Journal of Movement Disorders

Original Article

Nationwide Survey of Patient Knowledge and Attitudes towards Human Experimentation Using Stem Cells or Bee Venom Acupuncture for Parkinson’s Disease: Sun Ju Chung, Seong Beom Koh, Young-Su Ju, Jae Woo Kim; J Mov Disord. 2014;7(2):84-91. Published online October 30, 2014; DOI: https://doi.org/10.14802/jmd.14012

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Objective Stem cell treatment is a well-recognized experimental treatment among patients with Parkinson’s disease (PD), for which there are high expectations of a positive impact. Acupuncture with bee venom is one of the most popular complementary and alternative treatments for PD. Patient knowledge and attitudes towards these experimental treatments are unknown.
Methods Using a 12-item questionnaire, a nationwide survey was conducted of 963 PD patients and 267 caregivers in 44 Korean Movement Disorders Society member hospitals from April 2013 to June 2013. The survey was performed by trained interviewers using conventional methods.
Results Regarding questions on experimental treatments using stem cells or bee venom acupuncture, 5.1–17.7% of PD patients answered questions on safety, efficacy, and evidence-based practice incorrectly; however, more than half responded that they did not know the correct answer. Although safety and efficacy have not been established, 55.5% of PD patients responded that they were willing to receive stem cell treatment. With regard to participating in experimental treatments, there was a strong correlation between stem cell treatment and bee venom acupuncture (p < 0.0001, odds ratio = 5.226, 95% confidence interval 3.919–6.969). Younger age, higher education, and a longer duration of PD were all associated with a correct understanding of experimental treatments.
Conclusions Our data suggest that relatively few PD patients correctly understand the safety and efficacy of experimental treatments and that PD patients are greatly interested in new treatments. We hope that our data will be used to educate or to plan educational programs for PD patients and caregivers.

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Review Article

Genetics of Parkinson’s Disease - A Clinical Perspective: Sang-Myung Cheon, Lilian Chan, Daniel Kam Yin Chan, Jae Woo Kim; J Mov Disord. 2012;5(2):33-41.; DOI: https://doi.org/10.14802/jmd.12009

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Abstract PDF

Discovering genes following Medelian inheritance, such as autosomal dominant-synuclein and leucine-rich repeat kinase 2 gene, or autosomal recessive Parkin, P-TEN-induced putative kinase 1 gene and Daisuke-Junko 1 gene, has provided great insights into the pathogenesis of Parkinson’s disease (PD). Genes found to be associated with PD through investigating genetic polymorphisms or via the whole genome association studies suggest that such genes could also contribute to an increased risk of PD in the general population. Some environmental factors have been found to be associated with genetic factors in at-risk patients, further implicating the role of gene-environment interactions in sporadic PD. There may be confusion for clinicians facing rapid progresses of genetic understanding in PD. After a brief review of PD genetics, we will discuss the insight of new genetic discoveries to clinicians, the implications of ethnic differences in PD genetics and the role of genetic testing for general clinicians managing PD patients.

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Original Articles

Orthostatic Hypotension in Drug-Naïve Patients with Parkinson’s Disease: Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2011;4(1):33-37.; DOI: https://doi.org/10.14802/jmd.11005

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Abstract PDF

Background and Purpose

Orthostatic hypotension (OH) is known to be present even in patients with early Parkinson’s disease (PD). To affirm the presence of OH and find correlation between OH and other dysautonomic symptoms in PD, this study has done in newly-diagnosed PD patients.

Methods

Forty-five non-demented patients with no prior history of treatment for PD were recruited (17 men, 63.8 ± 10.1 years of age). All the patients were evaluated for OH before starting medications. Autonomic symptoms were evaluated with structured questionnaires. Clinical characteristics of PD were evaluated (median Hoehn and Yahr stage 2.0 (1–3), 1.3 ± 1.1 years of disease duration), and comorbid medical conditions that could affect blood pressure were also recorded.

Results

OH was prevalent, and eighteen patients (40%) showed orthostatic hypotension, and twenty-seven (60%) did not (normotensive group). There was no significant difference in demographic and clinical characteristics between groups. The presence or severity of symptoms of autonomic dysfunction in the OH group also not differed from those of the normotensive group.

Conclusions

OH was prevalent even in the early stage of PD, and was not related to presence or severity of any other symptoms of autonomic dysfunction. Our findings suggest that clinicians should pay attention to OH from the early stage of disease.

