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P.5.d.001 Sleep problems in patients with Parkinson's disease in a hospital setting from Romania
S546
P.5.d. Dementia and neurological disorders − Neurological disorders (clinical)
P.5.d. Dementia and neurological disorders − Neurological disorders (clinical)
Conclusions: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS. Physicians and patients must be educated so that sleep problems can be appropriately recognized and treated.
P.5.d.001 Sleep problems in patients with Parkinson’s disease in a hospital setting from Romania
References
M.M. Dumitru1 ° , V. Chirita1 , R. Chirita1 1 University Psychiatric Hospital “Socola” and University Medicine and Pharmacy Gr. T Popa, Adult psychiatry, Iasi, Romania Background: Sleep dysfunction is common among patients with Parkinson’s disease (PD) and occurs in approximately two thirds of patients. For patients with PD, sleep problems are the most prominent non-motor symptoms, influencing the quality of life of patients [1]. These disorders can be broadly categorized into those that involve nocturnal sleep and excessive daytime sleepiness (EDS). Sleep disturbances can be due to motor [2] or nonmotor features of PD [3], the effect of drugs used for Parkinson’s disease treatment, neurodegeneration of central sleep–wake areas [1], sleep apnea, restless leg syndrome (RLS)/periodic limb movements, reduced sleep efficiency and REM sleep behavior disorder [1]. Objectives: This cross-sectional study had as main objective examination of sleep problems and investigation of associated factors, with special emphasis on disease stage, age and sex, mental health, fatigue and restless legs syndrome in a sample of hospitalized patients with Parkinson’s disease. Methods: This cross-sectional study was conducted in Clinical Hospital of Recovery, Iasi, over a period of 6 months and included hospitalized patients with a PD diagnosis according to published diagnostic criteria. The inclusion criteria were: Parkinson’s disease diagnosis criteria, mentally and physically able to complete interviews, questionnaires and clinical examinations. All patients with motor fluctuations were examined during the on-period. All patients were on some form of dopaminergic medication and were tested while on medications. From all respondents was obtained appropriate informed consent. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS). Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). Results: A number of 44 consecutive PD inpatients (41% females) were included in this cross-sectional study of non-motor symptoms, including sleep problems, 41% were women, the mean age was 67.8 (SD 8.4). The mean duration of Parkinson’s disease was 7.8 years (SD 5.7). The mean UPDRS part 3 was 22.6 (SD 11.5). The mean Hoehn and Yahr stage was 2.73 (SD 0.89). According to Hoehn-Yahr staging 17 patients (34.1%) were in stage 1, 19 patients (38.6%) in stage 2, 5 patients (11.3%) in stage 3 and 3 patients (6.8%) in stage 4. The mean MMSE was 25 (range 23−28), the mean mental health SF-36 score was 70.1 (SD 17.7), and the mean total fatigue score was 16 (SD 6.0). Restless legs syndrome was reported by 29.5% patients. Sleep problems were common among PD patients. The mean of total PDSS score was 103.8 (SD 26.7). While 22.7% (N = 10) of the patients had a total PDSS score under 82, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS.
[1] Comella, CL., 2006 Sleep disturbances and excessive daytime sleepiness in Parkinson disease: an overview. J Neural Transm Suppl. 70, 349–355. [2] Comella, CL., 2003 Sleep disturbances in Parkinson’s disease. Curr Neurol Neurosci Rep. Mar 3(2), 173–180. [3] Larsen, J.P., Tandberg, E., 2001 Sleep disorders in patients with Parkinson’s disease: epidemiology and management. CNS Drugs 15(4), 267– 275.
