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Parkinson Disease: HELP
Articles by Andrew H. Evans
Based on 35 articles published since 2010
(Why 35 articles?)
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Between 2010 and 2020, Andrew Evans wrote the following 35 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience. 2020

Fasano, Alfonso / Antonini, Angelo / Katzenschlager, Regina / Krack, Paul / Odin, Per / Evans, Andrew H / Foltynie, Thomas / Volkmann, Jens / Merello, Marcelo. ·Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, Division of Neurology University of Toronto Toronto Ontario Canada. · Krembil Brain Institute Toronto Ontario Canada. · The Center for Advancing Neurotechnological Innovation to Application Toronto Ontario Canada. · Department of Neuroscience University of Padua Padua Italy. · Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders Donauspital Vienna Austria. · Department of Neurology, Center for Parkinson's Disease and Movement Disorders Inselspital, Bern University Hospital, University of Bern Bern Switzerland. · Division of Neurology, Department of Clinical Sciences Lund Lund University Lund Sweden. · Department of Neurology the Royal Melbourne Hospital Victoria Australia. · Department of Clinical & Movement Neurosciences University College London Institute of Neurology, Queen Square London United Kingdom. · Neurologischen Klinik Universitätsklinikum Würzburg Würzburg Germany. · Movement Disorders Section Fleni Buenos Aires Argentina. · Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina. ·Mov Disord Clin Pract · Pubmed #32373652.

ABSTRACT: Background: Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19. Objective: To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. Conclusion: Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.

2 Review Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations. 2019

Evans, Andrew H / Okai, David / Weintraub, Daniel / Lim, Shen-Yang / O'Sullivan, Sean S / Voon, Valerie / Krack, Paul / Sampaio, Cristina / Post, Bart / Leentjens, Albert F G / Martinez-Martin, Pablo / Stebbins, Glenn T / Goetz, Christopher G / Schrag, Anette / Anonymous961129. ·Department of Neurology, the Royal Melbourne Hospital, Parkville, Australia. · Kings College London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, London, UK. · Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (Philadelphia Parkinson's Disease Research, Education and Clinical Center (PADRECC) and Mental Illness Research Education Clinical, Centers of Excellence (MIRECC)), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. · Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Department of Neurology, Bon Secours Hospital, Cork, Ireland. · Department of Psychiatry, University of Cambridge, Cambridge, UK. · Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern Switzerland. · Cure Huntington's Disease InitiativeEl (CHDI) Management/CHDI Foundation, Princeton, New Jersey, USA. · Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. · Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands. · National Center of Epidemiology and Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain. · Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA. · Department of Clinical Neurosciences, Institute of Neurology, University College London, London, UK. ·Mov Disord · Pubmed #31136681.

ABSTRACT: Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.

3 Review Practical approaches to commencing device-assisted therapies for Parkinson disease in Australia. 2017

Williams, David R / Evans, Andrew H / Fung, Victor S C / Hayes, Michael / Iansek, Robert / Kimber, Thomas / O'Sullivan, John D / Sue, Carolyn M. ·Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia. · Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. · Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. · Department of Neuroscience, Concord Hospital, Sydney, New South Wales, Australia. · CRC for Movement Disorders and Gait Kingston Centre Monash Health, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia. · Neurology Unit, Royal Adelaide Hospital, Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia. · School of Medicine, University of Queensland, Brisbane, Queensland, Australia. · Department of Neurology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia. ·Intern Med J · Pubmed #28195385.

ABSTRACT: In Australia 1% of individuals aged over 50 years have Parkinson disease (PD). Guidance for commencing device-assisted therapies (DAT) for PD in Australia was developed based on a review of European recommendations and their relevance to the local clinical setting. An online survey and teleconference discussions were held by a group of eight local movement disorder experts to develop consensus. Referral to a movement disorder specialist and consideration of DAT is appropriate when motor fluctuations cause disability or reduced quality of life, response to treatment is inconsistent or motor fluctuations and dyskinesias require frequent treatment adjustment without apparent benefit and levodopa is required four or more times daily. Three types of DAT are available in Australia for patients with PD: continuous subcutaneous apomorphine; continuous levodopa-carbidopa intestinal gel infusion; and deep brain stimulation. All improve consistency of motor response. The most important aspects when considering which DAT to use are the preferences of the patient and their carers, patient comorbidities, age, cognitive function and neuropsychiatric status. Patients and their families need to be provided with treatment options that are suitable to them, with adequate explanations regarding the recommendations and comparison of potential device-related complications. DAT are best managed, where possible, in a specialist centre with experience in all three types of therapy. Proactive and early management of symptoms during disease progression is essential to maintain optimally motor responses and quality of life in patients with PD.

4 Review Integrating Patient Concerns into Parkinson's Disease Management. 2017

Lim, Shen-Yang / Tan, Ai Huey / Fox, Susan H / Evans, Andrew H / Low, Soon Chai. ·Division of Neurology, University of Malaya, Kuala Lumpur, Malaysia. limshenyang@ymail.com. · Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia. limshenyang@ymail.com. · Division of Neurology, University of Malaya, Kuala Lumpur, Malaysia. · Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, University of Malaya, Kuala Lumpur, Malaysia. · Movement Disorder Clinic, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada. · Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia. ·Curr Neurol Neurosci Rep · Pubmed #28102483.

