Cognitive and motor functioning in Parkinson disease: subjects with and without questionable dementia

We evaluated the data of the National Collegiate Athletic Association Injury Surveillance System on collegiate wrestling with a focus on musculoskeletal injuries. Over 800,000 athlete-exposures during an 11-year period compose these data. Findings particular to wrestling and a comparison with other collegiate sports are included. Collegiate wrestling had a relatively high rate of injury at 9.6 injuries per 1000 athlete-exposures. It was second to spring football in total injury rate. Most injuries in this study were not serious, with 6.3% resulting in surgery and 37.6% resulting in a week or more off from wrestling. There was only one catastrophic, nonfatal injury. The knee, shoulder, and ankle were the most commonly injured regions, and injuries to them were often the more serious. Sprains, strains, and contusions were the most common injury types. Takedowns and sparring were the most common activities at the time of injury. Mechanism of injury was evaluated; rotation about a planted foot and contact with environmental objects were identified as areas needing further attention. Illegal action accounted for only 4.6% of injuries in competition. Competition had a significantly higher injury rate than practice, but the injury profiles of these two areas showed both to be equally important. The preseason and regular season had higher injury rates than the postseason, but, again, the injury profiles of these periods were similar. Injury percentages were similar among the 10 weight classes.     

Managing the surgical orthopaedic patient with Parkinson''s disease

PURPOSE: To describe varicella zoster virus infection in the immunocompromised child and provide guidelines to decrease the risk of infection and complications for these children. POPULATION: Children infected with varicella zoster virus, particularly those with a compromised immune system. CONCLUSIONS: Varicella zoster virus infection can have serious consequences for children with malignancies and infection with the human immunodeficiency virus, as well as children on chronic steroid therapy. PRACTICE IMPLICATIONS: The advanced practice nurse often is responsible for identifying those children at increased risk for VZV infection and its complications and for planning and implementing interventions to decrease the risks to the immunocompromised child.     

Protein nitration in Parkinson''s disease

The development of five schistosome species was compared in mice by the recovery of schistosomula from chopped lung tissue and of adult worms by portal perfusion. Three developmental patterns appeared. (1) Schistosoma japonicum was unique in showing an early establishment of schistosomula in and a rapid departure from the lungs together with the highest worm recovery; (2) S. haematobium contrasted by establishing later and persisting in the lungs for at least 2 weeks while yielding the lowest adult worm recovery; and (3) S. intercalatum, S. mansoni, and S. rodhaini had an intermediate pattern--they resided in the lungs for several days, then disappeared and produced intermediate numbers of adults. Lung petechiae, known to accompany the migration of S. japonicum, were never detected after infection with the other species. We speculate that the three migration patterns of schistosomes are related to the size of the relative spectra of naturally infected definitive hosts.     

Current therapy of Parkinson''s disease

OBJECTIVE: To study the outcome of pregnancy in overt diabetes with retinopathy and the changes of retinopathy during pregnancy. METHOD: Retrospective study was made on 49 pregnancies with overt diabetes from 1981 to 1995. RESULTS: Maternal complications and perinatal morbidity were higher in pregnancies with retinopathy but there were no significant differences between those with and without retinopathy. Retinopathy progressed during pregnancy i 31.1% of the parturients. CONCLUSION: Pregnancies with overt diabetes complicated with retinopathy are not the indications for terminating pregnancy, but the changes of retinopathy should be carefully monitored during pregnancy.     

Technetium-99m hexamethylpropylene amine oxime single photon emission tomography of the brain in early Parkinson''s disease: correlation with dementia and lateralization

In order to assess the seroepidemiology of protective antibodies against rubella among women from León, Guanajuato, Mexico, a prospective study was done. The sample consisted in 176 serum samples from urban and rural women at reproductive age, drawn from June 1990 to June 1991. Samples were tested by the classic hemagglutination inhibition method, titers of 1:8 or higher were considered as positive. Global positivity was 71 per cent (125 sera). Seropositivity did not increase with women's age; the lowest values were seen at the rural zones (58.9%). This survey showed a lower seropositivity than the previously reported in Mexico, and confirms data from new official studies. With this information authors suggest that the utility and viability of a national vaccination program should be reviewed and propose that it could be risky that individual clinicians to recommend children vaccination because the lack of coordination could increase adult cases of rubella.     

