. PARKINSON'S DISEASE, PARKINSONISM, DE NOVO PARKINSON'S DISEASE, ESSENTIAL TREMOR: A COLOR VISION PRELIMINARY ANALYSIS Anna Piro 1, Antonio Tagarelli 1, Giuseppe Nicoletti 1, Angela Lupo 2, Robert Fletcher 3, Aldo Quattrone 1. 1 NRC, Bioimaging and Molecular Physiology Institute, Research Section, Germaneto, Italy; 2 Institute of Neurology, Magna Graecia University, Catanzaro, Italy; 3 The Northampton Institute, City University, London, United Kingdom Objectives: We confirmed the impair color vision is in Parkinson's disease (PD) and the tritan defect at the retinal level as its early diagnostic sign. In this study we wished assess color vision in four different sample groups (essential tremor ET; de novo PD; parkinsonism; idiopathic PD) to eventually confirm the same above role of color vision. Methods: 16 patients (all men; 5 with ET; 3 with parkinsonism; 4 with de novo PD; 4 with idiopathic PD) were enrolled, and underwent Ishihara test, Farnsworth's dichotomous test, 15D, the City University test. The plates were 70 cm distant from the observer, under natural lighting coming back to him and the maximal time of reading for each plate was 5 seconds. We considered each eye separately as well as the more “day to day” binocular use of vision. All patients underwent an ophthalmological and a psychological exams in order trouble out any ocular acquired