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Parkinson Disease: HELP
Articles by Erica Cassani
Based on 29 articles published since 2010
(Why 29 articles?)
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Between 2010 and 2020, E. Cassani wrote the following 29 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Diabetes and risk of Parkinson's disease: a systematic review and meta-analysis. 2011

Cereda, Emanuele / Barichella, Michela / Pedrolli, Carlo / Klersy, Catherine / Cassani, Erica / Caccialanza, Riccardo / Pezzoli, Gianni. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. e.cereda@smatteo.pv.it ·Diabetes Care · Pubmed #22110170.

ABSTRACT: OBJECTIVE: Diabetes has been associated with chronic neurodegeneration. We performed a systematic review and meta-analysis to assess the relationship between pre-existing diabetes and Parkinson's disease (PD). RESEARCH DESIGN AND METHODS: Original articles in English published up to 10 May 2011 were searched for in electronic databases (PubMed, Embase, and Scopus) and by reviewing references of eligible articles. Prospective cohort and case-control studies providing risk and precision estimates relating to pre-existing diabetes and PD were considered eligible. RESULTS: Nine studies/1,947 citations (cohort, N = 4; case-control, N = 5) fulfilled inclusion criteria for meta-analysis. In prospective studies, the onset of diabetes before onset of PD was found to be a risk factor for future PD (relative risk [RR] = 1.37 [95%CI 1.21-1.55]; P < 0.0001). This association was confirmed by secondary analyses based on estimates derived after the exclusion of participants who had vascular disease at baseline and/or who developed vascular disease during follow-up (RR = 1.34 [1.14-1.58]; P < 0.001) and by sensitivity analyses addressing the association with diabetes at baseline or during follow-up. However, the association found for case-control studies was not significant (odds ratio [OR] 0.75 [95%CI 0.50-1.11]; P = 0.835). Sensitivity analysis based on estimates adjusted for BMI confirmed the lack of a relationship between PD and diabetes (OR 0.56 [0.28-1.15]; P = 0.089). CONCLUSIONS: Although data from cohort studies suggest that diabetes is a risk factor for PD, there is no conclusive evidence on this association. Further prospective studies focused on putative pathogenic pathways and taking a broad range of confounders into account is required to clarify this relationship.

2 Clinical Trial None 2017

Cilia, Roberto / Laguna, Janeth / Cassani, Erica / Cereda, Emanuele / Pozzi, Nicolò G / Isaias, Ioannis U / Contin, Manuela / Barichella, Michela / Pezzoli, Gianni. ·From the Parkinson Institute (R.C., E. Cassani, M.B., G.P.), ASST Gaetano Pini-CTO, Milan, Italy · Neurology Clinic (J.L.), Clinica Niño Jesus, Santa Cruz, Bolivia · Nutrition and Dietetics Service (E. Cereda), Fondazione IRCCS Policlinico San Matteo, Pavia · Department of Pathophysiology and Transplantation (N.G.P., I.U.I.), LAMB Pierfranco & Luisa Mariani, University of Milan, Italy · Department of Neurology (N.G.P., I.U.I.), University Hospital Würzburg and Julius-Maximilians-University, Würzburg, Germany · IRCCS-Institute of Neurological Sciences of Bologna (M.C.) · and Department of Biomedical and Neuromotor Sciences (M.C.), University of Bologna, Italy. ·Neurology · Pubmed #28679598.

ABSTRACT: OBJECTIVE: To investigate whether METHODS: We investigated efficacy and safety of single-dose intake of MP powder from roasted seeds obtained without any pharmacologic processing. Eighteen patients with advanced PD received the following treatments, whose sequence was randomized: (1) dispersible levodopa at 3.5 mg/kg combined with the dopa-decarboxylase inhibitor benserazide (LD+DDCI; the reference treatment); (2) high-dose MP (MP-Hd; 17.5 mg/kg); (3) low-dose MP (MP-Ld; 12.5 mg/kg); (4) pharmaceutical preparation of LD without DDCI (LD-DDCI; 17.5 mg/kg); (5) MP plus benserazide (MP+DDCI; 3.5 mg/kg); (6) placebo. Efficacy outcomes were the change in motor response at 90 and 180 minutes and the duration of on state. Safety measures included any adverse event (AE), changes in blood pressure and heart rate, and the severity of dyskinesias. RESULTS: When compared to LD+DDCI, MP-Ld showed similar motor response with fewer dyskinesias and AEs, while MP-Hd induced greater motor improvement at 90 and 180 minutes, longer ON duration, and fewer dyskinesias. MP-Hd induced less AEs than LD+DDCI and LD-DDCI. No differences in cardiovascular response were recorded. CONCLUSION: Single-dose MP intake met all noninferiority efficacy and safety outcome measures in comparison to dispersible levodopa/benserazide. Clinical effects of high-dose MP were similar to levodopa alone at the same dose, with a more favorable tolerability profile. CLINICALTRIALSGOV IDENTIFIER: NCT02680977.

3 Article α-Synuclein oligomers in skin biopsy of idiopathic and monozygotic twin patients with Parkinson's disease. 2020

Mazzetti, Samanta / Basellini, Milo J / Ferri, Valentina / Cassani, Erica / Cereda, Emanuele / Paolini, Matilde / Calogero, Alessandra M / Bolliri, Carlotta / De Leonardis, Mara / Sacilotto, Giorgio / Cilia, Roberto / Cappelletti, Graziella / Pezzoli, Gianni. ·Department of Biosciences, Università degli Studi di Milano, Milan, Italy. · Fondazione Grigioni per il Morbo di Parkinson, Milan, Italy. · Parkinson Institute, ASST 'Gaetano Pini-CTO', Milan, Italy. · Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Fondazione IRCCS Istituto Neurologico 'Carlo Besta', Milan, Italy. · Center of Excellence on Neurodegenerative Diseases, Università degli Studi di Milano, Milan, Italy. ·Brain · Pubmed #32025699.