ABSTRACT: Parkinson's disease (PD) is a complex motor and non-motor disorder and management is often challenging. In this review, we explore emerging approaches to improve the care of patients, drawing from the literature regarding patient-centred care, patient and caregiver perspectives and priorities, gaps in knowledge among patients and caregivers and the need for accurate information, individual variability in disease manifestations, prognostication of disease course, new developments in health technologies and personalized medicine, specialty care, pharmacological and non-pharmacological management, financial burden, lifestyle and work-related issues, support groups and palliative care.

5 Review The efficacy of apomorphine - A non-motor perspective. 2016

Rosa-Grilo, Miguel / Qamar, Mubasher A / Evans, Andrew / Chaudhuri, K Ray. ·National Parkinson Foundation (NPF) International Center of Excellence at King's College Hospital, London, UK; Dept. Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychology, Psychiatry and Neurosciences, King's College London, UK. Electronic address: miguel.grilo@kcl.ac.uk. · Dept. Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychology, Psychiatry and Neurosciences, King's College London, UK. · Royal Melbourne Hospital, Melbourne, Australia. · National Parkinson Foundation (NPF) International Center of Excellence at King's College Hospital, London, UK; Dept. Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychology, Psychiatry and Neurosciences, King's College London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, Institute of Psychology, Psychiatry and Neurosciences, King's College London, UK. ·Parkinsonism Relat Disord · Pubmed #27939325.

ABSTRACT: Non-motor features have a great impact on progression and quality of life in individuals with Parkinson's disease. Current treatments for PD are limited and apomorphine is one of the advanced therapies available with advantageous effects on motor complications. Several studies have suggested that apomorphine has potential benefits in PD patients beyond its established role in the treatment of motor fluctuations and levodopa-induced dyskinesia. This review examines the efficacy of apomorphine in the treatment of non-motor symptoms (NMS), describing recent studies that highlight its possible effect on cognition. Despite a limited number of studies, the available evidence shows that apomorphine has an overall beneficial effect on NMS of PD patients, including neuropsychiatric symptoms, sleep disturbances, pain, urinary dysfunction, and impulse control disorders. If the effects of apomorphine on amyloid deposition are confirmed in the future, its place in the armamentarium of PD treatment could see a shift towards younger and non-demented PD patients.

6 Review Neuropsychiatric manifestations of Parkinson's disease. 2016

Molina Ruiz, Rosa M / Evans, Andrew H / Velakoulis, Dennis / Looi, Jeffrey Cl. ·Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain rmolinar@salud.madrid.org. · Head, Movement Disorders Program, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia. · Professor and Clinical Director, Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, Australia. · Clinical Associate Professor, Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, and; Associate Professor and Deputy Head, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia. ·Australas Psychiatry · Pubmed #27456351.

ABSTRACT: OBJECTIVE: This clinical update review focuses on the classification and description of common neuropsychiatric manifestations in Parkinson's disease (PD). METHOD: We conducted a systematic search of the literature using Pubmed and selected the most recent and relevant papers for this review. RESULTS: Neuropsychiatric manifestations in PD are are very frequent and may arise from an abnormal psychopathological response to the disease, neurobiological changes related to the disease itself, complications of treatments or a combination of all of these. CONCLUSIONS: Neuropsychiatric symptoms may precede the motor clinical presentation of PD. Early recognition is essential.

7 Review A guide to management of neuropsychiatric manifestations of Parkinson's disease. 2016

Molina Ruiz, Rosa M / Evans, Andrew H / Velakoulis, Dennis / Looi, Jeffrey Cl. ·Universitary Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain rmolinar@salud.madrid.org. · Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia. · Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, Australia. · Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, University of Melbourne & Northwestern Mental Health, Melbourne, VIC, and; Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Garran, ACT, Australia. ·Australas Psychiatry · Pubmed #27329643.

ABSTRACT: OBJECTIVE: This clinical update review focuses on treatment approaches of neuropsychiatric manifestations in Parkinson's disease. METHODS: We conducted a systematic search of the literature using Pubmed and selected recent and relevant papers for this review. RESULTS: Neuropsychiatric symptoms in Parkinson's disease usually require optimization of levodopa therapy as a first step. Most psychotropic drugs can be used in Parkinson's disease, however there is still lack of an evidence base due to limited studies and difficulties in diagnosis of neuropsychiatric disorders. Non-pharmacological treatments have also proved effective in Parkinson's disease. Cognitive impairment requires special consideration. CONCLUSIONS: Management of neuropsychiatric manifestations in Parkinson's disease is complicated by the lack of evidence. Treatment should be individualized and benefits and risks must be balanced.

8 Review Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease--Clinical practice recommendations. 2015

Trenkwalder, Claudia / Chaudhuri, K Ray / García Ruiz, Pedro J / LeWitt, Peter / Katzenschlager, Regina / Sixel-Döring, Friederike / Henriksen, Tove / Sesar, Ángel / Poewe, Werner / Anonymous6190836 / Baker, Mary / Ceballos-Baumann, Andres / Deuschl, Günther / Drapier, Sophie / Ebersbach, Georg / Evans, Andrew / Fernandez, Hubert / Isaacson, Stuart / van Laar, Teus / Lees, Andrew / Lewis, Simon / Martínez Castrillo, Juan Carlos / Martinez-Martin, Pablo / Odin, Per / O'Sullivan, John / Tagaris, Georgios / Wenzel, Karoline. ·Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurosurgery, University Medical Centre, Goettingen, Germany. Electronic address: trenkwalder@pk-mx.de. · National Parkinson Foundation Centre of Excellence, Kings College Hospital, Denmark Hill Campus, London, UK. · Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Madrid, Spain. · Wayne State University School of Medicine, Parkinson's Disease and Movement Disorders Program, Henry Ford West Bloomfield Hospital, West Bloomfield, MI, USA. · Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Danube Hospital, Vienna, Austria. · Centre of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany; Department of Neurology, Philipps-University, Marburg, Germany. · Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark. · Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain. · Department of Neurology, Medical University of Innsbruck, Austria. ·Parkinsonism Relat Disord · Pubmed #26189414.

