Journal of the neurological sciences
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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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Randomized Controlled Trial
Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in Parkinson's disease (PD). Dementia is considered as a contraindication for STN-DBS. However, no controlled study assessed the impact of STN-DBS on the QoL and motor outcome in PD patients with a borderline global cognitive impairment. ⋯ Twelve out of sixty patients of the STN-DBS group scored in the lowest quartile of the MDRS (range between one hundred thirty and one hundred thirty seven points). An individual analysis revealed that 3 of 12 patients showed a clinical relevant improvement in QoL whereas the group statistics did not reveal any significant improvement in QoL measures after STN-DBS compared to the BMT group. Since this failure to improve in QoL cannot be explained by a failure to improve in motor functions, stimulation settings and psychiatric scales after STN-DBS, the failure to improve in QoL in patients with a borderline global cognitive score might be specifically related to lower cognitive functioning.
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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.
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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.