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Central retinal microvasculature damage is associated with orthostatic hypotension in Parkinson’s disease
Jong Hyeon Ahn, Min Chae Kang, Dongyoung Lee, Jin Whan Cho, Kyung-Ah Park, Jinyoung Youn
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Pronounced Orthostatic Hypotension in GBA-Related Parkinson’s Disease
Tatiana Usnich, Henrike Hanssen, Katja Lohmann, Christina Lohse, Christine Klein, Meike Kasten, Norbert Brüggemann
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Javier Navarro-Zaragoza, Lorena Cuenca-Bermejo, Pilar Almela, María-Luisa Laorden, María-Trinidad Herrero
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Delayed orthostatic hypotension in Parkinson’s disease
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Neurogenic orthostatic hypotension in early stage Parkinson's disease: New insights from the first 105 patients of the BoProPark study
Francesca Baschieri, Luisa Sambati, Pietro Guaraldi, Giorgio Barletta, Pietro Cortelli, Giovanna Calandra-Buonaura
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Trajectory Analysis of Orthostatic Hypotension in Parkinson’s Disease: Results From Parkinson’s Progression Markers Initiative Cohort
Kui Chen, Kangshuai Du, Yichen Zhao, Yongzhe Gu, Yanxin Zhao
Frontiers in Aging Neuroscience.2021;[Epub] CrossRef
Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment
Zhichun Chen, Guanglu Li, Jun Liu
Neurobiology of Disease.2020; 134: 104700. CrossRef
Prevalence and factors related to orthostatic syndromes in recently diagnosed, drug-naïve patients with Parkinson disease
Cecilia Quarracino, Matilde Otero-Losada, Francisco Capani, Santiago Pérez-Lloret
Clinical Autonomic Research.2020; 30(3): 265. CrossRef
Orthostatic hypotension in Parkinson disease
Ylva Hivand Hiorth, Kenn Freddy Pedersen, Ingvild Dalen, Ole-Bjørn Tysnes, Guido Alves
Neurology.2019;[Epub] CrossRef
The range and nature of non-motor symptoms in drug-naive Parkinson’s disease patients: a state-of-the-art systematic review
Panagiotis Zis, Roberto Erro, Courtney C Walton, Anna Sauerbier, Kallol Ray Chaudhuri
npj Parkinson's Disease.2015;[Epub] CrossRef
Orthostatic Hypotension and Cognitive Impairment in <i>De Novo</i> Patients with Parkinson’s Disease
Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon
Journal of Movement Disorders.2014; 7(2): 102. CrossRef

Autonomic Dysfunctions in Parkinsonian Disorders: Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2009;2(2):72-77.; DOI: https://doi.org/10.14802/jmd.09019

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Abstract PDF

Background and Purpose:

Symptoms of autonomic dysfunctions are common in the patients with parkinsonian disorders. Because clinical features of autonomic dysfunctions are diverse, the comprehensive evaluation is essential for the appropriate management. For the appreciation of autonomic dysfunctions and the identification of differences, patients with degenerative parkinsonisms are evaluated using structured questionnaire for autonomic dysfunction (ADQ).

Methods:

Total 259 patients, including 192 patients with [idiopathic Parkinson’s disease (IPD, age 64.6 ± 9.6 years)], 37 with [multiple system atrophy (MSA, 62.8 ± 9.1)], 9 with [dementia with Lewy body (DLB, 73.9 ± 4.3)], and 21 with [progressive supranuclear palsy (PSP, 69.4 ± 9.6)]. The ADQ was structured for evaluation of the presence of symptoms and its severity due to autonomic dysfunction, covering gastrointestinal, urinary, sexual, cardiovascular and thermoregulatory domains. Patients were also evaluated for the orthostatic hypotension.

Results:

Although dementia with Lewy body (DLB) patients were oldest and duration of disease was longest in IPD, total ADQ scores of MSA and PSP (23.9 ± 12.6 and 21.1 ± 7.8) were significantly increased than that of IPD (15.1 ± 10.6). Urinary and cardiovascular symptom scores of MSA and gastrointestinal symptom score of PSP were significantly worse than those of IPD. The ratio of patient with orthostatic hypotension in IPD was 31.2% and not differed between groups (35.1% in MSA, 33.3% in DLB and 33.3% in PSP). But the systolic blood pressure dropped drastically after standing in patients with MSA and DLB than in patients with IPD and PSP.

Conclusions:

Patients with degenerative parkinsonism showed widespread symptoms of autonomic dysfunctions. The severity of those symptoms in patients with PSP were comparing to that of MSA patients and worse than that of IPD.

Citations

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Autonomic dysfunction in progressive supranuclear palsy
Francesca Baschieri, Maria Vitiello, Pietro Cortelli, Giovanna Calandra-Buonaura, Francesca Morgante
Journal of Neurology.2023; 270(1): 109. CrossRef
Orthostatic hypotension in dementia with Lewy bodies: a meta-analysis of prospective studies
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Sudhakar Pushpa Chaithra, Shweta Prasad, Vikram Venkappayya Holla, Albert Stezin, Nitish Kamble, Ravi Yadav, Pramod Kumar Pal
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Characteristics of Nonmotor Symptoms in Progressive Supranuclear Palsy
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Parkinson's Disease.2016; 2016: 1. CrossRef

The Correlation of ON and OFF Status With Clinical Characteristics in Patients With Parkinson’s Disease: Jung-Hwa Seo, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2008;1(2):65-70.; DOI: https://doi.org/10.14802/jmd.08012

