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Parkinson Disease: HELP
Articles by John C. Morgan
Based on 25 articles published since 2008
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Between 2008 and 2019, J. C. Morgan wrote the following 25 articles about Parkinson Disease.
 
+ Citations + Abstracts
1 Guideline Practice Parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. 2010

Zesiewicz, T A / Sullivan, K L / Arnulf, I / Chaudhuri, K R / Morgan, J C / Gronseth, G S / Miyasaki, J / Iverson, D J / Weiner, W J / Anonymous2020653. ·University of South Florida, Tampa, USA. ·Neurology · Pubmed #20231670.

ABSTRACT: OBJECTIVE: Nonmotor symptoms (sleep dysfunction, sensory symptoms, autonomic dysfunction, mood disorders, and cognitive abnormalities) in Parkinson disease (PD) are a major cause of morbidity, yet are often underrecognized. This evidence-based practice parameter evaluates treatment options for the nonmotor symptoms of PD. Articles pertaining to cognitive and mood dysfunction in PD, as well as treatment of sialorrhea with botulinum toxin, were previously reviewed as part of American Academy of Neurology practice parameters and were not included here. METHODS: A literature search of MEDLINE, EMBASE, and Science Citation Index was performed to identify clinical trials in patients with nonmotor symptoms of PD published between 1966 and August 2008. Articles were classified according to a 4-tiered level of evidence scheme and recommendations were based on the level of evidence. RESULTS AND RECOMMENDATIONS: Sildenafil citrate (50 mg) may be considered to treat erectile dysfunction in patients with Parkinson disease (PD) (Level C). Macrogol (polyethylene glycol) may be considered to treat constipation in patients with PD (Level C). The use of levodopa/carbidopa probably decreases the frequency of spontaneous nighttime leg movements, and should be considered to treat periodic limb movements of sleep in patients with PD (Level B). There is insufficient evidence to support or refute specific treatments for urinary incontinence, orthostatic hypotension, and anxiety (Level U). Future research should include concerted and interdisciplinary efforts toward finding treatments for nonmotor symptoms of PD.

2 Editorial Not all that goes "bump in the night" is RLS: leg motor restlessness in PD. 2011

Arnulf, Isabelle / Morgan, John. · ·Neurology · Pubmed #22076545.

ABSTRACT: -- No abstract --

3 Review Constipation in Parkinson's Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle? 2018

Sharma, Amol / Kurek, Julie / Morgan, John C / Wakade, Chandramohan / Rao, Satish S C. ·Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University Medical Center, 1120 15th Street, AD-2226, Augusta, GA, 30912, USA. amosharma@augusta.edu. · Parkinson's Foundation Center of Excellence, Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA. · Department of Physical Therapy, College of Allied Health Sciences, Augusta University & Charlie Norwood VAMC, Augusta, GA, USA. · Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University Medical Center, 1120 15th Street, AD-2226, Augusta, GA, 30912, USA. ·Curr Gastroenterol Rep · Pubmed #29350301.

ABSTRACT: PURPOSE OF REVIEW: Chronic constipation is a common, nonmotor, and prodromal symptom in Parkinson's disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels-brain/brainstem, spinal cord, and enteric nervous system. RECENT FINDINGS: Many recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula. In this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD-a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.

4 Review Treating the Motor Symptoms of Parkinson Disease. 2016

Morgan, John C / Fox, Susan H. · ·Continuum (Minneap Minn) · Pubmed #27495198.

ABSTRACT: PURPOSE OF REVIEW: After a patient is diagnosed with Parkinson disease (PD), there are many therapeutic options available. This article provides examples of prototypical patients encountered in clinical practice and illustrates the various pharmacologic and nonpharmacologic treatment options for the motor symptoms of PD. RECENT FINDINGS: Levodopa became available in the late 1960s and remains the gold standard for the treatment of PD even today. Since that time, amantadine, monoamine oxidase type B inhibitors, dopamine agonists, and catechol-O-methyltransferase inhibitors have emerged as monotherapy, add-on therapies, or both, in the armamentarium against PD. The most appropriate time to start such drugs remains a clinical decision according to patient symptoms. However, earlier use of levodopa is the more common practice due to its superior benefit and the side effects of dopamine agonists. Deep brain stimulation continues to be the most effective treatment for motor symptoms in appropriate patients, and advances in technology may improve efficacy. New ways to deliver levodopa have emerged (effective extended-release oral preparations and levodopa/carbidopa intestinal gel), and these medications provide additional options for certain patients. Exercise and neurorehabilitation are increasingly recognized as important tools to combat the motor symptoms of PD. Nondopaminergic drugs may help non-levodopa-responsive motor symptoms. SUMMARY: Treatment of PD is multifaceted and requires a tailored pharmacotherapeutic and nonpharmacologic approach for a given patient. Patients should be at the center of care, and clinicians should try to provide optimum benefit through the many treatment options available.

