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Parkinson Disease: HELP
Articles by Vladimir S. Kostić
Based on 80 articles published since 2010
(Why 80 articles?)
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Between 2010 and 2020, V. Kostic wrote the following 80 articles about Parkinson Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Don't ask, don't tell: Impulse control disorders in PD. 2018

Boylan, Laura S / Kostić, Vladimir S. ·From Division of Neurology (L.S.B.), Essentia Health, Duluth, MN · Albany-Stratton VA Medical Center (L.S.B.), Albany · Bellevue Hospital/New York University School of Medicine, Department of Neurology (L.S.B.), NY · and Institute of Neurology CCS (V.S.K.), School of Medicine University of Belgrade, Serbia. ·Neurology · Pubmed #29925552.

ABSTRACT: -- No abstract --

2 Review Artificial intelligence for assisting diagnostics and assessment of Parkinson's disease-A review. 2019

Belić, Minja / Bobić, Vladislava / Badža, Milica / Šolaja, Nikola / Đurić-Jovičić, Milica / Kostić, Vladimir S. ·Innovation Center, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia. Electronic address: minja.n.belic@gmail.com. · Innovation Center, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia; School of Electrical Engineering, University of Belgrade, Belgrade, Serbia. Electronic address: vladislava.bobic@ic.etf.bg.ac.rs. · Innovation Center, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia; School of Electrical Engineering, University of Belgrade, Belgrade, Serbia. Electronic address: milica.badza@ic.etf.bg.ac.rs. · School of Electrical Engineering, University of Belgrade, Belgrade, Serbia. Electronic address: sn183153m@student.etf.bg.ac.rs. · Innovation Center, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia. Electronic address: milica.djuric@etf.bg.ac.rs. · Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: vladimir.s.kostic@gmail.com. ·Clin Neurol Neurosurg · Pubmed #31351213.

ABSTRACT: Artificial intelligence, specifically machine learning, has found numerous applications in computer-aided diagnostics, monitoring and management of neurodegenerative movement disorders of parkinsonian type. These tasks are not trivial due to high inter-subject variability and similarity of clinical presentations of different neurodegenerative disorders in the early stages. This paper aims to give a comprehensive, high-level overview of applications of artificial intelligence through machine learning algorithms in kinematic analysis of movement disorders, specifically Parkinson's disease (PD). We surveyed papers published between January 2007 and January 2019, within online databases, including PubMed and Science Direct, with a focus on the most recently published studies. The search encompassed papers dealing with the implementation of machine learning algorithms for diagnosis and assessment of PD using data describing motion of upper and lower extremities. This systematic review presents an overview of 48 relevant studies published in the abovementioned period, which investigate the use of artificial intelligence for diagnostics, therapy assessment and progress prediction in PD based on body kinematics. Different machine learning algorithms showed promising results, particularly for early PD diagnostics. The investigated publications demonstrated the potentials of collecting data from affordable and globally available devices. However, to fully exploit artificial intelligence technologies in the future, more widespread collaboration is advised among medical institutions, clinicians and researchers, to facilitate aligning of data collection protocols, sharing and merging of data sets.

3 Review Chemical management of levodopa-induced dyskinesia in Parkinson's disease patients. 2019

Dragašević-Mišković, Nataša / Petrović, Igor / Stanković, Iva / Kostić, Vladimir S. ·a Neurology Clinic, CCS, School of Medicine , Universtiy of Belgrade , Belgrade , Serbia. ·Expert Opin Pharmacother · Pubmed #30411647.

ABSTRACT: INTRODUCTION: Levodopa-induced dyskinesias (LID) appears in more than 50% of Parkinson's disease patients after 5 years of treatment and clinicians always have to ensure that there is a balance between the beneficial effect of the treatment and the potential complications. AREAS COVERED: In this review, the authors discuss the treatment of LID. Treatment can be divided into strategies for preventing their occurrence, modification of dopaminergic therapy, and providing more continuous dopaminergic stimulation as well as the use of nondopaminergic drugs. EXPERT OPINION: Amantadine is currently considered the most effective drug for the treatment of LID. Several compounds developed to target adenosine, adrenergic, glutamatergic, and serotonergic receptors have shown to significantly decrease dyskinesias in animal models. However, despite promising preclinical results, translation to clinical practice remains challenging and majority of these compounds failed to decrease LID in randomized controlled trials with moderate-to-advanced parkinsonian patients. Despite promising results with nondopaminergic drugs, treatment of dyskinesias is still challenging and largely due to their side effects. Future research should focus on developing treatments that can provide continuous dopaminergic delivery throughout the day in a noninvasive manner. Studies on the impact of the early administration of long-acting formulations of levo-3,4-dihydroxy-phenylalanine on dyskinesias are also necessary.

4 Review Pharmacokinetic drug evaluation of opicapone for the treatment of Parkinson's disease. 2018

Svetel, Marina / Tomić, Aleksandra / Kresojević, Nikola / Kostić, Vladimir. ·a Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine , University of Belgrade , Belgrade , Serbia. · b Clinic of Neurology , Clinical Center of Serbia , Belgrade , Serbia. ·Expert Opin Drug Metab Toxicol · Pubmed #29345156.