P.5.d.002 Cannabidiol add-on usual treatment improves the outcome of patients with Parkinson’s disease M.H.N. Chagas1 , V. Tumas1 , M. Penna-Pereira1 , M. SobreiraNeto1 , E.T. Sobreira1 , A.L. Eckeli1 , J.E.C. Hallak1 , A.C. Dos Santos1 , J.A.S. Crippa1 , A.W. Zuardi1 ° 1 University of S˜ao Paulo, Ribeir˜ao Preto School of Medicine, Ribeir˜ao Preto, Brazil Introduction: Neuroprotective effects of Cannabidiol (CBD), a Cannabis sativa component devoid of the typical psychological effects of the plant in humans, have been reported in animal models of Parkinson’s disease (PD) [1]. The neuroprotective effects of CBD in the humans have been suggested to encompass the basal ganglia. A former study has demonstrated a strong positive correlation of N-acetyl-aspartate/ total creatine ratio (NAA/Cr) in the putamen/globus pallidum and CBD levels in recreational cannabis users, suggesting an enhancement of neuronal and axonal integrity in these regions by CBD [2]. In an open-label pilot study, we observed that PD patients who had psychosis for at least 3 months showed a significantly decrease in psychotic symptoms under CBD treatment. We also observed a decrease in the total scores of the Unified Parkinson’s Disease Rating Scale, suggesting that CBD also improved other PD symptoms [3]. Purpose: To evaluate the efficacy and safety of CBD added to treatment as usual on PD patients and to investigate its effects in relation to concentrations of brain metabolites (N-acetyl-aspartate, creatine and choline) in the basal ganglia. Method: Twenty patients with a confirmed diagnosis of idiopathic PD without dementia and on stable doses of anti-Parkinson drugs for at least 30 days were enrolled. The patients were randomly allocated into three groups treated for six weeks with daily doses of placebo (n = 7), CBD 75 mg (n = 6) or CBD 300 mg (n = 7) added to usual treatment in a double-blind procedure. Before the beginning and at the end of the study, the patients were evaluated with the Parkinson’s disease Questionnaire − 39 (PDQ-39) and the UKU Side Effects Rating Scale. We investigated possible metabolite changes in basal ganglia PD patients before and after treatment by proton magnetic resonance spectroscopy (MRS). Therefore, the patients with PD in aforementioned groups underwent spectroscopy to determine the NAA/Cr ratio, which reflects the degree of neuronal integrity in neurodegenerative diseases. Voxels were obtained from the bilateral basal ganglia, an area critical for a wide range of motor and executive mechanisms. Results: The repeated measures analysis of variance (rmANOVA) of the PDQ-39 scores showed significant effects
P.5.d. Dementia and neurological disorders − Neurological disorders (clinical)
P.5.d. Dementia and neurological disorders − Neurological disorders (clinical)
Conclusions: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS. Physicians and patients must be educated so that sleep problems can be appropriately recognized and treated.
P.5.d.001 Sleep problems in patients with Parkinson’s disease in a hospital setting from Romania
References
M.M. Dumitru1 ° , V. Chirita1 , R. Chirita1 1 University Psychiatric Hospital “Socola” and University Medicine and Pharmacy Gr. T Popa, Adult psychiatry, Iasi, Romania Background: Sleep dysfunction is common among patients with Parkinson’s disease (PD) and occurs in approximately two thirds of patients. For patients with PD, sleep problems are the most prominent non-motor symptoms, influencing the quality of life of patients [1]. These disorders can be broadly categorized into those that involve nocturnal sleep and excessive daytime sleepiness (EDS). Sleep disturbances can be due to motor [2] or nonmotor features of PD [3], the effect of drugs used for Parkinson’s disease treatment, neurodegeneration of central sleep–wake areas [1], sleep apnea, restless leg syndrome (RLS)/periodic limb movements, reduced sleep efficiency and REM sleep behavior disorder [1]. Objectives: This cross-sectional study had as main objective examination of sleep problems and investigation of associated factors, with special emphasis on disease stage, age and sex, mental health, fatigue and restless legs syndrome in a sample of hospitalized patients with Parkinson’s disease. Methods: This cross-sectional study was conducted in Clinical Hospital of Recovery, Iasi, over a period of 6 months and included hospitalized patients with a PD diagnosis according to published diagnostic criteria. The inclusion criteria were: Parkinson’s disease diagnosis criteria, mentally and physically able to complete interviews, questionnaires and clinical examinations. All patients with motor fluctuations were examined during the on-period. All patients were on some form of dopaminergic medication and were tested while on medications. From all respondents was obtained appropriate informed consent. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS). Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). Results: A number of 44 consecutive PD inpatients (41% females) were included in this cross-sectional study of non-motor symptoms, including sleep problems, 41% were women, the mean age was 67.8 (SD 8.4). The mean duration of Parkinson’s disease was 7.8 years (SD 5.7). The mean UPDRS part 3 was 22.6 (SD 11.5). The mean Hoehn and Yahr stage was 2.73 (SD 0.89). According to Hoehn-Yahr staging 17 patients (34.1%) were in stage 1, 19 patients (38.6%) in stage 2, 5 patients (11.3%) in stage 3 and 3 patients (6.8%) in stage 4. The mean MMSE was 25 (range 23−28), the mean mental health SF-36 score was 70.1 (SD 17.7), and the mean total fatigue score was 16 (SD 6.0). Restless legs syndrome was reported by 29.5% patients. Sleep problems were common among PD patients. The mean of total PDSS score was 103.8 (SD 26.7). While 22.7% (N = 10) of the patients had a total PDSS score under 82, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS.