ABSTRACT: A variety of cellular processes, including vesicle clustering in the presynaptic compartment, are impaired in Parkinson's disease and have been closely associated with α-synuclein oligomerization. Emerging evidence proves the existence of α-synuclein-related pathology in the peripheral nervous system, even though the presence of α-synuclein oligomers in situ in living patients remains poorly investigated. In this case-control study, we show previously undetected α-synuclein oligomers within synaptic terminals of autonomic fibres in skin biopsies by means of the proximity ligation assay and propose a procedure for their quantification (proximity ligation assay score). Our study revealed a significant increase in α-synuclein oligomers in consecutive patients with Parkinson's disease compared to consecutive healthy controls (P < 0.001). Proximity ligation assay score (threshold value > 96 using receiver operating characteristic) was found to have good sensitivity, specificity and positive predictive value (82%, 86% and 89%, respectively). Furthermore, to disclose the role of putative genetic predisposition in Parkinson's disease aetiology, we evaluated the differential accumulation of oligomers in a unique cohort of 19 monozygotic twins discordant for Parkinson's disease. The significant difference between patients and healthy subjects was confirmed in twins. Intriguingly, although no difference in median values was detected between consecutive healthy controls and healthy twins, the prevalence of healthy subjects positive for proximity ligation assay score was significantly greater in twins than in the consecutive cohort (47% versus 14%, P = 0.019). This suggests that genetic predisposition is important, but not sufficient, in the aetiology of the disease and strengthens the contribution of environmental factors. In conclusion, our data provide evidence that α-synuclein oligomers accumulate within synaptic terminals of autonomic fibres of the skin in Parkinson's disease for the first time. This finding endorses the hypothesis that α-synuclein oligomers could be used as a reliable diagnostic biomarker for Parkinson's disease. It also offers novel insights into the physiological and pathological roles of α-synuclein in the peripheral nervous system.

4 Article Muscle-targeted nutritional support for rehabilitation in patients with parkinsonian syndrome. 2019

Barichella, Michela / Cereda, Emanuele / Pinelli, Giovanna / Iorio, Laura / Caroli, Diana / Masiero, Irene / Ferri, Valentina / Cassani, Erica / Bolliri, Carlotta / Caronni, Serena / Maggio, Marcello / Ortelli, Paola / Ferrazzoli, Davide / Maras, Antonios / Riboldazzi, Giulio / Frazzitta, Giuseppe / Pezzoli, Gianni. ·From the Parkinson Institute (M.B., D.C., I.M., V.F., E.C., C.B., S.C., G. Pezzoli), ASST G.Pini-CTO, ex ICP, Milan · Clinical Nutrition and Dietetics Unit (E.C.), Fondazione IRCCS Policlinico San Matteo, Pavia · Dipartimento Riabilitazione Malattia di Parkinson e Disturbi del Movimento (G. Pinelli, P.O., D.F., G.F.), Ospedale Classificato Moriggia Pelascini di Gravedona · U.S. Riabilitazione Parkinson (L.I., A.M., G.R.), Fondazione Gaetano e Piera Borghi di Brebbia · and UOC Clinica Geriatrica (M.M.), Dipartimento Medico-Geriatrico-Riabilitativo, Università-Azienda Ospedaliero-Universitaria di Parma, Italy. ·Neurology · Pubmed #31278117.

ABSTRACT: OBJECTIVE: We evaluated the efficacy of muscle-targeted nutritional support on the functional outcomes of multidisciplinary intensive rehabilitation treatment (MIRT) in patients with Parkinson disease (PD) or parkinsonism. METHODS: We conducted a pragmatic, bicentric, randomized (1:1), assessor-blind controlled trial (Protein, Leucine and Vitamin D Enhancing Rehabilitation [PRO-LEADER]; April 2017 to January 2018) in cognitively intact patients with PD or parkinsonism and undergoing a 30-day MIRT. Patients (n = 150) received a standard hospital diet with or without a whey protein-based nutritional supplement enriched with leucine and vitamin D twice daily. The primary efficacy endpoint was the increase in the distance walked during a 6-minute walking test (6MWT). Secondary endpoints were changes in 4-meter walking speed, Timed Up and Go test (TUG), Berg balance scale, handgrip strength, Self-assessment Parkinson's Disease Disability Scale, body weight, and skeletal muscle mass (SMM). RESULTS: Nutritional support resulted in greater increase in the distance walked during 6MWT (mean 69.6 meters [95% confidence interval (CI) 60.7-78.6]) than no support (51.8 meters [95% CI 37.0-66.7]): center-adjusted mean difference, 18.1 meters (95% CI 0.9-35.3) ( CONCLUSION: The consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D with MIRT improved lower extremity function and preserved muscle mass in patients with PD or parkinsonism.Clinicaltrials.gov IDENTIFIER: NCT03124277. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with parkinsonism undergoing intensive rehabilitation, a whey protein-based nutritional formula enriched with leucine and vitamin D increased distance walked on the 6MWT.

5 Article Unraveling gut microbiota in Parkinson's disease and atypical parkinsonism. 2019

Barichella, Michela / Severgnini, Marco / Cilia, Roberto / Cassani, Erica / Bolliri, Carlotta / Caronni, Serena / Ferri, Valentina / Cancello, Raffaella / Ceccarani, Camilla / Faierman, Samanta / Pinelli, Giovanna / De Bellis, Gianluca / Zecca, Luigi / Cereda, Emanuele / Consolandi, Clarissa / Pezzoli, Gianni. ·Parkinson Institute, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-CTO, Milan, Italy. · Institute of Biomedical Technologies (IBT), Italian National Research Council (CNR), Milan, Italy. · IRCCS Istituto Auxologico Italiano, Obesity Research Laboratory, Milan, Italy. · Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy. · Department of Parkinson Disease Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Fondazione Europea Ricerca Biomedica (FERB), Gravedona, Italy. · Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY USA. · Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. ·Mov Disord · Pubmed #30576008.