ABSTRACT: Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical practice. This document outlines best-practice recommendations for selecting appropriate candidates for apomorphine intermittent injection (the pen-injection formulation) or apomorphine continuous infusion (the pump formulation), for initiating patients onto therapy and for managing their ongoing treatment. Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose 'off' periods can no longer be adequately controlled by standard oral PD treatment or for those in whom rescue doses of apomorphine injection are effective but either needed too frequently (more than 4-6 times per day), or are associated with increasing dyskinesia. In addition to treating motor fluctuations, there is evidence that apomorphine infusion may be effective for the management of specific non-motor symptoms of PD associated with 'off' periods. Apomorphine infusion is less invasive than other non-oral treatment options for advancing disease, intrajejunal levodopa infusion and deep-brain stimulation.

9 Review Clinical spectrum of impulse control disorders in Parkinson's disease. 2015

Weintraub, Daniel / David, Anthony S / Evans, Andrew H / Grant, Jon E / Stacy, Mark. ·Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. ·Mov Disord · Pubmed #25370355.

ABSTRACT: Impulse control disorders (ICDs), including compulsive gambling, buying, sexual behavior, and eating, are a serious and increasingly recognized psychiatric complication in Parkinson's disease (PD). Other impulsive-compulsive behaviors (ICBs) have been described in PD, including punding (stereotyped, repetitive, purposeless behaviors) and dopamine dysregulation syndrome (DDS; compulsive PD medication overuse). ICDs have been most closely related to the use of dopamine agonists (DAs), perhaps more so at higher doses; in contrast, DDS is primarily associated with shorter-acting, higher-potency dopaminergic medications, such as apomorphine and levodopa. Possible risk factors for ICDs include male sex, younger age and younger age at PD onset, a pre-PD history of ICDs, and a personal or family history of substance abuse, bipolar disorder, or gambling problems. Given the paucity of treatment options and potentially serious consequences, it is critical for PD patients to be monitored closely for development of ICDs as part of routine clinical care.

10 Review Dopamine agonist-induced substance addiction: the next piece of the puzzle. 2011

Evans, Andrew. ·Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. Andrew.Evans@mh.org.au ·J Clin Neurosci · Pubmed #20980151.

ABSTRACT: Traditional antiparkinson treatment strategies strive to balance the antiparkinson effects of dopaminergic drugs with the avoidance of motor response complications. Dopamine agonists have an established role in delaying the emergence of motor response complications or reducing motor "off" periods. The recent recognition of a range of "behavioural addictions" that are linked to dopamine agonist use has highlighted the role of dopamine in brain reward function and addiction disorders in general. Dopamine agonists have now even been linked occasionally to new substance addictions. The challenge now for the Parkinsonologist is to also balance the net benefits of using dopamine agonists for their motor effects with avoiding the harm from behavioural compulsions.

11 Article Parkinson disease: A systemic review of pain sensitivities and its association with clinical pain and response to dopaminergic stimulation. 2018

Sung, Simon / Vijiaratnam, Nirosen / Chan, Daniela Wan Chi / Farrell, Michael / Evans, Andrew H. ·Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia. · Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia. · Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC 3220, Australia. · Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, VIC 3800, Australia. · Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia. Electronic address: Andrew.evans@mh.org.au. ·J Neurol Sci · Pubmed #30401469.

ABSTRACT: Patients with Parkinson disease (PD) experience hyperalgesia on evoked pain sensitivity testing, although the relationship of this with persistent pain in PD is less certain. Studies examining this have generated contradictory findings. Further, the role of dopaminergic deficiency as an underlying substrate for hyperalgesia is controversial. We report the results of meta-analyses of the PD pain sensitivity literature in an attempt to answer these questions. We identified 429 records, of which ten articles compared pain sensitivity between PD patients that experienced clinical pain (PDP) to those who did not (PDNP), and twenty studies that examined the effect of dopaminergic medications on pain sensitivity in PD patients. PDP patients experienced a moderate increase in pain sensitivity, had more severe disease, required higher dosages of medication, and were more likely to be female when compared to those PDNP patients. PD patients also had reduced pain sensitivity when tested on dopaminergic medications compared to when they were not on medications. Overall, the results of this systematic review and meta-analysis supports the hypothesis that hyperalgesia contributes to clinical pain in PD, and that the underlying mechanism may be dopaminergically driven.

12 Article Feasibility of Smartphone-Based Testing of Interference in Parkinson's Disease. 2018

Lee, Will / Williams, David R / Evans, Andrew. ·Department of Neuroscience, The Alfred Hospital, Melbourne, Victoria, Australia. · Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia. · Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. ·Neurodegener Dis · Pubmed #29940579.