The health burdens of Parkinson''s disease

Glucocorticoid (GC) hormones induce apoptosis in lymphoid and leukemic cells by binding and activating cytosolic GC receptors. Because physiological stress often causes hormone-free GC receptor activation, we have investigated if stress-induced apoptosis of lymphoid cells is also mediated by the activation of the GC receptor pathway. In S49 T lymphoma cells, heat shock and deprivation of growth factors or nutrients caused nuclear translocation and loss of agonist binding capacity of GC receptors, similar to that in cells incubated with the glucocorticoid dexamethasone (DEX). In variant S49 H.2 cells, cross-resistance to DEX, temperature shocks and growth factor deprivation were associated with a higher threshold for hormone-dependent and -independent receptor activation in situ and with impaired in vitro activation of cytosolic receptors. Cross-resistance to DEX, low serum and heat shock was abrogated, however, by pharmacological sensitization of GC receptor activation with the drug meta-iodobenzylguanidine (MIBG). Sensitive S49 cells and resistant variants did not differ in the expression levels of the apoptosis-regulating genes bax, bad, bcl-X and bcl-2, the status of the p53 gene nor in a different requirement for the growth factors II-2, IL-4 or IL-9. The results suggest that ligand-independent activation of the GC receptor is a central signalling and controlling event in some forms of stress-induced apoptosis, assigning a novel function to the GC receptor in the regulation of lymphoid and leukemic cell numbers.     

Early morning dystonia in Parkinson''s disease

Proliferation of arterial smooth muscle cells has held center stage as the culprit in restenosis for almost two decades. Many strategies for combating restenosis target smooth muscle replication. However, none have proven beneficial in clinical trials. Indeed, inhibition of smooth muscle proliferation in human patients might produce the undesired effect of destabilizing vulnerable atherosclerotic plaques because these cells furnish the collagen responsible for the biomechanical strength of the plaque. Actually, in some cases the benefit of angioplasty may depend on stimulating smooth muscle replication and collagen elaboration, converting an "unstable" to a more stable plaque. Moreover, recent clinical and experimental evidence suggests that restenosis depends less on neointimal hyperplasia than on constrictive remodeling (i.e., advential scarring, producing a smaller lumen), a process independent of smooth muscle replication. The recognition that plaques vulnerable to disruption often do not produce flow-limiting stenoses highlights a need for reassessment of the strategies to treat or prevent the acute coronary syndromes. We should strive to treat aggressively risk factors such as hyperlipidemia whose control appears to stabilize plaques. Trials are even underway comparing such risk factor management with coronary artery intervention. If we could identify potentially unstable atheroma before they are evident, clinically, we might even contemplate angioplasty of nonsignificant stenoses to induce smooth muscle cell proliferation and reinforce the plaque's fibrous cap. This proposal may seem preposterous, yet we perform "primary" angioplasty every day in patients with an acute myocardial infarction whose "culprit" lesions underlying the thrombus are often not critical. Our knowledge of the biology of restenosis has lagged behind our practice of coronary intervention. Advances in understanding the biology of the complications of interventional therapy, hand in hand with technical advances, should help us to devise more rational and enduring approaches to benefiting our patients.     

Mental symptoms in Parkinson''s disease during chronic treatment with levodopa

The influence of epidural block with bupivacaine (Marcaine-adrenalin) on fetal heart rate, uterine activity, and the frequency and intensity of contractions was studied in twenty-five nulliparae at term. Uterine activity was found to decrease during the first 30 minutes following epidural block. In the time interval 30 to 40 minutes after epidural block uterine activity increased again and attained the same level as during the last 10 minutes before analgesia. The frequency of uterine contractions did not decrease after the block. The lower levels of uterine contractility were due only to a lower amplitude of the contractions. The regularizing effect of epidural analgesia on incoordinate uterine action was noted. The recording of fetal heart rate in the time interval studied revealed no pathological findings. Mode of delivery, mean labour duration and Apgar scores after epidural block were comparable with earlier studies of a larger patient population. This study suggest that epidural analgesia does not induce any important changes in fetal heart rate but temporarily decreases uterine activity.     

Suicide in patients with Parkinson''s disease. An epidemiological study

The purpose of this study was to estimate the risk of suicide for patients with Parkinson's disease (PD) in Denmark compared with that in the background population. The study involved 458 patients with a PD diagnosis, 226 men and 232 women. The follow-up period to either death or end of follow-up on December 31, 1990 was 0 to 17 years, mean 5.7 years. Deaths in the follow-up period amounted to 254, 135 men and 119 women. Two women committed suicide. The number of expected suicides was 1.06 for men and 0.55 for women, a total of 1.62. Neither for men nor for women was the difference between expected and observed suicides statistically significant.     