ABSTRACT: INTRODUCTION: Opicapone (OPC) is a novel, potent, reversible, and purely peripheral third-generation COMT inhibitor, which provides an enhancement in levodopa (L-Dopa) availability. It represents adjunctive therapy for L-Dopa treated patients with PD and motor fluctuations. Areas covered: The purpose of this study was to evaluate pharmacokinetic of OPC for the treatment of PD. Expert commentary: Oral OPC exhibits linear, dose-dependent absorption. However, following concomitant ingestion of a high-fat, high-calorie meal, the maximum plasma concentration will be decreased. A once-daily bedtime administration of OPC 1 h after the last daily L-Dopa/AADCi, are considered to avoid any interaction during the L-Dopa absorption phase. There are no clinically relevant effects of age (in adults), renal impairment or race on the pharmacokinetics of OPC. OPC dose adjustment is not needed in patients with mild to moderate chronic hepatic impairment. Opicapone exhibits the lowest potential for cytotoxicity in comparison with other COMT inhibitors. It significantly decreases COMT activity, with half-life of COMT inhibition in human erythrocytes of 61.6 h and increases systemic exposure to L-Dopa. This provides an enhancement in L-Dopa availability that translates into clinical benefit for PD patients in terms of significant decrease of OFF periods and increase in ON-time without troublesome dyskinesia.

5 Review The Pathophysiology of Fatigue in Parkinson's Disease and its Pragmatic Management. 2016

Kostić, Vladimir S / Tomić, Aleksandra / Ječmenica-Lukić, Milica. ·Institute of Neurology CCS School of Medicine University of Belgrade Belgrade Serbia. ·Mov Disord Clin Pract · Pubmed #30363584.

ABSTRACT: Background: Fatigue is 1 of the most common and most disabling symptoms among patients with Parkinson's disease (PD) and has a significant impact on their quality of life. Yet the pathophysiology of fatigue is poorly understood, while its treatment is "limited to an empirical approach based on plausible hypotheses." Methods: PubMed was searched for articles with the key words "Parkinson's disease" or "parkinsonism" and "fatigue" that were published by or before August 2015. The analysis of articles, which were selected on subjective grounds, was used to review the current knowledge of pathophysiology and treatment outcomes in studies focused on fatigue in PD. Conclusions: Clinical and experimental findings support the view that fatigue is a primary manifestation of PD. The main hypothesized pathophysiological mechanisms include abnormal basal ganglia (BG)-cortical mechanisms, particularly frontal loops, and an imbalance between neurotransmitters (e.g., dopamine [DA] and serotonin), along with an altered hypothalamus-pituitary-adrenal axis, neuroinflammation, cardiac sympathetic denervation, etc. Pragmatic treatment of fatigue in patients with PD includes various pharmacological (dopaminergic and psychostimulant drugs, antidepressants) and nonpharmacological strategies, although current knowledge suffers from insufficient evidence to support the use of any drug or nondrug therapy.

6 Review Pharmacogenetics of drug response in Parkinson's disease. 2015

Džoljić, Eleonora / Novaković, Ivana / Krajinovic, Maja / Grbatinić, Ivan / Kostić, Vladimir. ·1Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. ·Int J Neurosci · Pubmed #25226559.

ABSTRACT: Parkinson's disease (PD) is a debilitating, demoralizing and financially devastating condition affecting 1% of population at the age of 60 years. Thus, very important issue to address is individual therapy optimization. Recent results have shown evidence that variable efficacy of treatment and risk of motor and mental complications could have genetic origin. Significant roles in that process play (pharmaco)genomic/genetic studies of PD. Variability in genes coding for drug-metabolizing enzymes, drug receptors and proteins involved in drug pathway signaling is an important factor determining inter-individual variability in drug responses. Interpersonal differences in drug responses are clearly documented although individualized treatment of PD is not widely known. Treatment with antiparkinsonian drugs is associated with the development of complications, such as L-DOPA-induced dyskinesia (LID), hallucinations and excessive daytime sleepiness. Carriers of specific genetic polymorphisms are particularly susceptible to development of some of these drug adverse effects. Pharmacogenomics aims to understand the relationship between genetic factors and inter-individual variations in drug responses, and to translate this information in therapy tailored to individual patient genetics. Relatively few efforts have been made to investigate the role of pharmacogenetics in the individual response to anti-PD drugs. Thus, many genetic variations and polymorphisms in myriad of different proteins can influence individual response to anti-PD drugs.

7 Review EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. 2013

Berardelli, A / Wenning, G K / Antonini, A / Berg, D / Bloem, B R / Bonifati, V / Brooks, D / Burn, D J / Colosimo, C / Fanciulli, A / Ferreira, J / Gasser, T / Grandas, F / Kanovsky, P / Kostic, V / Kulisevsky, J / Oertel, W / Poewe, W / Reese, J-P / Relja, M / Ruzicka, E / Schrag, A / Seppi, K / Taba, P / Vidailhet, M. ·Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy. alfredo.berardelli@uniroma1.it ·Eur J Neurol · Pubmed #23279440.

ABSTRACT: BACKGROUND: A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS: Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS: For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS: The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.

8 Review Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. 2013

Ferreira, J J / Katzenschlager, R / Bloem, B R / Bonuccelli, U / Burn, D / Deuschl, G / Dietrichs, E / Fabbrini, G / Friedman, A / Kanovsky, P / Kostic, V / Nieuwboer, A / Odin, P / Poewe, W / Rascol, O / Sampaio, C / Schüpbach, M / Tolosa, E / Trenkwalder, C / Schapira, A / Berardelli, A / Oertel, W H. ·Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal. ·Eur J Neurol · Pubmed #23279439.

ABSTRACT: OBJECTIVE: To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS: For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS: For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.

9 Review Neuroanatomical correlates of depression and apathy in Parkinson's disease: magnetic resonance imaging studies. 2011

Kostić, Vladimir S / Filippi, Massimo. ·Department of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia. vladimir.s.kostic@gmail.com ·J Neurol Sci · Pubmed #21684552.