5 Review Biomarkers in Parkinson's disease. 2010

Morgan, John C / Mehta, Shyamal H / Sethi, Kapil D. ·Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA. ·Curr Neurol Neurosci Rep · Pubmed #20809400.

ABSTRACT: Biomarkers are objectively measured characteristics that are indicators of normal biological processes, pathogenic processes, or responses to therapeutic interventions. To date, clinical assessment remains the gold standard in the diagnosis of Parkinson's disease (PD) and clinical rating scales are well established as the gold standard for tracking progression of PD. Researchers have identified numerous potential biomarkers that may aid in the differential diagnosis of PD and/or tracking disease progression. Clinical, genetic, blood and cerebrospinal fluid (proteomics, transcriptomics, metabolomics), and neuroimaging biomarkers may provide useful tools in the diagnosis of PD and in measuring disease progression and response to therapies. Some potential biomarkers are inexpensive and do not require much technical expertise, whereas others are expensive or require specialized equipment and technical skills. Many potential biomarkers in PD show great promise; however, they need to be assessed for their sensitivity and specificity over time in large and varied samples of patients with and without PD.

6 Review Neuroimaging and transcranial ultrasonography in Parkinson's disease. 2008

Mehta, Shyamal H / Morgan, John C / Sethi, Kapil D. ·Movement Disorders Program, Department of Neurology, Medical College of Georgia, 1429 Harper Street, HF-1121, Augusta, GA 30912, USA. shmehta@mcg.edu ·Curr Neurol Neurosci Rep · Pubmed #18590613.

ABSTRACT: Parkinson's disease is a progressive, widespread, neurodegenerative disease in which the involvement of the dopaminergic neurons of the substantia nigra results in significant dopamine depletion in the striatum. Newer imaging modalities reviewed here, using various radioligands, positron emission tomography, and single-photon emission computed tomography, have made it possible to assess the in vivo presynaptic and postsynaptic dopaminergic function. This is not only important from a diagnostic standpoint; these tests are being increasingly studied as surrogate markers to assess disease progression and responses to various interventions, including drugs. A brief comment on their role as a putative biomarker of the disease is also included. Because Parkinson's disease involves multiple neurotransmitter systems, neuroimaging of neurotransmitter systems other than dopamine is also discussed. Lastly, the evidence supporting the use of transcranial ultrasonography and substantia nigra hyperechogenicity in the diagnosis of Parkinson's disease is presented, along with some controversies that surround this technique.

7 Review Sleep disorders associated with Parkinson's disease: role of dopamine, epidemiology, and clinical scales of assessment. 2008

Mehta, Shyamal H / Morgan, John C / Sethi, Kapil D. ·Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA. shmehta@mcg.edu ·CNS Spectr · Pubmed #18323761.

ABSTRACT: Sleep dysfunction is common among patients with Parkinson's disease and occurs in approximately two thirds of patients. The problems range from nocturnal issues such as difficulty with sleep initiation, sleep fragmentation, disturbance of circadian rhythm, and rapid eye movement sleep behavior disorder, to daytime problems such as excessive daytime sleepiness. Frequent nighttime awakening and sleep disruption are the most common sleep problems in Parkinson's disease. Dopamine plays an important role in maintaining wakefulness. To improve sleep in Parkinson's disease, it is important to achieve the critical balance of adequate dopaminergic therapy and control of symptoms. Increased dopaminergic agents can cause dyskinesias and painful dystonia, and undertreatment can cause nighttime akinesia, rigidity, and worse quality of sleep. Other nondopaminergic drugs commonly used in Parkinson's disease can also affect sleep. In patients with advanced Parkinson's disease, deep brain stimulation of the subthalamic nucleus has a favorable impact on sleep quality and sleep architecture.