ABSTRACT: BACKGROUND: Although several studies have suggested that abnormalities in gut microbiota may play a critical role in the pathogenesis of PD, data are still extremely heterogeneous. METHODS: 16S gene ribosomal RNA sequencing was performed on fecal samples of 350 individuals, subdivided into idiopathic PD (n = 193, of whom 39 were drug naïve) stratified by disease duration, PSP (n = 22), MSA (n = 22), and healthy controls (HC; n = 113). Several confounders were taken into account, including dietary habits. RESULTS: Despite the fact that unadjusted comparison of PD and HC showed several differences in relative taxa abundances, the significant results were greatly reduced after adjusting for confounders. Although most of these differences were associated with disease duration, lower abundance in Lachnospiraceae was the only difference between de novo PD and HC (remaining lower across almost all PD duration strata). Decreased Lachnospiraceae and increased Lactobacillaceae and Christensenellaceae were associated with a worse clinical profile, including higher frequencies of cognitive impairment, gait disturbances, and postural instability. When compared with HC, MSA and PSP patients shared the changes in PD, with a few exceptions: in MSA, Lachnospiraceae were not lower, and Prevotellaceae were reduced; in PSP, Lactobacillaceae were similar, and Streptococcaceae were reduced. CONCLUSIONS: Gut microbiota may be an environmental modulator of the pathogenesis of PD and contribute to the interindividual variability of clinical features. Data are influenced by PD duration and several confounders that need to be taken into account in future studies. Prospective studies in de novo PD patients are needed to elucidate the net effect of dysbiosis on the progression of the disease. © 2018 International Parkinson and Movement Disorder Society.

6 Article Daily intake of Mucuna pruriens in advanced Parkinson's disease: A 16-week, noninferiority, randomized, crossover, pilot study. 2018

Cilia, Roberto / Laguna, Janeth / Cassani, Erica / Cereda, Emanuele / Raspini, Benedetta / Barichella, Michela / Pezzoli, Gianni. ·Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy. Electronic address: roberto.cilia@gmail.com. · Neurology Clinic, Clinica Niño Jesus, Santa Cruz, Bolivia. · Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy. · Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. ·Parkinsonism Relat Disord · Pubmed #29352722.

ABSTRACT: BACKGROUND: Thousands of individuals with Parkinson's disease (PD) in low-income countries have limited access to marketed levodopa preparations. Mucuna pruriens (MP), a levodopa-containing leguminous plant growing in tropical areas, may be a sustainable alternative therapy for indigent patients. Single-dose intake of MP proved noninferior to marketed levodopa preparations. METHODS: Fourteen PD patients with motor fluctuations and dyskinesias received MP powder (obtained from roasted seeds) and marketed levodopa/carbidopa (LD/CD) in a randomized order and crossover design over a 16-week period. Efficacy measures were changes in quality of life, motor and non-motor symptoms, and time with good mobility without troublesome dyskinesias. Safety measures included tolerability, frequency of adverse events, changes in laboratory indices and electrocardiogram. RESULTS: Daily intake of MP was associated with a variable clinical response, especially in terms of tolerability. Seven patients (50%) discontinued MP prematurely due to either gastrointestinal side-effects (n = 4) or progressive worsening of motor performance (n = 3), while nobody discontinued during the LD/CD phase. In those who tolerated MP, clinical response to MP was similar to LD/CD on all efficacy outcome measures. Patients who dropped out entered a study extension using MP supernatant water (median[IQR], 16 [7-20] weeks), which was well tolerated. CONCLUSIONS: The overall benefit provided by MP on the clinical outcome was limited by tolerability issues, as one could expect by the relatively rapid switch from LD/CD to levodopa alone in advanced PD. Larger parallel-group studies are needed to identify appropriate MP formulation (e.g. supernatant water), titration scheme and maintenance dose to minimize side-effects in the long-term. CLINICAL TRIALS. GOV IDENTIFIER: NCT02680977.

7 Article Dietary habits in Parkinson's disease: Adherence to Mediterranean diet. 2017

Cassani, Erica / Barichella, Michela / Ferri, Valentina / Pinelli, Giovanna / Iorio, Laura / Bolliri, Carlotta / Caronni, Serena / Faierman, Samanta A / Mottolese, Antonia / Pusani, Chiara / Monajemi, Fatemeh / Pasqua, Marianna / Lubisco, Alessandro / Cereda, Emanuele / Frazzitta, Giuseppe / Petroni, Maria L / Pezzoli, Gianni. ·Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. Electronic address: erica.cassani@live.it. · Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. · Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy; Department of Parkinson Disease Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Fondazione Europea Ricerca Biomedica (FERB), Italy. · Department of Statistical Sciences "P. Fortunati", University of Bologna, Bologna, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Parkinson's disease and Brain Injury rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Como, Italy. · Scientific Coordinator of Osservatorio Grana Padano, Italy. ·Parkinsonism Relat Disord · Pubmed #28647435.

ABSTRACT: INTRODUCTION: Our objective is to describe the dietary habits, food preferences and adherence to Mediterranean diet (MeDi) of a large sample of Italian Parkinson's Disease (PD) patients compared to a group of controls. METHODS: Dietary habits of 600 PD patients from throughout Italy and 600 controls matched by gender, age, education, physical activity level and geographical residence, were collected using the ON-GP Food Frequency Questionnaire. Then, we compared patients by disease duration and the presence of swallowing disturbances. RESULTS: Overall, adherence of PD patients (males, 53.8%; mean disease duration, 9.2 ± 7.0 years) to MeDi was similar to controls (score, 4.8 ± 1.7 vs. 4.9 ± 1.6; P = 0.294). Patients consumed less alcohol and fish and drank significantly less water, coffee, and milk which resulted also in lower total fluids intake. On the contrary, they ate more fruit, cooked vegetables, cereals and baked items, more dressings and more sweets in general. Disease duration was associated with increased intake of several food groups but it was not associated with changes in MeDi score (P = 0.721). Patients with swallowing disturbances (n = 72) preferred softer and more viscous food but preferences did not result in differences in dietary pattern. However, patients with dysphagia drank less fluids (P = 0.043). DISCUSSION: PD patients presented different dietary habits and food preferences compared to the general population and adherence to MeDi was not associated with disease duration. Self-reported dysphagia was associated with reduced intake of fluids. These aspects may be amenable to change in order to improve the management of nutritional issues in this patient population.

8 Article Dietary habits and neurological features of Parkinson's disease patients: Implications for practice. 2017

Barichella, Michela / Cereda, Emanuele / Cassani, Erica / Pinelli, Giovanna / Iorio, Laura / Ferri, Valentina / Privitera, Giulia / Pasqua, Marianna / Valentino, Angela / Monajemi, Fatemeh / Caronni, Serena / Lignola, Caterina / Pusani, Chiara / Bolliri, Carlotta / Faierman, Samanta A / Lubisco, Alessandro / Frazzitta, Giuseppe / Petroni, Maria L / Pezzoli, Gianni. ·Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. · Department of Statistical Sciences "P. Fortunati", University of Bologna, Bologna, Italy. · Department of Parkinson Disease Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Fondazione Europea Ricerca Biomedica (FERB), "S.Isidoro" Hospital, Trescore Balneario, Italy. · Department of Functional Rehabilitation, "Sol et Salus" Hospital, Torre Pedrera, Rimini, Italy. ·Clin Nutr · Pubmed #27406858.