Smoking and Parkinson''s disease: a dose-response relationship

BACKGROUND: Previous studies questioned the link between early childhood anemia and detrimental child development. OBJECTIVE: A population-based study was conducted to examine the association between early childhood anemia and mild or moderate metal retardation at 10 y of age. DESIGN: The present study linked early childhood nutrition data collected by the Special Supplemental Program for Women, Infants, and Children (WIC) and school records. Hemoglobin values were used to determine the relation between anemia in early life and children's placement in special education classes for mild or moderate mental retardation. Subjects were all participants in the WIC program. A computer program was used to link data from birth, WIC, and school records. RESULTS: Logistic regression showed an increased likelihood of mild or moderate mental retardation associated with anemia, independent of birth weight, maternal education, sex, race-ethnicity, the mother's age, or the child's age at entry into the WIC program. CONCLUSION: These findings support the proposition that efforts to prevent mild and moderate mental retardation should include providing children with adequate nutrition during early childhood.     

Progressive aphasia without dementia

INTRODUCTION: Slowly progressive aphasia without generalized dementia is considered as a degenerative disorder that can be differentiated of others well-known neurodegenerative disorders. CLINICAL CASE: We present a case report of a patient with slowly progressive aphasia, characterized by a progressive anomia and without generalized dementia. The patient was evaluated in the last four years: a neuropsychological assessment, a neurological exploration and structural (MRI) and functional (SPECT) neuroimaging were performed. CONCLUSION: This case is interesting on account of a selective implication of the left temporal hemisphere is showed in the pathogenesis of this disorder.     

Medical treatment of essential tremor and Parkinson''s disease

Tremor is commonly the first neurologic sign of Parkinson's disease (PD) that leads patients to see a physician. Knowing how to differentiate the resting tremor of PD from essential tremor is an important diagnostic skill. Unlike patients with essential tremor, those with PD have other neurologic findings. A diagnosis of PD is likely if the patient has two of three major clinical features: resting tremor, bradykinesia, and rigidity. Minor signs may also be seen, including cognitive slowing, speech abnormalities, depression, dysautonomia, and sleep disturbances. The history and physical exam can determine if the patient has parkinsonism and whether the cause is Parkinson's disease.     

Recognition by familiarity is preserved in Parkinson's without dementia and Lewy-Body disease.

Objective: The retrieval deficit hypothesis states that the lack of deficit in recognition often observed in patients with Parkinson's disease is because of the low retrieval requirements of the task, given that these patients have retrieval and not encoding deficits. To test this hypothesis we investigated recognition memory by familiarity in Parkinson's patients and in patients with Lewy Bodies disease and Parkinson with dementia. Method: We analyzed to what extent the experimental groups were able to recognize by familiarity in a typical yes/no recognition memory task. The experimental groups were patients with early nondemented Parkinson's disease, advanced nondemented Parkinson's disease, demented Parkinson's patients, and patients with dementia with Lewy Bodies. We compared their performance with a group of young and another group of old healthy participants. The estimation of familiarity was made by analyzing recognition of word targets and distractors consisting of combinations of different letters in comparison with a condition in which targets and distractors were composed of similar letters, even though subjects were unaware of the independent variable. Results: The results indicate that familiarity was used at the same level by controls, patients with early Parkinson's disease and patients with dementia with Lewy Bodies. Although late Parkinson patients also used familiarity, its effect was only marginally significant. Patients with Parkinson's disease and dementia were not capable of using familiarity in recognition memory. Conclusions: Our results support the retrieval deficit hypothesis as Parkinson's patients without dementia show no deficit in a situation in which the retrieval requirements are minimal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The genetics of Parkinson''s disease and parkinsonian syndromes

General anaesthesia with 80% CO2/20% O2 and 5% halothane in O2 (mask induction) was compared for castration of 3-4 week-old piglets. One group was castrated without anaesthesia. Of the noncastrated control groups one had CO2- and one halothane anaesthesia, one breathed room air through the induction system, and one was held in castration position. The behaviour to induction and castration was assessed, and the cortisol-, ACTH- and beta-endorphin plasma concentrations were determined to quantify the stress elicited by anaesthesia, castration and handling. Violent struggling and vocalization were elicited by CO2 and positioning into the mask induction system while breathing room air; halothane induction was quiet. CO2 induced profound surgical anaesthesia; whereas under halothane anaesthesia some animals exhibited still a slight reaction to castration. Recovery was fast, smooth and quite. Permanent violent struggling and vocalization were elicited by castration without anaesthesia. Plasma cortisol was not a sensitive tool to judge castration stress. The high ACTH and beta-endorphin plasma concentrations elicited by CO2 anaesthesia confirm our clinical experience. General anaesthesia is fast and safely induced with CO2 in piglets and castration can be performed without any reaction, but with CO2 anaesthesia the stress is not reduced.     