[1] Comella, CL., 2006 Sleep disturbances and excessive daytime sleepiness in Parkinson disease: an overview. J Neural Transm Suppl. 70, 349–355. [2] Comella, CL., 2003 Sleep disturbances in Parkinson’s disease. Curr Neurol Neurosci Rep. Mar 3(2), 173–180. [3] Larsen, J.P., Tandberg, E., 2001 Sleep disorders in patients with Parkinson’s disease: epidemiology and management. CNS Drugs 15(4), 267– 275.
P.5.d.002 Cannabidiol add-on usual treatment improves the outcome of patients with Parkinson’s disease M.H.N. Chagas1 , V. Tumas1 , M. Penna-Pereira1 , M. SobreiraNeto1 , E.T. Sobreira1 , A.L. Eckeli1 , J.E.C. Hallak1 , A.C. Dos Santos1 , J.A.S. Crippa1 , A.W. Zuardi1 ° 1 University of S˜ao Paulo, Ribeir˜ao Preto School of Medicine, Ribeir˜ao Preto, Brazil Introduction: Neuroprotective effects of Cannabidiol (CBD), a Cannabis sativa component devoid of the typical psychological effects of the plant in humans, have been reported in animal models of Parkinson’s disease (PD) [1]. The neuroprotective effects of CBD in the humans have been suggested to encompass the basal ganglia. A former study has demonstrated a strong positive correlation of N-acetyl-aspartate/ total creatine ratio (NAA/Cr) in the putamen/globus pallidum and CBD levels in recreational cannabis users, suggesting an enhancement of neuronal and axonal integrity in these regions by CBD [2]. In an open-label pilot study, we observed that PD patients who had psychosis for at least 3 months showed a significantly decrease in psychotic symptoms under CBD treatment. We also observed a decrease in the total scores of the Unified Parkinson’s Disease Rating Scale, suggesting that CBD also improved other PD symptoms [3]. Purpose: To evaluate the efficacy and safety of CBD added to treatment as usual on PD patients and to investigate its effects in relation to concentrations of brain metabolites (N-acetyl-aspartate, creatine and choline) in the basal ganglia. Method: Twenty patients with a confirmed diagnosis of idiopathic PD without dementia and on stable doses of anti-Parkinson drugs for at least 30 days were enrolled. The patients were randomly allocated into three groups treated for six weeks with daily doses of placebo (n = 7), CBD 75 mg (n = 6) or CBD 300 mg (n = 7) added to usual treatment in a double-blind procedure. Before the beginning and at the end of the study, the patients were evaluated with the Parkinson’s disease Questionnaire − 39 (PDQ-39) and the UKU Side Effects Rating Scale. We investigated possible metabolite changes in basal ganglia PD patients before and after treatment by proton magnetic resonance spectroscopy (MRS). Therefore, the patients with PD in aforementioned groups underwent spectroscopy to determine the NAA/Cr ratio, which reflects the degree of neuronal integrity in neurodegenerative diseases. Voxels were obtained from the bilateral basal ganglia, an area critical for a wide range of motor and executive mechanisms. Results: The repeated measures analysis of variance (rmANOVA) of the PDQ-39 scores showed significant effects