ABSTRACT: BACKGROUND & AIMS: Parkinson's disease (PD) patients can benefit considerably from appropriate nutritional care, particularly from diet. However, there is limited evidence on the eating habits of PD patients and their relationship with the features of the disease. METHODS: We conducted a large case-control study. Consecutive PD patients (N = 600) receiving systematic nutritional care and healthy controls (N = 600) matched (1:1) for age, gender, education, physical activity level and residence were studied using a 66-item food frequency questionnaire. The relationship between dietary habits and the following features of PD were investigated in patients: body weight, energy balance, constipation, and levodopa therapy (dose) and its related motor complications. RESULTS: PD patients had lower BMI and reported higher food intake than controls. BMI was found to be inversely associated with disease duration and severity, and levodopa-related motor complications, whereas energy intake was positively associated with these variables. An increase in protein intake by 10 g over physiological requirements (0.8 g/kg/day) corresponded to a mean increase in levodopa dose of 0.7 mg/kg/day. Constipation was also associated with higher levodopa requirements. Finally, protein intake and its distribution throughout the day influenced levodopa-related motor complications. CONCLUSION: The management of protein intake and the treatment of constipation should be considered to be an integral part of the care of PD patients. Attention should always be focused on energy intake also. This would result in the maintenance of nutritional status, the optimization of levodopa-therapy and the minimization of its related motor complications.

9 Article Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT. 2016

Barichella, Michela / Pacchetti, Claudio / Bolliri, Carlotta / Cassani, Erica / Iorio, Laura / Pusani, Chiara / Pinelli, Giovanna / Privitera, Giulia / Cesari, Ilaria / Faierman, Samanta Andrea / Caccialanza, Riccardo / Pezzoli, Gianni / Cereda, Emanuele. ·From the Parkinson Institute (M.B., C.B., E. Cassani, L.I., C. Pusani, G. Pinelli, G. Privitera, I.C., S.A.F., G. Pezzoli), ASST G. Pini-CTO, ex ICP, Milan · Parkinson and Movement Disorders Unit (C. Pacchetti), IRCCS Istituto Neurologico Mondino, Pavia · and Nutrition and Dietetics Service (R.C., E. Cereda), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. ·Neurology · Pubmed #27543643.

ABSTRACT: OBJECTIVES: Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation. METHODS: We conducted a tertiary setting, randomized, double-blind, placebo-controlled trial in patients with PD with Rome III-confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4. RESULTS: For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval [CI] 0.8-1.6) than placebo (0.1, 95% CI -0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4-1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics-prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1-5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8-8.1) during weeks 3 and 4. CONCLUSIONS: The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD. CLINICALTRIALSGOV IDENTIFIER: NCT02459717. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with PD who have constipation, fermented milk containing probiotics and prebiotics increases the frequency of CBMs.

10 Article Mucuna pruriens for Parkinson's disease: Low-cost preparation method, laboratory measures and pharmacokinetics profile. 2016

Cassani, Erica / Cilia, Roberto / Laguna, Janeth / Barichella, Michela / Contin, Manuela / Cereda, Emanuele / Isaias, Ioannis U / Sparvoli, Francesca / Akpalu, Albert / Budu, Kwabena Ofosu / Scarpa, Maria Teresa / Pezzoli, Gianni. ·Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. Electronic address: erica.cassani@live.it. · Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. · Neurology Clinic, Clinica Niño Jesus, Santa Cruz, Bolivia. · IRCCS-Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Pathophysiology and Transplantation, LAMB Pierfranco & Luisa Mariani, University of Milan, Milan, Italy. · Instituto di Biologia e Biotecnologia Agraria, CNR, Milan, Italy. · Korle Bu Teaching Hospital, Accra, Ghana. · Institute of Agricultural Research, College of Agriculture & Consumer Sciences, University of Ghana, Ghana. ·J Neurol Sci · Pubmed #27206902.

ABSTRACT: BACKGROUND: Parkinson's disease (PD) is a progressive neurological condition. Levodopa (LD) is the gold standard therapy for PD patients. Most PD patients in low-income areas cannot afford long-term daily Levodopa therapy. The aim of our study was to investigate if Mucuna pruriens (MP), a legume with high LD content that grows in tropical regions worldwide, might be potential alternative for poor PD patients. METHODS: We analyzed 25 samples of MP from Africa, Latin America and Asia. We measured the content in LD in various MP preparations (dried, roasted, boiled). LD pharmacokinetics and motor response were recorded in four PD patients, comparing MP vs. LD+Dopa-Decarboxylase Inhibitor (DDCI) formulations. RESULTS: Median LD concentration in dried MP seeds was 5.29%; similar results were obtained in roasted powder samples (5.3%), while boiling reduced LD content up to 70%. Compared to LD+DDCI, MP extract at similar LD dose provided less clinical benefit, with a 3.5-fold lower median AUC. CONCLUSION: Considering the lack of a DDCI, MP therapy may provide clinical benefit only when content of LD is at least 3.5-fold the standard LD+DDCI. If long-term MP proves to be safe and effective in controlled clinical trials, it may be a sustainable alternative therapy for PD in low-income countries.

11 Article Sarcopenia and Dynapenia in Patients With Parkinsonism. 2016

Barichella, Michela / Pinelli, Giovanna / Iorio, Laura / Cassani, Erica / Valentino, Angela / Pusani, Chiara / Ferri, Valentina / Bolliri, Carlotta / Pasqua, Marianna / Pezzoli, Gianni / Frazzitta, Giuseppe / Cereda, Emanuele. ·Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy. · Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy; Department of Brain Injury and Parkinson Disease, Rehabilitation "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Como, Italy. · Department of Brain Injury and Parkinson Disease, Rehabilitation "Moriggia-Pelascini" Hospital Gravedona ed Uniti, Como, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. ·J Am Med Dir Assoc · Pubmed #27143236.

