Longo, Katia (2010) STUDIO DEI PARKINSONISMI IN FASE INIZIALE: ASPETTI CLINICI E NEUROPSICOLOGICI. [Tesi di dottorato] (Unpublished)

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Item Type: Tesi di dottorato
Uncontrolled Keywords: Parkinsonismo, atrofia multisistemica, mild cognitive impairment, sintomi non motori, test all'arginina.
Date Deposited: 10 Dec 2010 09:13
Last Modified: 30 Apr 2014 19:44
URI: http://www.fedoa.unina.it/id/eprint/8047

Abstract

Il lavoro si è strutturato intorno ai seguenti tre progetti: 1.00 Background: The European MSA study group (EMSA-SG) recently suggested that some warning signs found to be highly specific for multiple system atrophy (MSA) versus idiopathic Parkinson’s disease may allow an earlier diagnosis of MSA. We evaluated the frequency of warning signs in a cohort of untreated patients with early-stage parkinsonism. Methods: We recruited 115 untreated consecutive patients with early parkinsonism (<2 years history). All patients were investigated for the presence of warning signs and core features of MSA including autonomic, cerebellar and corticospinal dysfunction. Results: Warning signs were present in 40% of patients. Emotional incontinence was reported in 23% of patients, contractures of hands and feet in 17%, and early instability in 10% of patients. Core features of MSA were present in 29% of patients. Urinary symptoms were observed in 18% of patients, erectile dysfunction in 13% of males, hyperreflexia with Babinski sign in 3%. Occurrence of both warning signs and core features of MSA was observed in 16% of patients. Conclusions: Some warning signs and core features of MSA were frequent in untreated patients with early-stage parkinsonism. The early presence of these features could antedate a diagnosis of MSA in our population. 2.00 Mild Cognitive Impairment (MCI) is in an intermediate zone between normal cognition and dementia described in patients with Parkinson’s Disease (PD) receiving dopaminergic medications. Objects. The aim of this study was to explore the cognitive correlates of MCI in nondemented patients with early and untreated PD. Material and methods. Consecutive 56 untreated outpatients with newly diagnosed PD, with history of motor symptoms less than 2 years, without familial parkinsonism, without dementia and major depression. As control group, 20 educational level- and age-matched healthy subjects were enrolled. All subjects underwent a comprehensive neuropsychological battery assessing several cognitive domains, apathy and depressive symptoms. Results: The MCI was identified in 16/56 (28.57%) de novo PD patients. Among patients with MCI, we found amnestic single-domain MCI (aMCI-SD; only memory domain impaired) in 2 patients, amnestic multiple-domain MCI (aMCI-MD; memory plus one or more other domains impaired) in 4 patients, non-amnestic single-domain MCI (naMCI-SD; 1 non-memory domain impaired) in 8 patients, and non-amnestic multiple-domain MCI (naMCI-MD; more than 1 non-memory domain impaired) in 1 patient. 3.00 Nonmotor symptoms (NMSs) in parkinsonism have gained relevance in recent years for their frequence in the course of disease and their impact on patients’ quality of life.1 NMSs are present already at disease onset and some of them, like psychiatric and sleep disorders, may even precede motor symptoms.2,3 NMSs are very common in parkinsonian patients, but little is known about NMSs in de novo parkinsonian patients. 4 Objectives The objectives of this observational study were to evaluate the prevalence of NMSs in de novo parkinsonian patients and to correlate them with clinical variables. Patients and methods NMSs were evaluated with a structured interview in 127 untreated de novo parkinsonian patients of both sexes referring to Parkinson’s disease and Movement Disorders Centre of University “Federico II” of Naples. The severity of motor symptoms was rated using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III) and Hoehn and Yahr (HY) staging. NMSs were grouped into 12 domains (NMSd): Gastrointestinal, Pain, Urinary, Cardiovascular, Sleep, Fatigue, Apathy, Attention/Memory, Skin, Psychiatric, Respiratory, Miscellaneous. Results We found that 116 (93.7%) patients reported at least one NMS. Mean (SD) number of NMS per patient was 6.3 (5.1), ranging from 0 to 22. The most common were anxiety (51.2%), fatigue (44.1%), depression (40.9%) and REM sleep behaviour disorder (32.3%) (Tab.2). Given the wide range of NMSs, they were grouped into 12 domains (NMSd). Mean (SD) of NMSd was 4.01 (2.64) ranging from 0 to 11. The most frequently (>40%) involved NMSd were psychiatric (61.4%), sleep disorders (52%), gastrointestinal (49.6%), fatigue (44.1%). Objects. The aim of this study was to explore the cognitive correlates of MCI in nondemented patients with early and untreated PD. Material and methods. Consecutive 56 untreated outpatients with newly diagnosed PD, with history of motor symptoms less than 2 years, without familial parkinsonism, without dementia and major depression. As control group, 20 educational level- and age-matched healthy subjects were enrolled. All subjects underwent a comprehensive neuropsychological battery assessing several cognitive domains, apathy and depressive symptoms. Results: The MCI was identified in 16/56 (28.57%) de novo PD patients. Among patients with MCI, we found amnestic single-domain MCI (aMCI-SD; only memory domain impaired) in 2 patients, amnestic multiple-domain MCI (aMCI-MD; memory plus one or more other domains impaired) in 4 patients, non-amnestic single-domain MCI (naMCI-SD; 1 non-memory domain impaired) in 8 patients, and non-amnestic multiple-domain MCI (naMCI-MD; more than 1 non-memory domain impaired) in 1 patient. 3.00 Nonmotor symptoms (NMSs) in parkinsonism have gained relevance in recent years for their frequence in the course of disease and their impact on patients’ quality of life.1 NMSs are present already at disease onset and some of them, like psychiatric and sleep disorders, may even precede motor symptoms.2,3 NMSs are very common in parkinsonian patients, but little is known about NMSs in de novo parkinsonian patients. 4 Objectives The objectives of this observational study were to evaluate the prevalence of NMSs in de novo parkinsonian patients and to correlate them with clinical variables. Patients and methods NMSs were evaluated with a structured interview in 127 untreated de novo parkinsonian patients of both sexes referring to Parkinson’s disease and Movement Disorders Centre of University “Federico II” of Naples. The severity of motor symptoms was rated using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III) and Hoehn and Yahr (HY) staging. NMSs were grouped into 12 domains (NMSd): Gastrointestinal, Pain, Urinary, Cardiovascular, Sleep, Fatigue, Apathy, Attention/Memory, Skin, Psychiatric, Respiratory, Miscellaneous. Statistical Analysis Data were analyzed with Statistical Package for the Social Sciences program (SPSS). The frequency distribution of specific NMSs and domains was calculated as the ratio between the total number of patients complaining of a symptom/domain and the total number of patients. Correlation between NMSs and demographics and severity of motor symptoms was conducted with Spearman correlation test. Results Table 1 lists the demographics of the 127 parkinsonian patients enrolled in this study. We found that 116 (93.7%) patients reported at least one NMS. Mean (SD) number of NMS per patient was 6.3 (5.1), ranging from 0 to 22. The most common were anxiety (51.2%), fatigue (44.1%), depression (40.9%) and REM sleep behaviour disorder (32.3%) (Tab.2). Given the wide range of NMSs, they were grouped into 12 domains (NMSd). Mean (SD) of NMSd was 4.01 (2.64) ranging from 0 to 11. The most frequently (>40%) involved NMSd were psychiatric (61.4%), sleep disorders (52%), gastrointestinal (49.6%), fatigue (44.1%) (Fig.1).

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