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Abstract PDF: Background:
Status of the disease is the one of main concerns of clinicians, especially in the course of primary degenerative disorders. In Parkinson’s disease (PD), Unified Parkinson’s Disease Rating Scale (UPDRS) is an useful clinical score that can express severity of parkinsonian symptoms, but L-DOPA treatment and motor fluctuations can change the UPDRS scores. Even in the best ‘on’ state, there can be residual motor deficits, and it is very difficult to estimate the worst ‘off’ state due to long duration effect of L-DOPA.
Objective:
To find relevant examination scores of ‘on’ or ‘off’ state of PD patients which correlates with clinical and demographic variables those can represents the status of Parkinson’s disease.
Methods:
Sixty-four patients with PD (24 male, age 63.0±8.6 years, Hoehn and Yahr stage (HY) 2.8±0.5) were examined UPDRS at ‘on’ and practically defined ‘off’ (12 hours after last medication) state. We evaluated the association between the ‘on’ and ‘off’ scores of UPDRS and duration of disease and treatment, and equivalent L-DOPA dose of the patients. Patients were grouped according to the presence of motor fluctuation to find the differences in those associations.
Results:
There were significantly strong correlations between UPDRS ‘off’ scores and clinical variables such as duration of disease and treatment. In ‘on’ state, only complication part of UPDRS was correlated with duration of disease and treatment, but activity of daily living (ADL) and motor part of UPDRS were correlated well with age of the patients. Age at disease onset showed significant negative association with the difference between ‘off’ and ‘on’ state UPDRS scores. Thirty-one patients who had motor fluctuation (9 male, age 62.7±9.3 years, HY 3.0±0.6) showed significantly increased duration of the disease, duration of L-DOPA treatment and equivalent DOPA dose compared to those of 33 patients without motor fluctuation (15 male, age 63.3±8.1 years, HY 2.6±0.3). In patients without motor fluctuation, both ‘off’ and ‘on’ UPDRS showed association with duration of disease and treatment, but ‘off’ and ‘off’ – ‘on’ difference of UPDRS were better correlated with duration of disease and treatment in patients with motor fluctuation.
Conclusion:
We found that the UPDRS scores of practically defined ‘off’ state significantly correlated with the duration of the disease and treatment. Patients with motor fluctuation revealed better responsiveness to medication than those without motor fluctuation. In patients without motor fluctuation, UPDRS scores of ‘on’ state can reflect the clinical presentation as much as those of ‘off’ state.

Mild Cognitive Impairment in Parkinson’s Disease: Jae Woo Kim, Hee Young Jo, Min Jeong Park, Sang-Myung Cheon; J Mov Disord. 2008;1(1):19-25.; DOI: https://doi.org/10.14802/jmd.08004

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Abstract PDF

Background

To determine the frequency of mild cognitive impairment (MCI) of Parkinson’s disease (PD, PDMCI) and its subtypes among non-demented PD patients, and to identify the influence of the age and presenting symptom on the development of PDMCI.

Methods:

A total 141 non-demented PD patients underwent a comprehensive neuropsychological assessment including attention, language, visuospatial, memory and frontal functions. PDMCI was defined by neuropsychological testing and was classified into five subtypes. Patients were divided into two groups (tremor vs. akinetic-rigid type) for presenting symptom and three groups according to the age. Neuropsychological performance of patients was compared with normative data.

Results:

Almost half (49.6%) of non-demented PD patients had impairment in at least one domain and can be considered as having PDMCI. Executive type of PDMCI was the most frequent and amnestic, visuospatial, linguistic and attention types followed in the order of frequency. The population of PDMCI was increasing as the age of disease onset was higher. Whereas the frequency of executive and amnestic types of PDMCI was comparable in younger group, executive type was the most frequent in older group. The patients with tremor dominant type performed worse on tests, particularly on attention test.

Conclusions:

MCI was common even in the early stage of PD and the subtype was diverse. Unlike MCI developing Alzheimer’s disease later, executive type of PDMCI was the most common. Age was an important risk factor for development of MCI in PD. The concept of MCI should be introduced in PD.

Citations

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Orthostatic Hypotension and Cognitive Impairment in <i>De Novo</i> Patients with Parkinson’s Disease
Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon
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Correlated regions of cerebral blood flow with clinical parameters in Parkinson’s disease; comparison using ‘Anatomy’ and ‘Talairach Daemon’ software
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Correlation between neuropsychological tests and hypoperfusion in MCI patients: anatomical labeling using xjView and Talairach Daemon Software
Hyun Jin Yoon, Kyung Won Park, Young Jin Jeong, Do-Young Kang
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Significant correlation between cerebral hypoperfusion and neuropsychological assessment scores of patients with mild cognitive impairment
Hyun Jin Yoon, Kyung Won Park, Young Jin Jeong, Do-Young Kang
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Utility and Limitations of Addenbrooke’s Cognitive Examination-Revised for Detecting Mild Cognitive Impairment in Parkinson’s Disease
Natalie C. Komadina, Zoe Terpening, Yue Huang, Glenda M. Halliday, Sharon L. Naismith, Simon J.G. Lewis
Dementia and Geriatric Cognitive Disorders.2011; 31(5): 349. CrossRef
Characterizing mild cognitive impairment in Parkinson's disease
John C. Dalrymple‐Alford, Leslie Livingston, Michael R. MacAskill, Charlotte Graham, Tracy R. Melzer, Richard J. Porter, Richard Watts, Tim J. Anderson
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