ABSTRACT: OBJECTIVES: To estimate prevalence of sarcopenia and dynapenia in outpatients with Parkinson disease (PD) and to investigate their association with the features of the disease. DESIGN: Cross-sectional study. SETTING: A specialized tertiary care center. PARTICIPANTS: Consecutive patients (n = 364) aged 65 years or older, affected by parkinsonian syndromes. MEASUREMENTS: Skeletal muscle mass (SMM), as well as strength and gait speed (GS) were assessed by bioimpedence analysis, handgrip dynamometry, and the 4-meter walking test, respectively. Based on these assessments, sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Dynapenia was defined as handgrip strength less than 30 kg in men and less than 20 kg in women. RESULTS: In total, 235 patients (64.6%) had a diagnosis of idiopathic PD. Low SMM index was recorded in 27 patients. Due to gait disturbances and postural instability, GS could not be measured in 98 patients and was found to be reduced in 61.3% of those assessed. Prevalence of sarcopenia and dynapenia was 6.6% (95% confidence interval [CI] 4.3-9.7) and 75.5% (95% CI 70.8-79.9), respectively. Sarcopenia tended to be higher in patients unable to perform GS assessment and was unrelated to the type of parkinsonian syndrome. It was associated with older age, longer disease duration, more severe disease, and higher disability in activities of daily living, as assessed by disease-specific clinical rating scale. Dynapenia was directly associated with parkinsonism other than PD, older age, and disability, whereas regular physical therapy appeared to be a preventive factor. However, it was unrelated to disease duration and severity. Finally, the disability score of activities of daily living was inversely correlated with handgrip strength and GS, whereas no association was found with SMM index. CONCLUSION: Being primarily motor disorders, parkinsonian syndromes are characterized by progressive disability in performing activities of daily living. Impaired functional status is a prominent feature of this patient population, independently of disease duration and severity. Sarcopenia is mainly related to advancing disease and, due to a significant sparing of SMM, is an infrequent condition, likely to play a minor role in disability. Several factors could be responsible for this favorable body composition (eg, motor symptoms, levodopa therapy) and deserve further investigation. The prognostic impact of sarcopenia also needs to be addressed.

12 Article Dementia in Parkinson's disease: Is male gender a risk factor? 2016

Cereda, Emanuele / Cilia, Roberto / Klersy, Catherine / Siri, Chiara / Pozzi, Beatrice / Reali, Elisa / Colombo, Aurora / Zecchinelli, Anna Lena / Mariani, Claudio Bruno / Tesei, Silvana / Canesi, Margherita / Sacilotto, Giorgio / Meucci, Nicoletta / Zini, Michela / Isaias, Ioannis Ugo / Barichella, Michela / Cassani, Erica / Goldwurm, Stefano / Pezzoli, Gianni. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. · Parkinson Institute, ASST G.Pini - CTO, ex ICP, Milano, Italy. · Biometry and Statistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. ·Parkinsonism Relat Disord · Pubmed #26952697.

ABSTRACT: BACKGROUND: The rates of cognitive decline in patients with Parkinson's disease (PD) are higher than in the general population. Age and disease duration have been associated with increasing rates of dementia in PD. However, the role of other factors including gender has been poorly investigated. We investigated the relationship between dementia and gender along with other established risk factors, such as age and disease duration. METHODS: We conducted a cross-sectional retrospective study including all consecutive patients diagnosed with idiopathic PD attending a single out-patient tertiary clinic over an 18-year period (1995-2013). Dementia was diagnosed according to DSM-IV criteria. RESULTS: Prevalence of dementia was 11.5% (95%CI, 10.8-12.3) and 13.5% (95%CI, 12.7-14.5) in the whole population (N = 6599) and in those aged ≥60 years (N = 5373), respectively. Age and disease duration were independently associated with dementia, and the latter was associated with dementia up to 84 years of age. Male gender was an independent risk factor. In addition, while the rate of dementia increased in males over all age strata, we found that in females prevalence began to increase steadily after the age of 65 years, reaching male estimates only after 80 years of age. Higher rates in male gender were observed between 60 and 80 years of age. CONCLUSION: Age and PD duration are confirmed risk factors for dementia. However, disease duration appeared to be a less important factor in cognitive decline in patients aged ≥85 years. As opposed to gender-specific estimates in the general population, male gender is likely associated with higher rates of dementia in PD patients.

13 Article Increased urinary indoxyl sulfate (indican): new insights into gut dysbiosis in Parkinson's disease. 2015

Cassani, Erica / Barichella, Michela / Cancello, Raffaella / Cavanna, Ferruccio / Iorio, Laura / Cereda, Emanuele / Bolliri, Carlotta / Zampella Maria, Paola / Bianchi, Francesca / Cestaro, Benvenuto / Pezzoli, Gianni. ·Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy. Electronic address: erica.cassani@live.it. · Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy. · Istituto Auxologico Italiano, IRCCS, Milano, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Department of Biomedical and Clinical Sciences L. Sacco, School of Clinical Nutrition, Faculty of Medicine and Surgery-University of Milan, Milano, Italy. ·Parkinsonism Relat Disord · Pubmed #25707302.

ABSTRACT: INTRODUCTION: Changes in the composition of gut microflora have been associated with an increase in chronic diseases. Indican urinary concentration is one of the most common and easily assessable markers of intestinal dysbiosis. Little information is available on intestinal dysbiosis in Parkinson's disease (PD). We decided to investigate indican urinary concentrations in a cohort of PD patients. METHODS: A case-control study including PD patients (N = 68) on treatment with levodopa (PD) or on no pharmacological treatment (De Novo, DPD; N=34) and an age and gender-matched healthy control group (CTR; N=50). Main confounders, such as nutritional habits and constipation diagnosed according to Rome III criteria, were also investigated. RESULTS: Indican urinary concentrations were significantly higher in PD and DPD than in CTR (P < 0.001 and P < 0.01, respectively). In PD patients the concentrations were unrelated to the presence of constipation, whereas this symptom was associated with higher concentrations in controls (P=0.043). The frequency of dairy product consumption was also positively associated with increased concentrations (P=0.008). Predictors of indican concentrations were sought by multivariate linear regression analysis. The higher indican urinary concentrations found in both DPD (P=0.045) and PD (P=0.023) patients persisted after adjustment for age, gender, BMI, constipation and consumption of dairy products. CONCLUSIONS: Gut dysbiosis seems to be an important issue in PD, independently of the presence of constipation and starting from the early stages of the disease. The role of gut dysbiosis in the pathogenesis of PD deserves further investigation.