ABSTRACT: BACKGROUND: Interference refers to learned associations and established behaviors "interfering" with response to new material. It forms a core pillar of executive functions, which are commonly affected in Parkinson's disease (PD). Cognitive interference test (CIT) forms part of a smartphone application designed for ambulatory assessment in PD. OBJECTIVE: The aims of this study were to establish that CIT could effectively demonstrate interference and would perform comparably to the Stroop Color-Word Test Victoria version (VST) despite PD-related motor impairment. METHODS: Ninety-nine patients with PD were recruited. Initial evaluation included CIT, VST, Montreal cognitive assessment (MOCA), and Movement Disorders Society-sponsored revision of the -Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III). A group of patients underwent repeat assessment within 2 weeks. Thirty-four healthy controls were recruited for comparison. RESULTS: Patients' mean age was 66.2 years, disease duration was 8.7 years, on-state MDS-UPDRS-III was 22, and MOCA total score was 27. CIT effectively generated interference, whereby the total time taken to complete the incongruent task was 20% longer compared to that of the baseline task. CIT key test items demonstrated convergent validity to VST (r = 0.478-0.644, p < 0.0001) and satisfactory repeatability (intraclass correlation coefficient 0.46-0.808, p ≤ 0.0002). Performance on key CIT test parameters deteriorated with increasing age (r = 0.225-0.478, p < 0.01) and MDS-UPDRS-III total score (r = 0.354-0.481, p < 0.0001). When compared to controls and patients with less motor impairment, patients MDS-UPDRS-III > 30 took longer to complete CIT and VST and had lower MOCA-attention sub-score, implying that the degree of motor impairment could not be the sole explanation for reduced CIT performance. CONCLUSIONS: We established that despite motor impairment, the novel approach of using smartphone technology to test interference in PD patients is feasible.

13 Article Novel Approach to Stem Cell Therapy in Parkinson's Disease. 2018

Garitaonandia, Ibon / Gonzalez, Rodolfo / Sherman, Glenn / Semechkin, Andrey / Evans, Andrew / Kern, Russell. ·1 International Stem Cell Corporation , Carlsbad, California. · 2 Royal Melbourne Hospital , Parkville, Australia . · 3 Cyto Therapeutics , Melbourne, Australia . ·Stem Cells Dev · Pubmed #29882481.

ABSTRACT: In this commentary we discuss International Stem Cell Corporation's (ISCO's) approach to developing a pluripotent stem cell based treatment for Parkinson's disease (PD). In 2016, ISCO received approval to conduct the world's first clinical study of a pluripotent stem cell based therapy for PD. The Australian regulatory agency Therapeutic Goods Administration (TGA) and the Melbourne Health's Human Research Ethics Committee (HREC) independently reviewed ISCO's extensive preclinical data and granted approval for the evaluation of a novel human parthenogenetic derived neural stem cell (NSC) line, ISC-hpNSC, in a PD phase 1 clinical trial ( ClinicalTrials.gov NCT02452723). This is a single-center, open label, dose escalating 12-month study with a 5-year follow-up evaluating a number of objective and patient-reported safety and efficacy measures. A total of 6 years of safety and efficacy data will be collected from each patient. Twelve participants are recruited in this study with four participants per single dose cohort of 30, 50, and 70 million ISC-hpNSC. The grafts are placed bilaterally in the caudate nucleus, putamen, and substantia nigra by magnetic resonance imaging-guided stereotactic surgery. Participants are 30-70 years old with idiopathic PD ≤13 years duration and unified PD rating scale motor score (Part III) in the "OFF" state ≤49. This trial is fully funded by ISCO with no economic involvement from the patients. It is worth noting that ISCO underwent an exhaustive review process and successfully answered the very comprehensive, detailed, and specific questions posed by the TGA and HREC. The regulatory/ethic review process is based on applying scientific and clinical expertise to decision-making, to ensure that the benefits to consumers outweigh any risks associated with the use of medicines or novel therapies.

14 Article Neurocognitive correlates of medication-induced addictive behaviours in Parkinson's disease: A systematic review. 2018

Dawson, Andrew / Dissanayaka, Nadeeka N / Evans, Andrew / Verdejo-Garcia, Antonio / Chong, Trevor T J / Frazzitta, Giuseppe / Ferrazzoli, Davide / Ortelli, Paola / Yücel, Murat / Carter, Adrian. ·Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia. · University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia; School of Psychology, The University of Queensland, St. Lucia, Queensland 4029, Australia. · The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. · Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy. · Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia. ·Eur Neuropsychopharmacol · Pubmed #29653742.

ABSTRACT: Dopaminergic medication can induce severe addictive behaviours (e.g., pathological gambling) in susceptible Parkinson's disease (PD) patients. It is still unknown which particular neurocognitive processes become exacerbated or dysfunctional in PD patients with addictive behaviours. We sought to systematically review the relevant literature to identity potential neurocognitive correlates of medication-induced addictive behaviours in PD. We framed our review around neurocognitive processes central to four dominant accounts of substance addiction: 'aberrant learning', 'incentive sensitization', 'impulsivity to compulsivity' and 'impaired response inhibition and salience attribution'. Searches of the PubMed and Scopus databases were completed on June 23, 2017. To be included, studies were required to involve: (a) medicated PD patients, without a history of deep brain stimulation, with and without addictive behaviours; (b) a reward-related or decision-making task; and (c) statistical comparison of addictive and non-addictive groups' 'on' medication performance on the task(s). Studies were summarised qualitatively with statistically significant (p<.05) group differences and effect sizes (Cohen's d) highlighted. 35 studies were included. Findings showed that the extant literature is highly heterogeneous. The domains of reward and punishment learning, reflection impulsivity and disadvantageous decision-making exemplify this. More homogeneity exists in domains in which (a) neurocognitive dysfunction is not apparent (motor control, cognitive/attentional flexibility and cognitive control) or (b) typical neurocognitive processes appear exacerbated by medication (reward motivation and choice impulsivity). Future large-scale neurocognitive studies are still required to develop our scientific understanding of addictive behaviours in PD and aid their clinical treatment and prediction.