ABSTRACT: Depression and apathy are among the most common neuropsychiatric disturbances in Parkinson's disease (PD), and among the most important factors associated with a poor quality of life. However, their neural bases remain unclear. The results of the magnetic resonance imaging (MRI) studies on depression in PD differ dramatically. Some of them proposed a role of morphologic changes in the mediodorsal thalamus. In contrast to previous voxel-based morphometry (VBM) data, our study did not confirm a decrease in gray matter (GM) density in any brain region of depressed PD patients. Instead, a more severe white matter (WM) loss in the right frontal lobe was found, including the anterior cingulate bundle and the inferior orbitofrontal (OF) region. We suggested that the negative correlation between the severity of depression and WM density in the right OF region reinforces the hypothesis of depression in PD as a "disconnection syndrome". Only one MRI study using VBM found that high apathy scores correlated with low GM density values in the right (posterior) cingulate gyrus and the bilateral inferior frontal gyrus, in line with the findings in Alzheimer's disease and elderly adults with major depression.

10 Article Longitudinal assessment of autonomic dysfunction in early Parkinson's disease. 2019

Stanković, Iva / Petrović, Igor / Pekmezović, Tatjana / Marković, Vladana / Stojković, Tanja / Dragašević-Mišković, Nataša / Svetel, Marina / Kostić, Vladimir. ·Institute of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: idstanko139@gmail.com. · Institute of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. · Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia. · Institute of Neurology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: vladimir.s.kostic@gmail.com. ·Parkinsonism Relat Disord · Pubmed #31320275.

ABSTRACT: INTRODUCTION: Clinical correlates of autonomic nervous system (ANS) dysfunction in early Parkinson's disease (PD) have been addressed mainly in a cross-sectional way. METHODS: This is a combined cross-sectional and longitudinal prospective study of ANS dysfunction using the SCOPA-AUT in PD patients at the Hoehn and Yahr stage 1 with disease duration <2 years. PD patients (n = 107) were compared to healthy controls (HC, n = 79), and then followed-up for over 3 years. The severity of PD, depression, anxiety, apathy and cognitive impairment were evaluated using rating scales. RESULTS: At least one symptom of ANS dysfunction was present in 71% of PD patients in comparison to 30.4% of HC, and in all PD patients after three years. The overall severity of dysautonomia symptoms was mild (SCOPA-AUT mean ± SD; 4.16 ± 5.0), but worsened by 23%, 86% and 0.3% during the 1st, 2nd and 3rd year respectively. Nighttime voiding (38.3%), constipation (30.8%) and straining for defecation (29%) were the most common symptoms. Prevalence and severity of urinary, gastrointestinal, and orthostatic symptoms increased, in contrast to thermoregulatory and pupillomotor symptoms. Frequency of symptoms suggestive of multi-domain ANS dysfunction rose from 49% to 79%. Psychiatric symptoms and age, but not motor impairment, were associated with dysautonomia symptoms. CONCLUSION: Symptoms of ANS dysfunction were frequent in the initial motor stage of PD and progressed, yet remaining mild, within 3 years. An independent progression of dysautonomia symptoms from motor disability and its associations with non-motor, mainly psychiatric symptoms and age support the non-motor clustering in PD.

11 Article An Expert System for Quantification of Bradykinesia Based on Wearable Inertial Sensors. 2019

Bobić, Vladislava / Djurić-Jovičić, Milica / Dragašević, Nataša / Popović, Mirjana B / Kostić, Vladimir S / Kvaščev, Goran. ·University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia. vladislava.bobic@ic.etf.rs. · Innovation Center, School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia. vladislava.bobic@ic.etf.rs. · Innovation Center, School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia. milica.djuric@etf.rs. · Clinic of Neurology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia. ntdragasevic@gmail.com. · University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia. mpo@etf.rs. · Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia. mpo@etf.rs. · Clinic of Neurology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia. vladimir.s.kostic@gmail.com. · University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia. kvascev@etf.rs. ·Sensors (Basel) · Pubmed #31212680.

ABSTRACT: Wearable sensors and advanced algorithms can provide significant decision support for clinical practice. Currently, the motor symptoms of patients with neurological disorders are often visually observed and evaluated, which may result in rough and subjective quantification. Using small inertial wearable sensors, fine repetitive and clinically important movements can be captured and objectively evaluated. In this paper, a new methodology is designed for objective evaluation and automatic scoring of bradykinesia in repetitive finger-tapping movements for patients with idiopathic Parkinson's disease and atypical parkinsonism. The methodology comprises several simple and repeatable signal-processing techniques that are applied for the extraction of important movement features. The decision support system consists of simple rules designed to match universally defined criteria that are evaluated in clinical practice. The accuracy of the system is calculated based on the reference scores provided by two neurologists. The proposed expert system achieved an accuracy of 88.16% for files on which neurologists agreed with their scores. The introduced system is simple, repeatable, easy to implement, and can provide good assistance in clinical practice, providing a detailed analysis of finger-tapping performance and decision support for symptom evaluation.

12 Article Analysis of on-surface and in-air movement in handwriting of subjects with Parkinson's disease and atypical parkinsonism. 2019

Miler Jerkovic, Vera / Kojic, Vladimir / Dragasevic Miskovic, Natasa / Djukic, Tijana / Kostic, Vladimir S / Popovic, Mirjana B. ·Innovation Center, School of Electrical Engineering, University of Belgrade, Bulevar kralja Aleksandra 73, Belgrade 11000, Serbia, Phone: +381113218348. · Techalia Serbia Ltd., Vladetina 13, Belgrade, Serbia. · Neurology Clinic, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia. · Institute for Medical Research, University of Belgrade, Belgrade, Serbia. · University of Belgrade School of Electrical Engineering, Bulevar kralja Aleksandra 73, Belgrade 11000, Serbia. ·Biomed Tech (Berl) · Pubmed #29708872.