8 Clinical Trial Choice of dopaminergic therapy among early, mild Parkinson disease subjects in North America. 2016

Goudreau, John L / Pérez, Adriana / Aminoff, Michael J / Boyd, James T / Burau, Keith D / Christine, Chadwick W / Leehey, Maureen / Morgan, John C / Anonymous1440871. ·Department of Neurology, Michigan State University, 804 Service Rd Room A217, East Lansing, MI 48824, USA. Electronic address: john.goudreau@hc.msu.edu. · Department of Biostatistics, The University of Texas Health Science Center at Houston, UTHealth, USA. Electronic address: adriana.perez@uth.tmc.edu. · Department of Neurology, University of California San Francisco, 505 Parnassus Ave, Moffitt, San Francisco, CA 94143, USA. Electronic address: Michael.Aminoff@ucsf.edu. · Department of Neurological Sciences, University of Vermont, College of Medicine, 1 So. Prospect Street, UHC - Arnold 2, Burlington, VT 05401, USA. Electronic address: James.Boyd@uvm.edu. · Department of Biostatistics, The University of Texas Health Science Center at Houston, UTHealth, USA. Electronic address: kb_athome@yahoo.com. · Department of Neurology, University of California San Francisco, 505 Parnassus Ave, Moffitt, San Francisco, CA 94143, USA. Electronic address: chad.christine@ucsf.edu. · Department of Neurology, University of Colorado, School of Medicine, Academic Office 1, Mail Stop B-185, 12631 East 17th Avenue, Aurora, CO 80045, USA. Electronic address: maureen.leehey@ucdenver.edu. · Department of Neurology, Georgia Regent's University, 1120 15th St, Augusta, GA 30912, USA. Electronic address: jmorgan@gru.edu. ·J Neurol Sci · Pubmed #27288780.

ABSTRACT: The choice of dopaminergic therapy in early Parkinson disease (PD) is an important clinical decision, yet factors influencing this decision have not been extensively studied. We sought to investigate the factors that may be associated with the choice of dopaminergic therapy at the NINDS Exploratory Trials in PD (NET-PD) Long-Term Study-1 (LS1). NET-PD LS1 was a clinical trial of creatine versus placebo in participants with early, mild PD on stable doses of dopaminergic therapy. Baseline data from 1616 out of the 1741 participants were evaluated using univariable and multivariable logistic or generalized logit regression analyses for available factors associated with the choice of dopaminergic therapy. The dopaminergic therapy choice was determined as: (i) therapy that subjects recalled taking 180days before the study; (ii) therapy at baseline; and (iii) the longest duration of therapy reported by participants. Younger age, higher education level, longer length of time since PD diagnosis and use of an adjunctive, non-dopaminergic or monoamine oxidase inhibitor medication were associated with more frequent use of dopamine agonist compared to levodopa or combination therapy.

9 Clinical Trial Peripheral Biomarkers of Parkinson's Disease Progression and Pioglitazone Effects. 2015

Simon, David K / Simuni, Tanya / Elm, Jordan / Clark-Matott, Joanne / Graebner, Allison K / Baker, Liana / Dunlop, Susan R / Emborg, Marina / Kamp, Cornelia / Morgan, John C / Ross, G Webster / Sharma, Saloni / Ravina, Bernard / Anonymous8080844. ·Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. · Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. · Biostatistics, Medical University of South Carolina, Charleston, SC, USA. · Clinical Trials Coordination Center, University of Rochester, Medical Center, Rochester, NY, USA. · Neurology, Johns Hopkins University, Baltimore, MD, USA. · Wisconsin National Primate Research Center and Department of Medical Physics, University of Wisconsin, Madison, WI, USA. · Clinical Materials Services Unit, University of Rochester, Medical Center, Rochester, NY, USA. · Neurology, Medical College of Georgia, Augusta, GA, USA. · Neurology, Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, USA. · Voyager Therapeutics, Inc., Cambridge, MA, USA. ·J Parkinsons Dis · Pubmed #26444095.