15 Article Pain sensitivity in Parkinson's disease: Systematic review and meta-analysis. 2018

Sung, Simon / Vijiaratnam, Nirosen / Chan, Daniela Wan Chi / Farrell, Michael / Evans, Andrew H. ·Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia. Electronic address: sungsta@hotmail.com. · Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia. · Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC, 3220, Australia. · Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, Victoria 3800, Australia. · Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia. ·Parkinsonism Relat Disord · Pubmed #29398491.

ABSTRACT: INTRODUCTION: Pain is a common and disabling non-motor symptom of Idiopathic Parkinson's disease (PD) but its underlying pathophysiological mechanisms are not well understood. There is evidence to suggest that altered pain sensitivity may contribute to the experience of pain in PD patients, but clinical studies investigating this have yielded inconsistent results. OBJECTIVES: To examine whether pain thresholds are altered in PD patients compared to normal healthy controls (HC), via the use of systematic review and meta-analysis. DATA SOURCES: A systematic search of the MEDLINE and EMBASE library from 1966 to April 2015. STUDY SELECTION: Studies that compared pain thresholds in PD patients versus HC were included in the systematic review. Additionally, data comparing PD patients off dopaminergic medications (PD MAIN OUTCOMES: Heat pain threshold, cold pain threshold, electrical pain threshold, nociceptive withdrawal reflex threshold, pressure pain threshold, and pain ratings. RESULTS: 22 studies were reviewed, comprising of 616 PD and 451 HC. In the comparison of PD CONCLUSION: PD patients are more sensitive to noxious stimuli compared to HC when tested in the off medication state. This increase in pain sensitivity is observed across all modalities, but is not as apparent when PD patients are administered Levodopa, suggesting that dopamine deficient states may contribute to hyperalgesia. However, it remains to be seen whether or not increased pain sensitivity translates clinically into increased prevalence of pain. Similarly, it is unclear if dopaminergic medications influence pain sensitivity. Performing a meta-analysis on studies comparing pain thresholds in PD patients with and without pain, and on and off dopaminergic medications, may draw more definitive conclusions in this regard.

16 Article Objective Measurement and Characterization of Sleep Benefit in Parkinson's Disease. 2017

Lee, Will / Evans, Andrew H / Williams, David R. ·Neuroscience Department The Alfred Hospital Melbourne Victoria Australia. · Van Cleef Roet Centre for Nervous Diseases Monash University The Alfred Hospital Melbourne Victoria Australia. · Neurology Department The Royal Melbourne Hospital Parkville Victoria Australia. ·Mov Disord Clin Pract · Pubmed #30363502.

ABSTRACT: Background: Sleep benefit (SB) in Parkinson's disease refers to improved motor symptoms upon waking despite an entire night without medications. Although it was first proposed 30 years ago, this phenomenon proved difficult to investigate, and its true prevalence and underlying mechanisms remain unclear. Objective: This study aimed to identify and quantify SB through measurement of motor function using a validated smartphone application and to identify disease characteristics that predicted SB. Methods: Ninety-two patients recruited from 2 Movement Disorder Services were clinically assessed at home using a validated smartphone application. Each patient was tested in the on-state, at the end of dose, and on waking (before medications) 3 times. Differences between the 3 states were used to determine the impact of sleep and levodopa on motor function. SB was considered to be a "measurable improvement in parkinsonism from the end of dose." Results: The morning waking motor function of 20 patients (22%) improved compared with the end-of-dose function, with 9 patients demonstrating superior function compared with their on-state. No clinical features predicted SB. Although all participants subjectively reported motor fluctuations, only 35 patients (38%) demonstrated an objective improvement with levodopa. Patients who had SB more often demonstrated objective motor fluctuations compared with those who did not (65% vs. 31%; Conclusions: SB is a genuine motor phenomenon: 1 in 5 patients have a measurable improvement in motor function on waking. It remains questionable whether this improvement is a direct effect of sleep. Until its underlying mechanism is better understood, it is more appropriate to refer to this phenomenon as simply morning improvement or diurnal fluctuation of motor symptoms.

17 Article Subjective perception of sleep benefit in Parkinson's disease: Valid or irrelevant? 2017

Lee, Will / Evans, Andrew / Williams, David R. ·Neuroscience Department, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, Victoria 3004, Australia. · Neurology Department, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. · Neuroscience Department, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, Victoria 3004, Australia. Electronic address: david.williams@monash.edu. ·Parkinsonism Relat Disord · Pubmed #28688983.

ABSTRACT: INTRODUCTION: The phenomenon of sleep benefit (SB) in Parkinson's disease (PD), whereby waking motor function is improved despite no dopaminergic treatment overnight, is controversial. Previous studies suggested a significant discrepancy between subjective functional and objective motor improvement. The aim of this study was to determine how well subjective reporting of SB correlates with objective measures and if true motor improvement can be predicted by a standardized questionnaire. METHODS: Ninety-two patients with PD participated. A structured questionnaire was developed to assess subjective SB. Quantitative motor assessment was performed using a validated smartphone application. Objective motor SB was considered to be present when the waking motor function was similar or superior to the daytime on-state. RESULTS: Twenty (22%) patients showed objective motor improvement on waking compared to end-of-dose. Most patients (77%) reported subjective SB without corresponding objective motor benefit. Our structured questionnaire could not predict Motor SB. The ability to delay morning medications and a perception of indifference or paradoxical worsening following the morning levodopa dose may suggest Motor SB. CONCLUSIONS: Most patients experience subjective SB with no measureable motor improvement. This perceived benefit could be related to non-motor improvement that is distinctly different to objective motor benefit.