ABSTRACT: The purpose of this paper is to emphasize the importance of in-air movement besides on-surface movement for handwriting analysis. The proposed method uses a classification of drawing healthy subjects and subjects with Parkinson's disease, according to their on-surface and in-air handwriting parameters during their writing on a graphical tablet. Experimental results on real data sets demonstrate that the highest accuracy of subject's classification was obtained by combining both on-surface and in-air kinematic parameters.

13 Article Change in fear of falling in Parkinson's disease: a two-year prospective cohort study. 2019

Gazibara, Tatjana / Tepavcevic, Darija Kisic / Svetel, Marina / Tomic, Aleksandra / Stankovic, Iva / Kostic, Vladimir S / Pekmezovic, Tatjana. ·Institute of Epidemiology,Faculty of Medicine,University of Belgrade,Belgrade,Serbia. · Clinic of Neurology,Clinical Centre of Serbia,Faculty of Medicine,University of Belgrade,Belgrade,Serbia. ·Int Psychogeriatr · Pubmed #29145921.

ABSTRACT: ABSTRACTBackground:Fear of falling in Parkinson's disease (PD) has been suggested as predictor of future falling. The purpose of this study was to compare fear of falling score after two years of follow-up with those observed at baseline and to assess factors associated with change in fear of falling over time. METHODS: A total of 120 consecutive persons with PD were recruited and followed for two years. Fear of falling was assessed by using the 10-item Falls Efficacy Scale (FES). Occurrence of falling was registered during the first year of follow-up. RESULTS: After two years, the average FES score statistically significantly changed (p = 0.003) from 30.5 to 37.5 out of 100 (increase of 22.9%). We observed that median scores of all FES items, except for "Preparing a meal, not requiring carrying of heavy or hot objects" and "Personal grooming," significantly increased after two-year follow-up. After accounting for age, gender, PD duration, levodopa dosage, Hoehn and Yayhr stage, Unified Parkinson's Disease Rating Scale score three, depression, anxiety, and falling, we observed that sustaining greater number of falls in the first year of follow-up was associated with higher increase in FES score after two years (odds ratio 3.08, 95% confidence interval 1.30-4.87). CONCLUSION: After two years of follow-up, we observed a decrease in confidence at performing nearly all basic daily activities. Fall prevention programs should be prioritized in management of PD.

14 Article Challenges of Stride Segmentation and Their Implementation for Impaired Gait. 2018

Bobic, Vladislava N / Djuric-Jovieic, Milica D / Radovanovic, Saa M / Dragaevic, Nataa T / Kostic, Vladimir S / Popovic, Mirjana B. · ·Conf Proc IEEE Eng Med Biol Soc · Pubmed #30440862.

ABSTRACT: Stride segmentation represents important but challenging part of the gait analysis. Different methods and sensor systems have been proposed for detection of markers for segmentation of gait sequences. This task is often performed with wearable sensors comprising force sensors and/or inertial sensors. In this paper, we have compared four different methods for stride segmentation based on signals collected from force sensing resistors, accelerometers and gyro sensors. The results were evaluated on 15 healthy and 15 patients with Parkinson's disease, and expressed in terms of number of imprecisely, missed or wrongly detected gait events, as well as temporal absolute error. It was established that the methods using the inertial data, provide results with up to 12% higher error rate comparing to detection from force sensing resistors.

15 Article Identification of mutations in the PARK2 gene in Serbian patients with Parkinson's disease. 2018

Jankovic, M Z / Dobricic, V / Kresojevic, N / Markovic, V / Petrovic, I / Svetel, M / Pekmezovic, T / Novakovic, I / Kostic, V. ·Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr. Subotica 6, Belgrade, Serbia. Electronic address: milena.jankovic.82@gmail.com. · Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr. Subotica 6, Belgrade, Serbia. · Institute for Epidemiology, School of Medicine, University of Belgrade, Visegradska 26, Belgrade, Serbia. · Institute for Human Genetics, School of Medicine, University of Belgrade, Visegradska 26, Belgrade, Serbia. ·J Neurol Sci · Pubmed #30099245.

ABSTRACT: Mutations in the PARK2 (PRKN) gene are the most common cause of autosomal-recessive (AR) juvenile parkinsonism and young-onset Parkinson's disease (YOPD). >100 different variants have been reported, including point mutations, small indels and single or multiple exon copy number variations. Mutation screening of PARK2 was performed in 225 Serbian PD patients (143 males and 82 females) with disease onset before 50 years and/or positive family history with apparent AR inheritance. All coding regions and their flanking intronic sequences were amplified and directly sequenced. Whole exon multiplications or deletions were detected using Multiple Ligation Probe Amplification (MLPA) method. We identified 12 PD patients with PARK2 mutations (5.3%). Five patients (2.2%) had biallelic mutations and seven (3.1%) were single mutation carriers. Patients with compound heterozygous mutations had earlier onset of the disease compared to non-carriers (p = 0.005) or heterozygotes (p = 0.001). Other clinical features in mutation carriers were not different compared to non-carriers. In our cohort, sequence and dosage variants were equally represented in patients, inducing their first symptoms mainly before the age of 30. For efficient genetic testing strategy, patients with early, especially juvenile onset of PD were strong candidates for both dosage and sequence variants screening of PARK2 gene.