ABSTRACT: Pioglitazone, an oral hypoglycemic agent, recently failed to show promise as a disease-modifying agent in a 44-week phase 2 placebo-controlled study in 210 Parkinson's disease (PD) subjects. We analyzed peripheral biomarkers, including leukocyte PGC-1α and target gene expression, plasma interleukin 6 (IL-6) as a marker of inflammation, and urine 8-hydroxydeoxyguanosine (8OHdG) as a marker of oxidative DNA damage. Baseline or changes from baseline in biomarker levels were not associated with the rate of progression of PD. Pioglitazone did not significantly alter biomarker levels. Other agents that more effectively target these mechanisms remain of potential interest as disease modifying therapies in PD.

10 Article The dimensionality of fatigue in Parkinson's disease. 2018

Chong, Raymond / Albor, Lauren / Wakade, Chandramohan / Morgan, John. ·Department of Interdisciplinary Health Sciences, Augusta University, Augusta, Georgia, USA. rchong@augusta.edu. · Augusta VMAC, Augusta, Georgia, USA. rchong@augusta.edu. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · Department of Interdisciplinary Health Sciences, Augusta University, Augusta, Georgia, USA. · Department of Neurology, Augusta University, Augusta, Georgia, USA. · Augusta VMAC, Augusta, Georgia, USA. ·J Transl Med · Pubmed #29996887.

ABSTRACT: BACKGROUND: Fatigue is a common problem among individuals with Parkinson's disease (PD). It may occur before the overt symptoms of bradykinesia, rigidity and tremor. Little is understood about how to measure fatigue in PD. Here we determined the dimensionality of the constructs of fatigue. METHODS: Four recommended scales, the Fatigue Severity Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, Parkinson Fatigue Scale and Visual Analog Fatigue Scale (VAFS) were tested against quality of life measures including cognition, depression, sleep, life orientation, physical activity and PD symptoms in 22 PD subjects and 15 caregivers. RESULTS: Fatigue was associated with many quality of life variables, with the PDQ-39 summary index showing the strongest association. PD subjects agreed more strongly than caregivers that they experienced higher levels of fatigue. 27% of PD subjects rated fatigue as one of their top three most bothersome symptoms. The constructs of fatigue was captured within one dimension which explained 67% of the total variance, of which the VAFS showed the highest internal consistency. The highest likelihood ratio gave a cut-off score of < 5.5 on the VAFS. The change in scores required to produce a perceptible difference or is grossly observable ranged between 1.4 and 2.2 points respectively. CONCLUSION: The potential utility of a single measure such as the VAFS in PD that is reliably correlated with quality of life is consistent with the pursuit to develop clinical tests and measurements that are accessible, easy to use and universally interpretable across health science disciplines.

11 Article National randomized controlled trial of virtual house calls for Parkinson disease. 2017

Beck, Christopher A / Beran, Denise B / Biglan, Kevin M / Boyd, Cynthia M / Dorsey, E Ray / Schmidt, Peter N / Simone, Richard / Willis, Allison W / Galifianakis, Nicholas B / Katz, Maya / Tanner, Caroline M / Dodenhoff, Kristen / Aldred, Jason / Carter, Julie / Fraser, Andrew / Jimenez-Shahed, Joohi / Hunter, Christine / Spindler, Meredith / Reichwein, Suzanne / Mari, Zoltan / Dunlop, Becky / Morgan, John C / McLane, Dedi / Hickey, Patrick / Gauger, Lisa / Richard, Irene Hegeman / Mejia, Nicte I / Bwala, Grace / Nance, Martha / Shih, Ludy C / Singer, Carlos / Vargas-Parra, Silvia / Zadikoff, Cindy / Okon, Natalia / Feigin, Andrew / Ayan, Jean / Vaughan, Christina / Pahwa, Rajesh / Dhall, Rohit / Hassan, Anhar / DeMello, Steven / Riggare, Sara S / Wicks, Paul / Achey, Meredith A / Elson, Molly J / Goldenthal, Steven / Keenan, H Tait / Korn, Ryan / Schwarz, Heidi / Sharma, Saloni / Stevenson, E Anna / Zhu, William / Anonymous471268. ·From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY · National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL · Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.T.K., R.K., S.S., E.A.S., W.Z.), University of Rochester Medical Center, NY · Division of Geriatric Medicine and Gerontology, Department of Medicine (C.M.B., Z.M., B.D.), Johns Hopkins University School of Medicine, Baltimore, MD · Simone Consulting (R.S.), Sunnyvale, CA · Departments of Neurology and Biostatistics and Epidemiology (A.W.W., M.S., S.R.), University of Pennsylvania Perelman School of Medicine, Philadelphia · University of California San Francisco (N.B.G., M.K., C.M.T., K.D.) · Northwest Neurological, PLLC (J. Aldred), Spokane, WA · Oregon Health and Science University (J.C., A. Fraser), Portland · Baylor College of Medicine (J.J.-S., C.H.), Houston, TX · Augusta University (J.C.M., D.M.), GA · Duke Medical Center (P.H., L.G.), Durham, NC · Massachusetts General Hospital (N.I.M., G.B.), Boston · Struthers Parkinson's Center (M.N.), Minneapolis, MN · Beth Israel Deaconess Medical Center (L.C.S.), Boston, MA · University of Miami (C.S., S.V.-P.), FL · Northwestern University (C.Z., N.O.), Evanston, IL · The Feinstein Institute for Medical Research (A. Feigin, J. Ayan), Northwell Health, Manhasset, NY · Medical University of South Carolina (C.V.), Charleston · University of Kansas Medical Center (R.P.), Kansas City · Parkinson's Institute (R.D.), Sunnyvale, CA · Mayo Clinic (A.H.), Rochester, MN · Center for Information Technology Research in the Interest of Society (CITRIS) (S.D.), University of California, Berkeley · Health Informatics Centre (S.S.R.), Karolinska Institute, Stockholm, Sweden · and PatientsLikeMe (P.W.), Derby, UK. ·Neurology · Pubmed #28814455.