Cognitive and affective functioning in Parkinson''s disease patients with lateralized motor signs

OBJECTIVE: This study aimed to compare recordings of the electrically evoked whole nerve action potential (EAP) made using the reverse telemetry system of the Nucleus CI24M device with those recorded from individuals who use the Ineraid cochlear implant system. STUDY DESIGN: Data were collected in a prospective fashion from Nucleus CI24M cochlear implant users and compared with retrospective data collected from patients who use the Ineraid device. SETTING: All data were collected at the Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics. PATIENTS: Data are reported from 8 patients who use the Nucleus CI24M cochlear implant and 20 patients who use the Ineraid cochlear implant system. INTERVENTIONS: The interventions described in this study were diagnostic in nature. MAIN OUTCOME MEASURES: EAP growth and refractory recovery data are reported. EAP thresholds recorded from patients who use the Nucleus CI24M device also are compared with behavioral thresholds for the stimulus used to evoke the EAP as well as the stimulation levels needed to program the speech processor. RESULTS: EAP morphology, growth, and refractory recovery functions recorded using the Nucleus CI24M reverse telemetry system compared favorably with similar measures recorded from Ineraid cochlear implant users. CONCLUSIONS: Reasonable EAP responses can be recorded using the Nucleus CI24M device. More data are needed to determine whether the information about neural responsiveness available with this device will be clinically useful.     

Quantified electroencephalographic changes in depressed patients with and without dementia

We carried out quantified electroencephalograms (qEEG) in 17 patients with probable Alzheimer's disease (AD), who also met the DSM-III-R criteria for either dysthymia or major depression, and 18 AD patients with comparable intellectual impairment but no depression, 13 patients with depression but no AD, and 10 age-matched normal controls. There was a significant effect for depression in alpha relative power: depressed patients (with or without AD) showed a significantly lower alpha relative power in the right posterior region as compared to nondepressed patients; however, this change was observed over the right hemisphere in depressed non-AD patients, and in left, medial, and right posterior regions in depressed-AD patients. Depressed patients without AD showed a significant global decrease in delta power, whereas depressed patients with AD showed significant increments in delta power in posterior brain areas. In conclusion, AD patients with depression showed qEEG changes that were significantly different from qEEG changes in depressed non-AD patients.     

The prevalence of verbal communication disability in patients with Parkinson''s disease

BACKGROUND: We evaluated and compared the efficacy and safety of sertraline and fluvoxamine in a randomized, double-blind, parallel-group study during a follow-up of 24 months. METHOD: Sixty-four patients with recurrent, unipolar depression (DSM-IV criteria) who had at least one depressive episode during the 18 months preceding the index episode were accepted into the trial. Patients were randomly assigned to one of the two long-term treatment groups and evaluated monthly by trained psychiatrists, blinded to treatment option, on the basis of the Hamilton Rating Scale for Depression. RESULTS: All patients completed the 24-month follow-up period. Sertraline and fluvoxamine showed an equal efficacy in preventing new recurrences. In fact, there was no significant difference in survival rates between the two medication groups: 7 sertraline-treated patients (21.9%) and 6 fluvoxamine-treated patients (18.7%) had a single new recurrence (z = 0.14; p = .88). Moreover, recurrence observed during maintenance therapies was less severe and/or of shorter duration than index episodes. CONCLUSION: Long-term treatment with sertraline or fluvoxamine has been shown to be effective for prevention of highly recurrent unipolar depression. The high tolerability of these compounds, together with their prophylactic effectiveness, has an important role in improving the quality of life of these patients.     

Postmenopausal hormone replacement therapy and cardiovascular disease

Cardiovascular disease is the leading cause of mortality in postmenopausal women in developed countries. A possible cardioprotective role of hormone replacement therapy (HRT) is suggested by epidemiologic studies of HRT and reduced risk of coronary heart disease, as well as by randomized trials of HRT and lipid subfractions. Estrogen has beneficial effects on the lipid profile, raising high-density lipoprotein cholesterol levels and reducing low-density lipoprotein cholesterol levels each by approximately 10%. Other possible biologic mechanisms include beneficial effects on vascular function, oxidative status, endothelial-dependent vasodilation, intimal hyperplasia and insulin sensitivity. Estrogen's net effects on coagulation and fibrinolysis are less clear. Estrogen replacement therapy is associated with decreased atherosclerosis in several animal models. However, most of the available data on HRT derive from observational studies or small randomized trials assessing biologic intermediates rather than clinical events. Further research, including large-scale randomized clinical trials, are required to evaluate definitively the role of estrogen replacement therapy, especially given uncertainties about the effects of combined estrogen-progestin therapy and the balance of benefits and risk of this common intervention in postmenopausal women.