16 Article Axial motor clues to identify atypical parkinsonism: A multicentre European cohort study. 2018

Borm, Carlijn D J M / Krismer, Florian / Wenning, Gregor K / Seppi, Klaus / Poewe, Werner / Pellecchia, Maria Teresa / Barone, Paolo / Johnsen, Erik L / Østergaard, Karen / Gurevich, Tanya / Djaldetti, Ruth / Sambati, Luisa / Cortelli, Pietro / Petrović, Igor / Kostić, Vladimir S / Brožová, Hana / Růžička, Evžen / Marti, Maria Jose / Tolosa, Eduardo / Canesi, Margherita / Post, Bart / Nonnekes, Jorik / Bloem, Bastiaan R / Anonymous6510951. ·Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Centre Nijmegen (ParC) Nijmegen, The Netherlands. · Department of Neurology, Medical University Innsbruck, Austria. · Centre for Neurodegenerative Diseases, Department of Medicine and Surgery, University of Salerno, Italy. · Department of Neurology, University Hospital, Aarhus, Denmark. · Neurological Institute, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel. · Department of Neurology, Rabin Medical Centre, Petach-Tiqva, Israel. · IRCCS Institute of Neurological Sciences of Bologna and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. · Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia. · Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia. · Department of Neurology and Centre of Clinical Neuroscience Charles University in Prague, Czech Republic. · Neurology Service, Hospital Clínic Universitari, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain. · Department of Neurology, Parkinson Centre Milano, Italy. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, The Netherlands. · Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Centre Nijmegen (ParC) Nijmegen, The Netherlands. Electronic address: bas.bloem@radboudumc.nl. ·Parkinsonism Relat Disord · Pubmed #29910157.

ABSTRACT: OBJECTIVE: Differentiating Parkinson's disease (PD) from atypical parkinsonian disorders (APD) such as Multiple System Atrophy, parkinsonian type (MSA-p) or Progressive Supranuclear Palsy (PSP-RS) can be challenging. Early signs of postural Instability and gait disability (PIGD) are considered clues that may signal presence of APD. However, it remains unknown which PIGD test - or combination of tests - can best distinguish PD from APD. We evaluated the discriminative value of several widely-used PIGD tests, and aimed to develop a short PIGD evaluation that can discriminate parkinsonian disorders. METHODS: In this multicentre cohort study patients were recruited by 11 European MSA Study sites. Patients were diagnosed using standardized criteria. Postural instability and gait disability was evaluated using interviews and several clinical tests. RESULTS: Nineteen PD, 21 MSA-p and 25 PSP-RS patients were recruited. PIGD was more common in APD compared to PD. There was no significant difference in axial symptoms between PSP-RS and MSA-p, except for self-reported falls (more frequent in PSP-RS patients). The test with the greatest discriminative power to distinguish APD from PD was the ability to perform tandem gait (AUC 0.83; 95% CI 71-94; p < 0.001), followed by the retropulsion test (AUC 0.8; 95% CI 0.69-0.91; p < 0.001) and timed-up-and-go test (TUG) (AUC 0.77; 95% CI 0.64-0.9; p = 0.001). The combination of these three tests yielded highest diagnostic accuracy (AUC 0.96; 95% CI 0.92-1.0; p < 0.001). CONCLUSIONS: Our study suggests that simple "bedside" PIGD tests - particularly the combination of tandem gait performance, TUG and retropulsion test - can discriminate APD from PD.

17 Article Exploring the relationship between motor impairment, vascular burden and cognition in Parkinson's disease. 2018

Stojkovic, Tanja / Stefanova, Elka / Soldatovic, Ivan / Markovic, Vladana / Stankovic, Iva / Petrovic, Igor / Agosta, Federica / Galantucci, Sebastiano / Filippi, Massimo / Kostic, Vladimir. ·Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia. tanjili80@gmail.com. · School of Medicine, University of Belgrade, Belgrade, Serbia. tanjili80@gmail.com. · Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia. · School of Medicine, University of Belgrade, Belgrade, Serbia. · Institute of Medical Statistics, Belgrade, Serbia. · Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. ·J Neurol · Pubmed #29572571.

ABSTRACT: OBJECTIVE: To determine frequency and type of cognitive disorders in cross-sectional analysis of a Parkinson's disease (PD) cohort, and explore its relations to motor symptoms, modifiable vascular risk factors and white matter lesions (WML) volume. METHODS: In a group of 133 PD patients, mild cognitive impairment (PD-MCI) and dementia (PDD) were diagnosed according to Movement Disorders Society Task Force criteria (level 2 for PD-MCI). Detailed motor measurements were applied, including rigidity, axial, bradykinesia, tremor and postural instability gait disorders (PIGD) scores. Vascular risk was estimated by the Framingham General Cardiovascular Disease risk scoring algorithm and WML volume was measured for whole brain and frontal lobe. RESULTS: Sixty-one (46.9%) patients fulfilled criteria for PD-MCI, and 23 (17.7%) for PDD. Non-amnestic multiple domain MCI was most frequent (52% of PD-MCI patients). Motor scores were significantly higher in cognitively impaired patients, but only axial score discriminated between MCI and dementia. High vascular risk was related to impaired cognition, bradykinesia, axial, PIGD and freezing of gait (FOG) score, while whole brain WML volume was associated with PDD, FOG and attention deficits. Furthermore, high vascular risk was identified as a potential predictor of both MCI and dementia in PD. Additionally, age and bradykinesia score were independently associated with PD-MCI and age, axial score and whole brain WML volume with PDD. CONCLUSION: Cognitive disorders in PD are associated with more severe, predominantly axial motor deficits and increased, but partly modifiable vascular burden, thus opening a possibility for development of preventive strategies in PD.