ABSTRACT: OBJECTIVE: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable. METHODS: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings. RESULTS: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; CONCLUSIONS: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. CLINICALTRIALSGOV IDENTIFIER: NCT02038959. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

12 Article Factors associated with falling in early, treated Parkinson's disease: The NET-PD LS1 cohort. 2017

Chou, Kelvin L / Elm, Jordan J / Wielinski, Catherine L / Simon, David K / Aminoff, Michael J / Christine, Chadwick W / Liang, Grace S / Hauser, Robert A / Sudarsky, Lewis / Umeh, Chizoba C / Voss, Tiffini / Juncos, Jorge / Fang, John Y / Boyd, James T / Bodis-Wollner, Ivan / Mari, Zoltan / Morgan, John C / Wills, Anne-Marie / Lee, Stephen L / Parashos, Sotirios A / Anonymous5170905. ·Departments of Neurology and Neurosurgery, University of Michigan, Ann Arbor, MI, United States. Electronic address: klchou@med.umich.edu. · Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States. · Struthers Parkinson's Center, Golden Valley, MN, United States. · Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States. · Department of Neurology, University of California, San Francisco, CA, United States. · Neurocrine Biosciences, Inc., San Diego, CA, United States. · University of South Florida, Parkinson's Disease and Movement Disorders Center, Tampa, FL, United States. · Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States. · Merck & Co., North Wales, PA, United States. · Department of Neurology, Emory University, Atlanta, GA, United States. · Department of Neurology, Vanderbilt University, Nashville, TN, United States. · Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, United States. · Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States. · Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. · Department of Neurology, Medical College of Georgia, Augusta, GA, United States. · Department of Neurology, Massachusetts General Hospital, Boston, MA, United States. · Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States. ·J Neurol Sci · Pubmed #28477684.

ABSTRACT: BACKGROUND: Recognizing the factors associated with falling in Parkinson's disease (PD) would improve identification of at-risk individuals. OBJECTIVE: To examine frequency of falling and baseline characteristics associated with falling in PD using the National Institute of Neurological Disorders and Stroke (NINDS) Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1) dataset. METHODS: The LS-1 database included 1741 early treated PD subjects (median 4year follow-up). Baseline characteristics were tested for a univariate association with post-baseline falling during the trial. Significant variables were included in a multivariable logistic regression model. A separate analysis using a negative binomial model investigated baseline factors on fall rate. RESULTS: 728 subjects (42%) fell during the trial, including at baseline. A baseline history of falls was the factor most associated with post-baseline falling. Men had lower odds of post-baseline falling compared to women, but for men, the probability of a post-baseline fall increased with age such that after age 70, men and women had similar odds of falling. Other baseline factors associated with a post-baseline fall and increased fall rate included the Unified PD Rating Scale (UPDRS) Activities of Daily Living (ADL) score, total functional capacity (TFC), baseline ambulatory capacity score and dopamine agonist monotherapy. CONCLUSION: Falls are common in early treated PD. The biggest risk factor for falls in PD remains a history of falling. Measures of functional ability (UPDRS ADL, TFC) and ambulatory capacity are novel clinical risk factors needing further study. A significant age by sex interaction may help to explain why age has been an inconsistent risk factor for falls in PD.