18 Article A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. 2017

Morris, Meg E / Taylor, Nicholas F / Watts, Jennifer J / Evans, Andrew / Horne, Malcolm / Kempster, Peter / Danoudis, Mary / McGinley, Jennifer / Martin, Clarissa / Menz, Hylton B. ·La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University; Northpark Private Hospital (Healthscope). · La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health. · Centre for Population Health Research, Faculty of Health, Deakin University. · The University of Melbourne. · Florey Institute for Neurosciences and Mental Health; Department of Medicine, University of Melbourne. · Neurosciences Department, Monash Health; Department of Medicine, Monash University. · La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University. · Physiotherapy Department, The University of Melbourne. · Physiotherapy Department, Monash University, Melbourne, Australia. ·J Physiother · Pubmed #28342682.

ABSTRACT: QUESTIONS: For people with idiopathic Parkinson's disease, does a 6-week, comprehensive, home exercise program reduce falls and disability and improve health-related quality of life? Is the program cost-effective? DESIGN: Randomised, controlled trial with concealed allocation and assessor blinding. PARTICIPANTS: One hundred and thirty-three community-dwelling adults with Parkinson's disease. INTERVENTION: The experimental group completed a 6-week home program comprising progressive resistance strength training, movement strategy training and falls education. The control group completed 6 weeks of non-specific life skills training. Participants in both groups received weekly therapist-guided sessions for 6 consecutive weeks and a weekly self-directed home program. OUTCOME MEASURES: The primary outcome was the rate of falls, documented for the 12-month period immediately after therapy. Secondary outcomes were disability and health-related quality of life, assessed before and after intervention and at a 12-month follow-up. RESULTS: A total of 2255 falls were reported by the 12-month follow-up. The proportion of fallers in the experimental and control groups was 61 and 72%, respectively, which was not statistically significantly different (RR=0.85, 95% CI 0.66 to 1.09). There was no significant between-group difference in the rate of falls (incidence rate ratio=1.58, 95% CI 0.73 to 3.43). A survival analysis of participant time to first fall did not show a significant between-group difference (log-rank test χ CONCLUSION: A home program of strength and movement strategy training and falls education does not prevent falls when applied at the dose used in this study. Arguably, the dosage of therapy was insufficient. Future trials need to explore further therapy content, repetitions and duration, in order to optimise outcomes and cost-effectiveness. [Morris ME, Taylor NF, Watts JJ, Evans A, Horne M, Kempster P, Danoudis M, McGinley J, Martin C, Menz HB (2017) A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. Journal of Physiotherapy 63: 94-100].

19 Article Immortalized Parkinson's disease lymphocytes have enhanced mitochondrial respiratory activity. 2016

Annesley, Sarah J / Lay, Sui T / De Piazza, Shawn W / Sanislav, Oana / Hammersley, Eleanor / Allan, Claire Y / Francione, Lisa M / Bui, Minh Q / Chen, Zhi-Ping / Ngoei, Kevin R W / Tassone, Flora / Kemp, Bruce E / Storey, Elsdon / Evans, Andrew / Loesch, Danuta Z / Fisher, Paul R. ·Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia. · Department of Psychology and Counselling, School of Psychology and Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria 3986, Australia. · Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010, Australia. · Department of Medicine, University of Melbourne St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia. · UC Davis MIND Institute, Sacramento, CA 95817, USA. · Department of Medicine (Neuroscience), Monash University, (Alfred Hospital Campus), Commercial Road, Melbourne, Victoria 3004, Australia. · Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria 3052, Australia. · Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia P.Fisher@latrobe.edu.au. ·Dis Model Mech · Pubmed #27638668.

ABSTRACT: In combination with studies of post-mortem Parkinson's disease (PD) brains, pharmacological and genetic models of PD have suggested that two fundamental interacting cellular processes are impaired - proteostasis and mitochondrial respiration. We have re-examined the role of mitochondrial dysfunction in lymphoblasts isolated from individuals with idiopathic PD and an age-matched control group. As previously reported for various PD cell types, the production of reactive oxygen species (ROS) by PD lymphoblasts was significantly elevated. However, this was not due to an impairment of mitochondrial respiration, as is often assumed. Instead, basal mitochondrial respiration and ATP synthesis are dramatically elevated in PD lymphoblasts. The mitochondrial mass, genome copy number and membrane potential were unaltered, but the expression of indicative respiratory complex proteins was also elevated. This explains the increased oxygen consumption rates by each of the respiratory complexes in experimentally uncoupled mitochondria of iPD cells. However, it was not attributable to increased activity of the stress- and energy-sensing protein kinase AMPK, a regulator of mitochondrial biogenesis and activity. The respiratory differences between iPD and control cells were sufficiently dramatic as to provide a potentially sensitive and reliable biomarker of the disease state, unaffected by disease duration (time since diagnosis) or clinical severity. Lymphoblasts from control and PD individuals thus occupy two distinct, quasi-stable steady states; a 'normal' and a 'hyperactive' state characterized by two different metabolic rates. The apparent stability of the 'hyperactive' state in patient-derived lymphoblasts in the face of patient ageing, ongoing disease and mounting disease severity suggests an early, permanent switch to an alternative metabolic steady state. With its associated, elevated ROS production, the 'hyperactive' state might not cause pathology to cells that are rapidly turned over, but brain cells might accumulate long-term damage leading ultimately to neurodegeneration and the loss of mitochondrial function observed post-mortem. Whether the 'hyperactive' state in lymphoblasts is a biomarker specifically of PD or more generally of neurodegenerative disease remains to be determined.