18 Article Brain structural and functional signatures of impulsive-compulsive behaviours in Parkinson's disease. 2018

Imperiale, F / Agosta, F / Canu, E / Markovic, V / Inuggi, A / Jecmenica-Lukic, M / Tomic, A / Copetti, M / Basaia, S / Kostic, V S / Filippi, M. ·Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. · Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. · Unit of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genoa, Italy. · Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy. · Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. ·Mol Psychiatry · Pubmed #28265121.

ABSTRACT: This study assessed brain structural and functional alterations in patients with Parkinson's disease and impulsive-compulsive behaviours (PD-ICB) compared with controls and PD no-ICB cases. Eighty-five PD patients (35 PD-ICB) and 50 controls were recruited. All subjects underwent three-dimensional T1-weighted, diffusion tensor (DT), and resting state functional magnetic resonance imaging (RS fMRI). We assessed cortical thickness with surface-based morphometry, subcortical volumes using FIRST, DT MRI metrics using region of interest and tractography approaches, and RS fMRI using a model free approach. Compared with controls, both PD groups showed a pattern of brain structural alterations in the basal ganglia (more evident in PD no-ICB patients), sensorimotor and associative systems. Compared with PD no-ICB, PD-ICB cases showed left precentral and superior frontal cortical thinning, and motor and extramotor white matter tract damage. Compared with controls, all patients had an increased functional connectivity within the visual network. Additionally, PD no-ICB showed increased functional connectivity of bilateral precentral and postcentral gyri within the sensorimotor network compared with controls and PD-ICB. Severity and duration of PD-ICB modulated the functional connectivity between sensorimotor, visual and cognitive networks. Relative to PD no-ICB, PD-ICB patients were characterised by a more severe involvement of frontal, meso-limbic and motor circuits. These data suggest ICB in PD as the result of a disconnection between sensorimotor, associative and cognitive networks with increasing motor impairment, psychiatric symptoms, and ICB duration. These findings may have important implications in understanding the neural substrates underlying ICB in PD.

19 Article Near-falls in people with Parkinson's disease: Circumstances, contributing factors and association with falling. 2017

Gazibara, Tatjana / Kisic Tepavcevic, Darija / Svetel, Marina / Tomic, Aleksandra / Stankovic, Iva / Kostic, Vladimir S / Pekmezovic, Tatjana. ·Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Serbia. · Clinic of Neurology, Dr. Subotica 6, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia. · Institute of Epidemiology, Visegradska 26a, Faculty of Medicine, University of Belgrade, Serbia. Electronic address: pekmezovic@sezampro.rs. ·Clin Neurol Neurosurg · Pubmed #28858631.

ABSTRACT: OBJECTIVES: To describe circumstances of near-falls among persons with Parkinson's disease (PD), assess factors associated with near-falling and assess whether near-falls in the first 6 months are associated with falling in the latter 6 months over one year of follow-up. MATERIALS AND METHODS: In the period August 2011-December 2012, 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited at Clinical center of Serbia in Belgrade. Occurrence of falling and near-falls was followed for one year. RESULTS: A total of 31 persons with PD (25.8%) experienced near-falls, but did not fall. Of 42 fallers, 32 (76.2%) experienced near-falls. Tripping was the most common cause of near-falls among fallers, whereas postural instability was the most common in non-fallers. Regardless of falling experience, the most common manner to avoid fall was holding onto furniture or wall. After adjustment for multiple motor and non-motor PD features, more severe freezing of gait was associated with occurrence of near-falls over one year of follow-up (odds ratio [OR]=1.08, 95% confidence interval [CI] 1.01-1.16; p=0.043). Adjusted regression analysis did not show associations between near-falling in the first 6 months and falling in the latter 6 months of follow-up. CONCLUSION: Near-falls commonly occur in persons with PD. More severe freezing of gait appears to predispose near-falling. Fall prevention programs focusing on balance maintenance when experiencing freezing of gait could potentially be useful in reduction of near-falls.

20 Article White matter tract alterations in Parkinson's disease patients with punding. 2017

Canu, Elisa / Agosta, Federica / Markovic, Vladana / Petrovic, Igor / Stankovic, Iva / Imperiale, Francesca / Stojkovic, Tanja / Copetti, Massimiliano / Kostic, Vladimir S / Filippi, Massimo. ·Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. · Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia. · Clinic of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia. · Biostatistics Unit, IRCCS-Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy. · Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: filippi.massimo@hsr.it. ·Parkinsonism Relat Disord · Pubmed #28780181.

ABSTRACT: OBJECTIVE: To assess brain white matter tract alterations in patients with Parkinson's disease and punding (PD-punding) compared with controls and PD cases without any impulsive-compulsive behaviour. METHODS: Forty-nine PD patients (21 PD-punding and 28 PD with no impulsive-compulsive behaviours) and 28 controls were consecutively recruited. Clinical, cognitive and psychopathological evaluations were performed. Diffusion tensor MRI metrics of the main white matter tracts were assessed using a tractography approach. RESULTS: Compared with controls, both PD groups showed white matter microstructural alterations of the left pedunculopontine tract and splenium of the corpus callosum. PD-punding patients showed a further damage to the right pedunculopontine tract and uncinate fasciculus, genu of the corpus callosum, and left parahippocampal tract relative to controls. When adjusting for depression and/or apathy severity, a greater damage of the genu of the corpus callosum and the left pedunculopontine tract was found in PD-punding compared with patients with no impulsive-compulsive behaviours. CONCLUSIONS: PD-punding is associated with a disconnection between midbrain, limbic and white matter tracts projecting to the frontal cortices. These alterations are at least partially independent of their psychopathological changes. Diffusion tensor MRI is a powerful tool for understanding the neural substrates underlying punding in PD.