13 Article Emulation of Physician Tasks in Eye-Tracked Virtual Reality for Remote Diagnosis of Neurodegenerative Disease. 2017

Orlosky, Jason / Itoh, Yuta / Ranchet, Maud / Kiyokawa, Kiyoshi / Morgan, John / Devos, Hannes. · ·IEEE Trans Vis Comput Graph · Pubmed #28129166.

ABSTRACT: For neurodegenerative conditions like Parkinson's disease, early and accurate diagnosis is still a difficult task. Evaluations can be time consuming, patients must often travel to metropolitan areas or different cities to see experts, and misdiagnosis can result in improper treatment. To date, only a handful of assistive or remote methods exist to help physicians evaluate patients with suspected neurological disease in a convenient and consistent way. In this paper, we present a low-cost VR interface designed to support evaluation and diagnosis of neurodegenerative disease and test its use in a clinical setting. Using a commercially available VR display with an infrared camera integrated into the lens, we have constructed a 3D virtual environment designed to emulate common tasks used to evaluate patients, such as fixating on a point, conducting smooth pursuit of an object, or executing saccades. These virtual tasks are designed to elicit eye movements commonly associated with neurodegenerative disease, such as abnormal saccades, square wave jerks, and ocular tremor. Next, we conducted experiments with 9 patients with a diagnosis of Parkinson's disease and 7 healthy controls to test the system's potential to emulate tasks for clinical diagnosis. We then applied eye tracking algorithms and image enhancement to the eye recordings taken during the experiment and conducted a short follow-up study with two physicians for evaluation. Results showed that our VR interface was able to elicit five common types of movements usable for evaluation, physicians were able to confirm three out of four abnormalities, and visualizations were rated as potentially useful for diagnosis.

14 Article Longer Duration of MAO-B Inhibitor Exposure is Associated with Less Clinical Decline in Parkinson's Disease: An Analysis of NET-PD LS1. 2017

Hauser, Robert A / Li, Ruosha / Pérez, Adriana / Ren, Xuehan / Weintraub, Dan / Elm, Jordan / Goudreau, John L / Morgan, John C / Fang, John Y / Aminoff, Michael J / Christine, Chadwick W / Dhall, Rohit / Umeh, Chizoba C / Boyd, James T / Stover, Natividad / Leehey, Maureen / Zweig, Richard M / Nicholas, Anthony P / Bodis-Wollner, Ivan / Willis, Allison / Kieburtz, Karl / Tilley, Barbara C / Anonymous4700889. ·Departments of Neurology, Molecular Pharmacology and Physiology, University of South Florida, Parkinson's Disease and Movement Disorders Center, National Parkinson Foundation Center of Excellence, Tampa FL, USA. · Department of Biostatistics, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA. · Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. · Medical University of South Carolina, Department of Public Health Sciences, Charleston, SC, USA. · Department of Neurology, Michigan State University, East Lansing, MI, USA. · National Parkinson Foundation Center of Excellence, Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA. · Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA. · University of California, San Francisco, Department of Neurology, University of California, San Francisco, CA, USA. · The Parkinson's Institute and Clinical Center, Sunnyvale, CA, USA. · Division of Movement Disorders, Brigham and Women's Hospital, Boston, MA, USA. · Department of Neurological Sciences, University of Vermont, College of Medicine, Burlington, VT, USA. · Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA. · Department of Neurology, University of Colorado, School of Medicine, Aurora, CO, USA. · Department of Neurology, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA, USA. · Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA. · Departments of Neurology and Ophthalmology, Parkinson's Disease and Related Disorders Clinic, Center of Excellence, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. · Department of Neurology, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · University of Rochester, Center for Human Experimental Therapeutics, Rochester, NY, USA. ·J Parkinsons Dis · Pubmed #27911341.