14 Article Swallowing disturbances in Parkinson's disease: a multivariate analysis of contributing factors. 2014

Cereda, Emanuele / Cilia, Roberto / Klersy, Catherine / Canesi, Margherita / Zecchinelli, Anna Lena / Mariani, Claudio Bruno / Tesei, Silvana / Sacilotto, Giorgio / Meucci, Nicoletta / Zini, Michela / Isaias, Ioannis Ugo / Cassani, Erica / Goldwurm, Stefano / Barichella, Michela / Pezzoli, Gianni. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. · Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy. · Biometry and Statistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. ·Parkinsonism Relat Disord · Pubmed #25456827.

ABSTRACT: BACKGROUND: Swallowing disturbances are an important issue in Parkinson's disease (PD) as several studies have shown that they are associated with increased risk of aspiration pneumonia and mortality. Information about factors related to swallowing disturbances, such as disease duration, age at assessment and concomitant dementia, is limited and would be useful for their management. METHODS: All consecutive PD out-patients evaluated at a movement disorders clinic over a 7-year period (2007-2014), were included in the present retrospective study. Presence of symptomatic swallowing disturbances was assessed using the specific item of the Non Motor Symptom Questionnaire. RESULTS: In the whole PD population (N = 6462), prevalence of symptomatic swallowing disturbances was 11.7% (95%CI, 10.9-12.5). Multivariable logistic regression analysis (adjusted for education) disclosed a significant interaction between disease duration and gender (P = 0.009). In both gender strata, swallowing disturbances were significantly associated with longer disease duration and dementia (P < 0.001 for all). A significant effect for age at assessment was also found in male patients. In non-demented patients, swallowing disturbances were associated with male gender, age and disease duration (P < 0.02 for all). In demented patients an association was found only with male gender (P = 0.018) and disease duration (P < 0.001). CONCLUSIONS: Gender, age, disease duration and dementia all seem to contribute to the occurrence of swallowing disturbances independently. However, the role played by these factors in sub-groups of patients stratified by gender and concomitant dementia suggests that swallowing disturbances are likely related to different neuro-degenerative patterns within the brain. The underlying mechanisms deserve further investigation.

15 Article Later age at onset in Parkinson's disease over twenty years in an Italian tertiary clinic. 2014

Pezzoli, Gianni / Klersy, Catherine / Cilia, Roberto / Canesi, Margherita / Zecchinelli, Anna Lena / Mariani, Claudio Bruno / Tesei, Silvana / Sacilotto, Giorgio / Meucci, Nicoletta / Zini, Michela / Isaias, Ioannis Ugo / Ruffmann, Claudio / Barichella, Michela / Cassani, Erica / Goldwurm, Stefano / Cereda, Emanuele. ·Parkinson Institute - Istituti Clinici di Perfezionamento, Milano, Italy. · Biometry and Statistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. · Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. ·Parkinsonism Relat Disord · Pubmed #25219972.

ABSTRACT: BACKGROUND: Age is considered an important risk factor for Parkinson's disease (PD). However, although life-expectancy has increased considerably, incidence rates of PD appeared to be stable over the last two decades. Accordingly, an increase in mean age at onset over time could be expected. We investigated the changes in age at onset in PD over the last two decades. METHODS: All consecutive PD patients assessed over a 18-year period (1995-2013) in a single tertiary outpatient clinic were included in the present retrospective cohort study. RESULTS: After adjusting for several confounders (gender, positive family history for PD, education, smoking at onset and past exposure to environmental/occupational pollutants), 5-year cohorts of year of disease onset were associated with increasing age at onset in both prevalent (N = 6996) and incident (N = 4172) cases (for trend, P < 0.001). From 1995-2000 to 2010-2013 there was an increase in predicted age of 4.1 years (95% CI, 3.0-5.2) and 3.9 years (95% CI, 2.7-5.1) in prevalent and incident cases, respectively. However, the change in predicted age at PD onset, across cohorts of year at onset, showed a steeper increase than the corresponding sex and cohort-matched mean age from the official Italian statistics. CONCLUSIONS: Over the last two decades, age at onset of PD appeared to shift progressively towards more advanced age. However, sequential, high-quality population-based incidence studies are required. To establish whether there is a trend towards increase in age at onset over and above general population ageing and to assess whether the increase is associated with improved medical and socio-economic conditions.

16 Article Cardiometabolic factors and disease duration in patients with Parkinson's disease. 2013

Cassani, Erica / Cereda, Emanuele / Barichella, Michela / Madio, Carmen / Cancello, Raffaella / Caccialanza, Riccardo / Zini, Michela / Cilia, Roberto / Pezzoli, Gianni. ·Parkinson Institute-Istituti Clinici di Perfezionamento, Milano, Italy. ·Nutrition · Pubmed #24035054.

ABSTRACT: OBJECTIVE: Previous studies have reported that patients with Parkinson's disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease. METHODS: One hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases. RESULTS: In sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = -0.20; P < 0.05) and BF% (r = -0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose-response effect of levodopa on metabolic risk factors was observed. CONCLUSIONS: HDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.

17 Article Reproductive factors and clinical features of Parkinson's disease. 2013

Cereda, Emanuele / Barichella, Michela / Cassani, Erica / Caccialanza, Riccardo / Pezzoli, Gianni. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it. ·Parkinsonism Relat Disord · Pubmed #23931933.