21 Article Selection of gait parameters for differential diagnostics of patients with de novo Parkinson's disease. 2017

Djurić-Jovičić, Milica / Belić, Minja / Stanković, Iva / Radovanović, Saša / Kostić, Vladimir S. ·a Innovation Center, School of Electrical Engineering , University of Belgrade , Belgrade , Serbia. · c Neurology Clinic, Clinical Center of Serbia, School of Medicine , University of Belgrade , Belgrade , Serbia. · b Institute for Medical Research, University of Belgrade , Belgrade , Serbia. ·Neurol Res · Pubmed #28715936.

ABSTRACT: BACKGROUND: Gait disturbances are an integral part of clinical manifestations of Parkinson's disease (PD), even in the initial stages of the disease. Our goal was to identify the set of spatio-temporal gait parameters that bear the highest relevance for characterizing de novo PD patients. METHODS: Forty patients with de novo PD and forty healthy controls were recorded while walking over an electronic walkway in three different conditions: (1) base walking, (2) walking with an additional motor task, (3) walking with an additional mental task. Both groups were well balanced concerning age and gender. To select a smaller number of relevant parameters, affinity propagation clustering was applied on parameter pairwise correlation. The exemplars were then sorted by importance using the random forest algorithm. Classification accuracy of a support vector machine was tested using the selected parameters and compared to the accuracy of the model using a set of parameters derived from literature. RESULTS: Final selection of parameters included: stride length and stride length coefficient of variation (CV), stride time and stride time CV, swing time and swing time CV, step time asymmetry, and heel-to-heel base support CV. Classification performed using these parameters showed higher overall accuracy (85%) than classification using the common parameter set containing: stride time, stride length, swing time and double support time, along with their CVs (78%). CONCLUSION: In early stages of PD, double support time and its CV appear to be weak indicators of the disease. We instead found step time asymmetry and support base CV to significantly contribute to classification accuracy.

22 Article Dynamics of change in self-reported disability among persons with Parkinson's disease after 2 years of follow-up. 2017

Gazibara, Tatjana / Kisic-Tepavcevic, Darija / Svetel, Marina / Tomic, Aleksandra / Stankovic, Iva / Kostic, Vladimir / Pekmezovic, Tatjana. ·Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000, Serbia. · Clinic of Neurology, Faculty of Medicine, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia. · Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, 11000, Serbia. pekmezovic@sezampro.rs. ·Neurol Sci · Pubmed #28502059.

ABSTRACT: Symptoms of Parkinson's disease (PD) progress over time causing significant disability. Yet, change in disability over shorter time periods has not been entirely understood. The purpose of this study was to assess the Self-Assessment Disability Scale (SADS) in persons with Parkinson's disease (PD) after 2 years of follow-up and compare it with the score observed at baseline. Additionally, we aimed at evaluating association of motor and non-motor PD features at baseline with a higher disability after 2 years of follow-up. A total of 120 consecutive persons with PD, who denied falling in the past 6 months, were initially recruited. After 2 years of follow-up, 88 (73.3%) persons with PD were evaluated for SADS. The total disability (SADS) score did not change after follow-up (p = 0.529). We observed increase in difficulty at "Getting out of bed" (p = 0.006), "Getting up out of armchair" (p = 0.013), "Walking about house/flat" (p = 0.003), "Walking outside" (p = 0.010), and "Traveling by public transport" (p = 0.014). After adjusting for several potential confounding factors, falls in the past year (β = 8.32, 95% confidence interval (CI) 1.04-15.59) and higher Unified Parkinson's Disease Rating Scale part 3 at baseline (β = 0.26, 95%CI 0.01-0.51) remained associated with higher PD-related disability. This finding suggests that accumulation of overall PD-related disability tends to occur over a longer time span. Further studies are needed to gradually assess long-term evolution of disability in PD.

23 Article Role of habenula and amygdala dysfunction in Parkinson disease patients with punding. 2017

Markovic, Vladana / Agosta, Federica / Canu, Elisa / Inuggi, Alberto / Petrovic, Igor / Stankovic, Iva / Imperiale, Francesca / Stojkovic, Tanja / Kostic, Vladimir S / Filippi, Massimo. ·From the Neuroimaging Research Unit (V.M., F.A., E.C., F.I., M.F.) and Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience (M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy · Clinic of Neurology, School of Medicine (V.M., I.P., I.S., T.S., V.S.K.), University of Belgrade, Serbia · and Unit of Robotics, Brain and Cognitive Sciences (A.I.), Istituto Italiano di Tecnologia, Genoa, Italy. ·Neurology · Pubmed #28490656.

ABSTRACT: OBJECTIVE: To assess whether a functional dysregulation of the habenula and amygdala, as modulators of the reward brain circuit, contributes to Parkinson disease (PD) punding. METHODS: Structural and resting-state functional MRI were obtained from 22 patients with PD punding, 30 patients with PD without any impulsive-compulsive behavior (ICB) matched for disease stage and duration, motor impairment, and cognitive status, and 30 healthy controls. Resting-state functional connectivity of the habenula and amygdala bilaterally was assessed using a seed-based approach. Habenula and amygdala volumes and cortical thickness measures were obtained. RESULTS: Compared to both healthy controls and PD cases without any ICB (PD-no ICB), PD-punding patients showed higher functional connectivity of habenula and amygdala with thalamus and striatum bilaterally, and lower connectivity between bilateral habenula and left frontal and precentral cortices. In PD-punding relative to PD-no ICB patients, a lower functional connectivity between right amygdala and hippocampus was also observed. Habenula and amygdala volumes were not different among groups. PD-punding patients showed a cortical thinning of the left superior frontal and precentral gyri and right middle temporal gyrus and isthmus cingulate compared to healthy controls, and of the right inferior frontal gyrus compared to both controls and PD-no ICB patients. CONCLUSIONS: A breakdown of the connectivity among the crucial nodes of the reward circuit (i.e., habenula, amygdala, basal ganglia, frontal cortex) might be a contributory factor to punding in PD. This study provides potential instruments to detect and monitor punding in patients with PD.

