Journal of the neurological sciences
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Our objective was to assess which clinical factors contribute most to the impairment of instrumental activities of daily living (IADL) in patients with dementia in Parkinson's disease (PDD) as compared to age- and dementia duration-matched patients with Alzheimer's disease (AD). ⋯ Our pilot study results show that motor deficits remain the major contributor to IADL impairment in PDD.
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Impulsive-compulsive behaviours (ICBs) are an increasingly well-recognised adverse-effect of dopaminergic medications used to treat Parkinson's disease. ICBs include pathological gambling, compulsive sexual behaviour, compulsive buying, and binge eating, together with punding and the addiction-like compulsive use of dopamine replacement therapy, or dopamine dysregulation syndrome. The prevalence of ICBs was approximately 14% in a large study undertaken in specialist movement disorder clinics. ⋯ Other mechanisms implicated in the development and perpetuation of ICBs in PD include aberrant learning from reward-related situations, including decreased learning from negative feedback, increased measures of impulsivity or sensation seeking, and strong preference for immediate over future rewards. Treatment options for impulsive-compulsive behaviours include pharmacological, surgical and psychological interventions. The early recognition and prevention of ICBs, coupled with awareness of clinical risk factors for the development of these behaviours is of paramount importance, given the lack of specific treatments for these sometimes debilitating behaviours.
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Pain is a well-recognized feature of Parkinson disease (PD), and for some patients it is the most disabling symptom. Patients with PD may experience various types of pain, and the treatment of their pain depends on its presumed cause. However, in many patients, both pain that appears to be unrelated to PD and PD-related pain can be alleviated by medical and surgical interventions that target the motor symptoms of PD. In this article we review reports on the improvement of pain in PD by surgical interventions such as subthalamic deep brain stimulation (STN DBS), and discuss the possible mechanisms by which STN DBS improves pain in PD.
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A subtle cognitive impairment can be detected early in the course of Parkinson's disease (PD). Executive, memory and visuospatial functions are specifically affected, but the underlying pathophysiological basis is not well elucidated yet and may be heterogeneous. The recent identification of a PD-related cognitive metabolic pattern (PDCP), including hypometabolism in associative frontal, parietal and posterior limbic structures, has integrated the classical notion of a striato-frontal syndrome at the basis of cognitive dys-function. ⋯ Administration of AchE inhibitors to PDD patients increased brain metabolism in bilateral frontal and left parietal regions, and left posterior cingulate. Finally, the recent availability of radiopharmaceuticals able to disclose amyloid brain deposition has allowed to demonstrate amyloid load in a part of patients with PDD, possibly due to diffuse rather than neuritic plaques. Brain PET and SPECT have strongly contributed to the understanding of the pathophysiology of cognitive impairment in PD and may serve as probes to monitor the effects of therapeutic interventions.
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Sexual problems are common in Parkinson's disease and contribute to poor quality of life of patients and partners. Nonmotor and motor disease manifestations can affect sexual function. This article reviews the progressive and multidimensional sexual manifestations and provides practical suggestions for taking sexual history and treating sexual problems, which may enable clinicians to contribute to the sexual wellbeing of patients.