20 Article Validation of a Smartphone Application Measuring Motor Function in Parkinson's Disease. 2016

Lee, Will / Evans, Andrew / Williams, David R. ·Neuroscience Department, The Alfred Hospital, Melbourne, VIC, Australia. · Van Cleef Roet Centre for Nervous Diseases, Monash University, The Alfred Hospital, Melbourne, VIC, Australia. · Neurology Department, The Royal Melbourne Hospital, Parkville, VIC, Australia. ·J Parkinsons Dis · Pubmed #27061062.

ABSTRACT: BACKGROUND: Measurement of motor function is critical to the assessment and management of Parkinson's disease. Ambulatory motor assessment has the potential to provide a glimpse of the patient's clinical state beyond the consultation. We custom-designed a smartphone application that quantitatively measures hand dexterity and hypothesized that this can give an indication of a patient's overall motor function. OBJECTIVE: The aims of this study were to (i) validate this smartphone application against MDS-UPDRS motor assessment (MDS-UPDRS-III) and the two-target tapping test; (ii) generate a prediction model for MDS-UPDRS-III; (iii) assess repeatability of our smartphone application and (iv) examine compliance and user-satisfaction of this application. METHODS: 103 patients with Parkinson's disease were recruited from two movement disorders clinics. After initial assessment, a group of patients underwent repeat assessment within two weeks. Patients were invited to use the smartphone application at home over three days, followed by a survey to assess their experience. RESULTS: Significant correlation between key smartphone application test parameters and MDS-UPDRS-III (r = 0.281-0.608, p < 0.0001) was demonstrated. A prediction model based on these parameters accounted for 52.3% of variation in MDS-UPDRS-III (R2 = 0.523, F(4,93) = 25.48, p < 0.0001). Forty-eight patients underwent repeat assessment under identical clinical conditions. Repeatability of key smartphone application tests parameters and predicted MDS-UPDRS-III was moderate to strong (intraclass correlation coefficient 0.584-0.763, p < 0.0001). The follow-up survey identified that our patients were very comfortable with the smartphone application and mobile technology. CONCLUSIONS: Our smartphone application demonstrated satisfactory repeatability and validity when measured against MDS-UPDRS-III. Its performance is acceptable considering our smartphone application measures hand dexterity only.

21 Article The relationship between specific cognitive defects and burden of care in Parkinson's disease. 2016

Zhong, Michael / Peppard, Richard / Velakoulis, Dennis / Evans, Andrew H. ·University of Melbourne,Melbourne,Victoria,Australia. · Department of Clinical Neurosciences,St Vincent's Hospital,Melbourne,Victoria,Australia. · Melbourne Neuropsychiatry Centre,University of Melbourne,Melbourne,Victoria,Australia. · Department of Neurology,Royal Melbourne Hospital,Melbourne,Victoria,Australia. ·Int Psychogeriatr · Pubmed #26434985.

ABSTRACT: BACKGROUND: In spite of the recognized physical and psychosocial effects of caring for patients with Parkinson's disease (PD), caregiver burden (CB) in this setting is poorly understood. The objective of this research was to identify factors that were associated with CB in an Australian population of PD caregivers using a novel instrument - the Parkinson's Disease Caregiver Burden (PDCB) questionnaire. METHODS: Fifty patient-caregiver couples were recruited from three movement disorders clinics in Melbourne, Australia. Burden on caregivers was rated using the PDCB questionnaire. Burden scores were correlated with patient factors, including motor symptom severity (Unified Parkinson's Disease Ratings Scale and Hoehn & Yahr (H&Y) scale), patient cognition (Neuropsychiatry Unit Cognitive Assessment Tool; NUCOG), presence of impulsive and compulsive behaviors (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease), and patient olfaction. Caregiver and patient demographics, as well as results for depression and anxiety (Hospital Anxiety and Depression Scale; HADS), were also examined for their relationship with CB. RESULTS: H&Y stage, depression or anxiety in either caregiver or patient, and decreased patient NUCOG score were significantly associated with higher PDCB score. Multiple linear regression analysis identified caregiver and patient depression score and patient score for the visuoconstructional subscale of NUCOG to predict burden score. In addition, disease duration, duration of caregiving, and increased hours per day spent in giving care were significantly associated with increased burden. CONCLUSIONS: We found psychiatric and cognitive factors to be the most relevant factors in the perception of burden in PD caregivers. On top of this, we found deficits in the domain of visuoconstruction predicted burden - a relationship not yet described in literature. Targeting depression and anxiety in this setting as well as identifying caregivers at high risk of burden may give clinicians the chance to optimize care of patients with PD through the caregiver.

22 Article A conditioned response as a measure of impulsive-compulsive behaviours in Parkinson's disease. 2014

Evans, Andrew H / Kettlewell, Jade / McGregor, Sarah / Kotschet, Katya / Griffiths, Robert I / Horne, Malcolm. ·The Royal Melbourne Hospital, Parkville Victoria, Australia. · Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia. · St Vincent's Hospital, Fitzroy, Victoria, Australia. · Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia ; St Vincent's Hospital, Fitzroy, Victoria, Australia. · Florey Neuroscience Institute, University of Melbourne, Parkville Victoria, Australia ; St Vincent's Hospital, Fitzroy, Victoria, Australia ; Department of Medicine, St Vincent's Hospital, Fitzroy, Victoria, Australia. ·PLoS One · Pubmed #24586685.