ABSTRACT: BACKGROUND: Literature suggests that sex steroid hormones may modify the risk for Parkinson's disease (PD). We investigated the potential effect of reproductive factors on the clinical features of idiopathic PD (IPD) patients. METHODS: All IPD female patients admitted to and evaluated at our Institute over a 12-month period were included in the present cross-sectional study. We investigated the effect of the following parameters by multivariate linear regression analysis: age at menarche, age at menopause, length of fertile life, duration of exposure to endogenous estrogens and cumulative length of pregnancies, use of contraceptives and hormonal replacement therapy. RESULTS: In total, 579 patients were evaluated and 497 reported menopause before PD onset. In this population, age at PD onset was positively associated with age at menarche and at menopause, length of fertile life and duration of estrogen exposure. Moreover, UPDRS motor score was inversely associated with age at menopause, length of fertile life and duration of estrogen exposure. Increasing age at menarche was also associated with predominant resting tremor at PD onset. In models refitted on patients with early PD (disease duration <5 years; N = 226) all the associations found were confirmed. The relationship between surrogates of estrogen exposure and UPDRS motor score actually became more significant. CONCLUSIONS: Our observations support the concept that hormonal exposure of the nigro-striatal network during life may influence its susceptibility to degenerative stimuli in later life, but the association does not seem to be unique? unidirectional. In particular, increased severity of PD signs correlates with shorter duration of estrogen exposure. The underlying mechanisms need to be clarified.

18 Article Nutritional status and dietary habits in Parkinson's disease patients in Ghana. 2013

Barichella, Michela / Akpalu, Albert / Cham, Momodou / Privitera, Giulia / Cassani, Erica / Cereda, Emanuele / Iorio, Laura / Cilia, Roberto / Bonetti, Alba / Pezzoli, Gianni. ·Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy. ·Nutrition · Pubmed #23312767.

ABSTRACT: OBJECTIVE: Dietary treatment is important for the management of Parkinson's disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country. METHODS: Fifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia). RESULTS: The mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively. CONCLUSION: This study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.

19 Article Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson's disease outpatients hospitalised on a scheduled basis. 2013

Barichella, Michela / Cereda, Emanuele / Madio, Carmen / Iorio, Laura / Pusani, Chiara / Cancello, Raffaella / Caccialanza, Riccardo / Pezzoli, Gianni / Cassani, Erica. ·Parkinson Institute, Istituti Clinici di Perfezionamento, via Bignami 1, 20126 Milan, Italy. ·Br J Nutr · Pubmed #23228187.

ABSTRACT: Dysautonomia symptoms of nutritional interest may often occur in Parkinson's disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Malnutrition Universal Screening Tool. Presence of dysautonomia symptoms (dysphagia, sialorrhoea and constipation) was investigated using clinical rating scales. In our population, prevalence of nutritional risk was 17·2 (95 % CI 12·1, 24·0) % and relied mainly on unintentional weight loss. Sialorrhoea, dysphagia, dysphagia to liquids and constipation were observed in 10·6, 11·0, 14·4 and 59·6 % of the patients, respectively. Nutritional risk was independently associated with the number of dysautonomia symptoms (OR 1·39 (95 % CI 1·00, 1·96); P= 0·048) but not with single symptoms. An independent association was also found with the severity of motor symptoms (Hoehn-Yahr stage, OR 1·48 (95 % CI 1·00, 2·55); P= 0·049) and levodopa dose (OR 1·16 (95 % CI 1·04, 1·31) mg/kg per d; P= 0·009). Nutritional risk in PD outpatients appears to depend mainly on dysautonomic syndrome, disease severity and levodopa dosage. Implications for outcome deserve further investigation. The assessment of nutritional status and of gastrointestinal dysautonomia symptoms should be part of the routine work-up of a PD patient.

20 Article The sleeve gastrectomy intervention to treat morbid obesity in a Parkinson's disease patient. 2013

Barichella, Michela / Cassani, Erica / Cancello, Raffaella / Zecchinelli, Anna / Faillace, Giuseppe / Moise, Gabriella / Zulian, Alessandra / Privitera, Giulia / Pezzoli, Gianni. ·Parkinson Institute, Istituti Clinici di Perfezionamento, via Bignami 1, 20126 Milan, Italy. ·Clin Nutr · Pubmed #22841399.

ABSTRACT: BACKGROUND & AIMS: Some Parkinson's disease patients may develop morbid obesity, on account of the reduction in exercise and/or of the appearance of compulsive food intake in the first years after diagnosis. The prescription of central appetite suppressants is actually not recommended in Parkinson's disease patients. To the best of our knowledge, no cases of morbidly obese Parkinson's disease patients submitted to bariatric surgery procedures have been reported in literature before. METHODS: We here describe for the first time the outcome of a sleeve gastrectomy intervention in a morbidly obese Parkinson's disease patient, resistant to several non-surgical weight-loss treatments. RESULTS: The outcome of the sleeve gastrectomy intervention was satisfactory in terms of body weight-loss, long term weight stabilization and improvement of cardioprotective circulating factors, including adiponectin. Furthermore, the antiparkinson therapy (levodopa) was reduced by 25%. CONCLUSIONS: These observations suggest that morbidly obese Parkinson's disease patients, who are resistant to other dietary treatments, might be candidated for sleeve gastrectomy.

21 Article Anthropometric indices of fat distribution and cardiometabolic risk in Parkinson's disease. 2013

Cereda, E / Cassani, E / Barichella, M / Caccialanza, R / Pezzoli, G. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. e.cereda@smatteo.pv.it ·Nutr Metab Cardiovasc Dis · Pubmed #21906920.

ABSTRACT: BACKGROUND & AIMS: To investigate the association between anthropometric indices of body fat distribution and cardiometabolic risk factors in a population of Parkinson's disease (PD) patients. METHODS & RESULTS: One hundred and fifty-seven PD patients (57.3% males) were studied measuring: waist circumference (WC), waist-hip ratio (WHR), waist-to-height ratio (WtHR), body fat percentage (BF%) by impedance, fasting glucose, serum lipids. Information was collected also on diabetes, hypertension and metabolic syndrome (MetS). Increased cardiometabolic risk was defined by ≥2 MetS component traits other than abdominal adiposity. In the whole population, prevalence of overweight and obesity were 35.0% and 19.2%, respectively. However, prevalence of MetS and elevated cardiometabolic risk were 14.6% and 18.5%, respectively. Prevalence was similar between genders, with one exception: adverse fat distribution according to WC and WHR was more common in females (P < 0.001). Using a multivariable model (adjustments: age, smoking status and disease duration), indices were highly correlated with BF% in both genders. WC and WtHR were associated with the number of MetS criteria and elevated risk. The only cardiometabolic parameters associated with anthropometric indices were HDL in men and triglycerides in women. After adjusting also for BMI all the associations found with anthropometric indices disappeared. CONCLUSIONS: Despite their correlation with BF%, anthropometric indices of body fat distribution appear to poorly account for the reduced cardiometabolic risk of the PD patient. This finding suggests a low metabolic activity within the adipose tissue. The implications of fat distribution on the cardiometabolic risk of PD patients clearly deserves further investigation.