24 Article The utility of FDG-PET in the differential diagnosis of Parkinsonism. 2017

Brajkovic, Leposava / Kostic, Vladimir / Sobic-Saranovic, Dragana / Stefanova, Elka / Jecmenica-Lukic, Milica / Jesic, Ana / Stojiljkovic, Milica / Odalovic, Strahinja / Gallivanone, Francesca / Castiglioni, Isabella / Radovic, Branislava / Trajkovic, Goran / Artiko, Vera. ·a Center for Nuclear Medicine, Clinical Center of Serbia , Belgrade , Serbia. · b Clinic for Neurology , Clinical Center of Serbia , Belgrade , Serbia. · c Faculty of Medicine , University of Belgrade , Belgrade , Serbia. · d Institute of Molecular Bioimaging and Physiology, National Research Council , Milan , Italy. · e Faculty of Medicine , University of Pristina , Kosovska Mitrovica , Serbia. · f Faculty of Medicine , Institute for Medical Statistcis and Informatics, University of Belgrade , Belgrade , Serbia. ·Neurol Res · Pubmed #28378615.

ABSTRACT: INTRODUCTION: Differential diagnosis of parkinsonian disorders can be difficult on clinical grounds, especially in the early stage. Recent advancements in 18-F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging reveals different patterns of regional glucose metabolism in idiopathic Parkinson's disease (IPD) and atypical parkinsonian syndromes, such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), which may help differentiating between these conditions. PURPOSE: To assess the utility of FDG-PET imaging in differential diagnosis of Parkinsonism in clinical practice. METHODS: FDG-PET was performed in 72 patients with parkinsonism (age 34-80 years) referred to our center by movement disorder specialists. FDG-PET diagnosis was obtained by visual assessment of individual scans combined with voxel-based statistical parametric mapping analysis. FDG-PET diagnosis assigned at the time of imaging was compared with the final clinical diagnosis made by the movement disorder specialists after ≥2 years follow-up. RESULTS: FDG-PET findings were consistent with IPD in 27, MSA in 18, PSP in 19 and CBS in 2 patients. The final clinical diagnosis was IPD in 29, MSA in 20, PSP in 21 and CBS in 2 patients. Concordance between the FDG-PET and clinical diagnoses was 92% in the overall sample (IPD 93%, MSA 90%, PSP 91% and CBS 100%). The diagnostic accuracy of FDG-PET was 93% for IPD and MSA and 97% for PSP. CONCLUSION: FDG-PET may help differentiate between IPD, MSA, PSP and CBS among patients presenting with parkinsonian symptoms, which is important for patient counselling and making early decisions about treatment.

25 Article Structural Brain Connectome and Cognitive Impairment in Parkinson Disease. 2017

Galantucci, Sebastiano / Agosta, Federica / Stefanova, Elka / Basaia, Silvia / van den Heuvel, Martijn P / Stojković, Tanja / Canu, Elisa / Stanković, Iva / Spica, Vladana / Copetti, Massimiliano / Gagliardi, Delia / Kostić, Vladimir S / Filippi, Massimo. ·From the Neuroimaging Research Unit (S.G., F.A., S.B., E.C., D.G., M.F.) and Department of Neurology (M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy · Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (E.S., T.S., I.S., V.S., V.S.K.) · Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands (M.P.v.d.H.) · and Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy (M.C.). ·Radiology · Pubmed #27924721.

ABSTRACT: Purpose To investigate the structural brain connectome in patients with Parkinson disease (PD) and mild cognitive impairment (MCI) and in patients with PD without MCI. Materials and Methods This prospective study was approved by the local ethics committees, and written informed consent was obtained from all subjects prior to enrollment. The individual structural brain connectome of 170 patients with PD (54 with MCI, 116 without MCI) and 41 healthy control subjects was obtained by using deterministic diffusion-tensor tractography. A network-based statistic was used to assess structural connectivity differences among groups. Results Patients with PD and MCI had global network alterations when compared with both control subjects and patients with PD without MCI (range, P = .004 to P = .048). Relative to control subjects, patients with PD and MCI had a large basal ganglia and frontoparietal network with decreased fractional anisotropy (FA) in the right hemisphere and a subnetwork with increased mean diffusivity (MD) involving similar regions bilaterally (P < .01). When compared with patients with PD without MCI, those with PD and MCI had a network with decreased FA, including basal ganglia and frontotemporoparietal regions bilaterally (P < .05). Similar findings were obtained by adjusting for motor disability (P < .05, permutation-corrected P = .06). At P < .01, patients with PD and MCI did not show network alterations relative to patients with PD without MCI. Network FA and MD values were used to differentiate patients with PD and MCI from healthy control subjects and patients with PD without MCI with fair to good accuracy (cross-validated area under the receiver operating characteristic curve [principal + secondary connected components] range, 0.75-0.85). Conclusion A disruption of structural connections between brain areas forming a network contributes to determine an altered information integration and organization and thus cognitive deficits in patients with PD. These results provide novel information concerning the structural substrates of MCI in patients with PD and may offer markers that can be used to differentiate between patients with PD and MCI and patients with PD without MCI.

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