ABSTRACT: OBJECTIVES: Parkinson's Disease patients wore a device on the wrist that gave reminders to take levodopa and also measured bradykinesia and dyskinesia. Consumption of medications was acknowledged by placing the thumb on the device. Some patients performed this acknowledgement repeatedly and unconsciously. This study examines whether this behaviour reflected increased impulsivity. METHODS AND RESULTS: Twenty five participants were selected because they had i) excess acknowledgements described above or ii) Impulsive-Compulsive Behaviours or iii) neither of these. A blinded assessor applied clinical scales to measure Impulsive-Compulsive Behaviours, cognition, depression, anxiety and apathy. A Response Ratio, representing the number of acknowledgements/number of doses (expressed as a percentage) was tightly correlated with ratings of Impulsive-Compulsive Behaviours (r² = 0.79) in 19/25 subjects. Some of these patients had dyskinesia, which was higher with extraneous responses than with response indicating medication consumption. Six of the 25 subjects had high Impulsive-Compulsive Behaviour Scores, higher apathy scores, low levels of dyskinesia and normal Response Ratios. Patients without ICB (low RR) also had low dyskinesia levels regardless of the relevance of the response. CONCLUSION: An elevated Response Ratio is a specific measure of a type of ICB where increased incentive salience is attributed to cues by the presence of high striatal dopamine levels, manifested by high levels of dyskinesia. This study also points to a second form of ICBs which occur in the absence of dyskinesia, has normal Response Ratios and higher apathy scores, and may represent prefrontal pathology.

23 Article Validity and reliability of the PDCB: a tool for the assessment of caregiver burden in Parkinson's disease. 2013

Zhong, Michael / Evans, Andrew / Peppard, Richard / Velakoulis, Dennis. ·Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia. mzhong23@gmail.com ·Int Psychogeriatr · Pubmed #23635603.

ABSTRACT: BACKGROUND: Existing instruments for caregiver burden assessment are not specific or sensitive to various aspects of caring for patients with Parkinson's disease. A better understanding of burden may enhance patient care and improve health of both patient and caregiver. The goal of this study was to evaluate the validity of the Parkinson's Disease Caregiver Burden (PDCB) questionnaire, a novel instrument designed to appraise more accurately the burden experienced by caregivers in the setting of Parkinson's disease. METHODS: Common sources of distress for caregivers were taken from discussions with Parkinson's disease patients, caregivers, and clinicians, and used as the foundation of the PDCB questionnaire items. Fifty patients and their respective caregivers were recruited from three specialist movement disorder clinics. Caregiver burden in the sample was gauged with the PDCB scale and the Caregiver Burden Inventory (CBI). Item sensitivity and questionnaire validity were assessed. RESULTS: In this pilot analysis, the PDCB questionnaire was found to be feasible and reliable. Strong correlations were found between the PDCB questionnaire and the CBI. The PDCB questionnaire contained more relevant items for this population compared with the CBI. CONCLUSION: Strong initial feasibility, reliability, validity, and sensitivity for the PDCB questionnaire were demonstrated. With further evaluation and development, the PDCB questionnaire may prove to be a valuable supplementary tool to the existing CBI or a standalone instrument for use in the setting of Parkinson's disease.

24 Article Automated assessment of bradykinesia and dyskinesia in Parkinson's disease. 2012

Griffiths, Robert I / Kotschet, Katya / Arfon, Sian / Xu, Zheng Ming / Johnson, William / Drago, John / Evans, Andrew / Kempster, Peter / Raghav, Sanjay / Horne, Malcolm K. ·Florey Neuroscience Institutes, University of Melbourne, Parkville, Victoria, Australia. ·J Parkinsons Dis · Pubmed #23939408.

ABSTRACT: There is a need for objective measures of dyskinesia and bradykinesia of Parkinson's disease (PD) that are continuous throughout the day and related to levodopa dosing. The output of an algorithm that calculates dyskinesia and bradykinesia scores every two minutes over 10 days (PKG: Global Kinetics Corporation) was compared with conventional rating scales for PD in PD subjects. The algorithm recognises bradykinesia as movements made with lower acceleration and amplitude and with longer intervals between movement. Similarly the algorithm recognises dyskinesia as having movements of normal amplitude and acceleration but with shorter periods without movement. The distribution of the bradykinesia and dyskinesia scores from PD subjects differed from that of normal subjects. The algorithm predicted the clinical dyskinesia rating scale AIMS with a 95% margin of error of 3.2 units compared with the inter-rater 95% limits of agreement from 3 neurologists of -3.4 to +4.3 units. Similarly the algorithm predicted the UPDRS III score with a margin of error similar to the inter-rater limits of agreement. Improvement in scores in response to changes in medication could be assessed statistically in individual patients. This algorithm provides objective, continuous and automated assessment of the clinical features of bradykinesia and dyskinesia in PD.

25 Article Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson's disease. 2012

Morris, Meg E / Martin, Clarissa / McGinley, Jennifer L / Huxham, Frances E / Menz, Hylton B / Taylor, Nicholas F / Danoudis, Mary / Watts, Jennifer J / Soh, Sze-Ee / Evans, Andrew H / Horne, Malcolm / Kempster, Peter. ·Department of Physiotherapy, The University of Melbourne, Carlton, VIC 3010, Australia. m.morris@unimelb.edu.au ·BMC Neurol · Pubmed #22799601.

ABSTRACT: BACKGROUND: The high incidence of falls associated with Parkinson's disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson's has not been convincingly demonstrated. METHODS/DESIGN: 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined. DISCUSSION: This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD. TRIAL REGISTRATION: The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).

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