ABSTRACT: BACKGROUND: Monoamine oxidase type B (MAO-B) inhibitors exhibit neuroprotective effects in preclinical models of PD but clinical trials have failed to convincingly demonstrate disease modifying benefits in PD patients. OBJECTIVE: To perform a secondary analysis of NET-PD LS1 to determine if longer duration of MAO-B inhibitor exposure was associated with less clinical decline. METHODS: The primary outcome measure was the Global Outcome (GO), comprised of 5 measures: change from baseline in the Schwab and England (ADL) scale, the 39-item Parkinson's Disease Questionnaire (PDQ-39), the UPDRS Ambulatory Capacity Scale, the Symbol Digit Modalities Test, and the most recent Modified Rankin Scale. A linear mixed model was used to explore the association between the cumulative duration of MAO-B inhibitor exposure and the GO, adjusting for necessary factors and confounders. Associations between MAO-B inhibitor exposure and each of the five GO components were then studied individually. RESULTS: 1616 participants comprised the analytic sample. Mean observation was 4.1 (SD = 1.4) years, and 784 (48.5%) participants received an MAO-B inhibitor. The regression coefficient of cumulative duration of MAO-B inhibitor exposure (in years) on the GO was - 0.0064 (SE = 0.002, p = 0.001). Significant associations between duration of MAO-B inhibitor exposure and less progression were observed for ADL (p < 0.001), Ambulatory Capacity (p < 0.001), and the Rankin (p = 0.002). CONCLUSIONS: Our analysis identified a significant association between longer duration of MAO-B inhibitor exposure and less clinical decline. These findings support the possibility that MAO-B inhibitors slow clinical disease progression and suggest that a definitive prospective trial should be considered.

15 Article Use of a driving simulator to improve on-road driving performance and cognition in persons with Parkinson's disease: A pilot study. 2016

Devos, Hannes / Morgan, John C / Onyeamaechi, Arinze / Bogle, Craig A / Holton, Katie / Kruse, Jonathon / Sasser, Sierra / Akinwuntan, Abiodun E. ·Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA. · Department of Neurology, Georgia Regents University, Augusta, GA, USA. · Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA. ·Aust Occup Ther J · Pubmed #27071987.

ABSTRACT: BACKGROUND/AIM: The use of simulators as an assessment and intervention tool for driving is an emerging field in occupational therapy. We investigated the potential usefulness of a driving simulator to improve on-road skills and cognitive functions in drivers with Parkinson's disease (PD). METHOD: Fifteen participants with PD, and Hoehn and Yahr stages between 2 and 3 participated in this pre-post comparison study. Twelve of the 15 individuals (median age (Q1-Q3), 68 (63.5-72.5); 10 men) completed 10 hours of training in a high-fidelity driving simulator. A practical road test as well as off-road cognitive and simulator tests were administered at pre-training and post-training. RESULTS: Nine participants, who passed the road test before training, passed at post-training. Furthermore, all three participants who initially failed the on-road test passed after training. Participants' performance improved significantly from pre- to post-training on two cognitive tests: (i) the Montreal Cognitive Assessment and (ii) Dot Cancellation test. CONCLUSION: This pilot study demonstrates the potential usefulness of a simulator to improve on-road driving and driving-related cognitive skills in PD. Adequately powered randomized controlled trials are needed to further expand this field of study.