22 Article Clinical features of Parkinson disease when onset of diabetes came first: A case-control study. 2012

Cereda, E / Barichella, M / Cassani, E / Caccialanza, R / Pezzoli, G. ·Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. e.cereda@smatteo.pv.it ·Neurology · Pubmed #22539572.

ABSTRACT: OBJECTIVE: Recent literature suggests that diabetes is a risk factor for Parkinson disease (PD). We investigated the clinical features of patients with idiopathic PD (IPD) in whom the onset of diabetes came first. METHODS: We designed a case-control study. From the cohort of all new patients with IPD free of vascular disease (n = 783) admitted and evaluated at our institute over a 3-year period (2007-2010), we included all the patients with a diagnosis of diabetes prior to PD onset (n = 89) and a control group (n = 89) matched (1:1) for gender, body mass index (± 1 kg/m(2)), and duration of PD (± 1 year). The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was the primary endpoint. RESULTS: At study entry, patients with diabetes were similar to controls in terms of most demographic, lifestyle, and general medical features with exception of statins (18% vs 3.4%; p = 0.003). However, diabetes was associated with higher UPDRS motor (22.3 ± 9.0 vs 19.3 ± 7.9; p = 0.019) and activities of daily living (9.7 ± 5.1 vs 8.3 ± 4.3; p = 0.049) scores, more severe Hoehn & Yahr staging (p = 0.009), and higher treatment doses of levodopa (mg/day, 448 ± 265 vs 300 ± 213; p < 0.0001; mg/kg/day, 5.8 ± 4.0 vs 3.8 ± 2.9; p < 0.0001). CONCLUSIONS: Onset of diabetes before the onset of PD appears to be a risk factor for more severe PD symptoms. These findings support the hypothesis that diabetes has a role in the etiopathogenesis of PD. Neurologists should be aware of the potential impact of diabetes on overall PD management.

23 Article Low cardiometabolic risk in Parkinson's disease is independent of nutritional status, body composition and fat distribution. 2012

Cereda, Emanuele / Cassani, Erica / Barichella, Michela / Spadafranca, Angela / Caccialanza, Riccardo / Bertoli, Simona / Battezzati, Alberto / Pezzoli, Gianni. ·Parkinson Institute, Istituti Clinici di Perfezionamento, Milano, Italy. e.cereda@smatteo.pv.it ·Clin Nutr · Pubmed #22402420.

ABSTRACT: BACKGROUND & AIMS: To investigate if the reduced cardiometabolic risk in Parkinson's disease (PD) is independent of nutritional status, body composition and fat distribution. METHODS: We designed a case-control study comparing 80 non underweight PD patients with 80 controls matched for sex, age and body mass index (BMI). Nutritional assessment included: anthropometry (BMI and waist circumference [WC]), body composition estimated by impedance and biochemistry (fasting glucose, serum lipids and transaminases). The presence of arterial hypertension, diabetes mellitus and metabolic syndrome (MetS) were noted. RESULTS: Compared to controls and independently of gender, PD patients showed lower percentage of body fat (P < 0.001) and biochemical parameters (glucose, P < 0.001; total cholesterol, P < 0.001; LDL, P < 0.001; triglycerides, P = 0.002; alanine aminotransferase, P < 0.001 and aspartate aminotransferase, P = 0.015) but similar WC (P = 0.324). The prevalence of hypertension and MetS was similar in the two groups, as well as the frequency and the number of MetS criteria. The relationship between PD and low cardiometabolic profile was independent of age, gender, current smoking and BMI. After adjusting for WC and body fat, most of the associations remained significant. CONCLUSIONS: PD patients seem to have a more favorable cardiometabolic risk profile, independently of nutritional status, body composition and fat distribution.

24 Article Increased levels of endothelial progenitor cells in Parkinson's disease. 2011

Cavanna, Ferruccio / Barichella, Michela / Cassani, Erica / Pezzoli, Gianni. ·Parkinson Institute, Istituti Clinici di Perfezionamento (ICP),Via Bignami 1, 20126 Milan, Italy. ·Parkinsonism Relat Disord · Pubmed #21664170.

ABSTRACT: -- No abstract --

25 Article Use of probiotics for the treatment of constipation in Parkinson's disease patients. 2011

Cassani, E / Privitera, G / Pezzoli, G / Pusani, C / Madio, C / Iorio, L / Barichella, M. ·Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy. erica.cassani@icp.mi.it ·Minerva Gastroenterol Dietol · Pubmed #21587143.

ABSTRACT: AIM: The aim of this paper was to assess the effects of milk fermented with the probiotic strain Lactobacillus casei Shirota on constipation in Parkinson's disease patients. Constipation is a common secondary symptom in patients suffering from Parkinson's Disease (PD), generally treated with dietary therapy, soluble fiber supplements and macrogol laxatives without sodium sulfate. There are no studies on the use of probiotics in the treatment of constipation in these patients. The effects of the administration of Lactobacillus casei Shirota on gastrointestinal symptoms have been assessed in two randomized controlled trials on patients suffering from chronic constipation. METHODS: Forty PD patients suffering from constipation according to Rome III criteria were recruited. We compared the characteristic of intestinal function during two periods with different treatments: in the first week the patients treated constipation only with dietetic therapy; in the following 5 weeks the patients treated constipation not only with dietetic therapy, but also taking a 65 mL fermented milk drink containing 6.5×109 CFU of Lactobacilus casei Shirota daily.They completed a daily diary for 6 weeks, recording details related to their intestinal function. RESULTS: After probiotic intake we observed a statistically significant increase in the number of days per week in which stools were of normal consistency (P<0.01) and significant reductions in the number of days per week in which patients felt bloated (P<0.01), experienced abdominal pain (P<0.01) and sensation of incomplete emptying (P<0.01). CONCLUSION: This pilot study showed that a regular intake of probiotics can significantly improve stool consistency and bowel habits in Parkinson's disease patients.

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