16 Article National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers. 2016

Dorsey, E Ray / Achey, Meredith A / Beck, Christopher A / Beran, Denise B / Biglan, Kevin M / Boyd, Cynthia M / Schmidt, Peter N / Simone, Richard / Willis, Allison W / Galifianakis, Nicholas B / Katz, Maya / Tanner, Caroline M / Dodenhoff, Kristen / Ziman, Nathan / Aldred, Jason / Carter, Julie / Jimenez-Shahed, Joohi / Hunter, Christine / Spindler, Meredith / Mari, Zoltan / Morgan, John C / McLane, Dedi / Hickey, Patrick / Gauger, Lisa / Richard, Irene Hegeman / Bull, Michael T / Mejia, Nicte I / Bwala, Grace / Nance, Martha / Shih, Ludy / Anderson, Lauren / Singer, Carlos / Zadikoff, Cindy / Okon, Natalia / Feigin, Andrew / Ayan, Jean / Vaughan, Christina / Pahwa, Rajesh / Cooper, Jessica / Webb, Sydney / Dhall, Rohit / Hassan, Anhar / Weis, Delana / DeMello, Steven / Riggare, Sara S / Wicks, Paul / Smith, Joseph / Keenan, H Tait / Korn, Ryan / Schwarz, Heidi / Sharma, Saloni / Stevenson, E Anna / Zhu, William. ·1 Department of Neurology, Rochester, New York. · 2 CHET, University of Rochester Medical Center , Rochester, New York. · 3 Duke University School of Medicine , Durham, North Carolina. · 4 Department of Biostatistics, University of Rochester , Rochester, New York. · 5 National Parkinson Foundation , Miami, Florida. · 6 Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland. · 7 Simone Consulting , Sunnyvale, California. · 8 Department of Neurology, Philadelphia, Pennsylvania. · 9 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania. · 10 Department of Neurology, University of California San Francisco , San Francisco, California. · 11 Northwest Neurological, PLLC , Spokane, Washington. · 12 Parkinson Center and Movement Disorders Program, Oregon Health and Science University , Portland, Oregon. · 13 Department of Neurology, Baylor College of Medicine , Houston, Texas. · 14 Department of Neurology and Neurosurgery, Johns Hopkins University , Baltimore, Maryland. · 15 Department of Neurology, Georgia Regents University , Augusta, Georgia . · 16 Department of Neurology, Duke Medical Center , Durham, North Carolina. · 17 Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts. · 18 Struthers Parkinson's Center , Golden Valley, Minnesota. · 19 Department of Neurology, Beth Israel Deaconess Medical Center , Boston, Massachusetts. · 20 Department of Neurology, University of Miami , Miami, Florida. · 21 Department of Neurology, Northwestern University , Evanston, Illinois. · 22 The Feinstein Institute for Medical Research, North Shore-LIJ Health System , Manhasset, New York. · 23 Department of Neurology, Medical University of South Carolina , Charleston, South Carolina. · 24 Department of Neurology, University of Kansas Medical Center , Kansas City, Kansas. · 25 Parkinson's Institute , Sunnyvale, California. · 26 Department of Neurology, Mayo Clinic , Rochester, Minnesota. · 27 Center for Information Technology Research in the Interest of Society, University of California , Berkeley, California. · 28 Health Informatics Centre, Karolinska Institute , Stockholm, Sweden . · 29 PatientsLikeMe, Cambridge, Massachusetts . · 30 West Health Institute , La Jolla, California. ·Telemed J E Health · Pubmed #26886406.

ABSTRACT: BACKGROUND: Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. MATERIALS AND METHODS: Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. RESULTS: During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. CONCLUSIONS: Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.

17 Article Association Between Change in Body Mass Index, Unified Parkinson's Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease: Secondary Analysis of Longitudinal Data From NINDS Exploratory Trials in Parkinson Disease Long-term Study 1. 2016

Wills, Anne-Marie A / Pérez, Adriana / Wang, Jue / Su, Xiao / Morgan, John / Rajan, Suja S / Leehey, Maureen A / Pontone, Gregory M / Chou, Kelvin L / Umeh, Chizoba / Mari, Zoltan / Boyd, James / Anonymous3950854. ·Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston. · Department of Biostatistics, The University of Texas Health Science Center at Houston UTHealth, School of Public Health, Austin. · UTHealth, The University of Texas School of Public Health, Houston. · Department of Neurology, Medical College of Georgia, Georgia Regents University, Augusta. · Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston UTHealth, School of Public Health, Houston. · Department of Neurology, University of Colorado Hospital and University of Colorado School of Medicine, Aurora. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland. · Departments of Neurology and Neurosurgery, University of Michigan, Ann Arbor. · Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Neurology, Johns Hopkins University, Baltimore, Maryland. · Department of Neurological Sciences, University of Vermont College of Medicine, Burlington. ·JAMA Neurol · Pubmed #26751506.

ABSTRACT: IMPORTANCE: Greater body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) is associated with improved survival among persons with Huntington disease or amyotrophic lateral sclerosis. Weight loss is common among persons with Parkinson disease (PD) and is associated with worse quality of life. OBJECTIVE: To explore the association between change in BMI, Unified Parkinson's Disease Rating Scale (UPDRS) motor and total scores, and survival among persons with PD and to test whether there is a positive association between BMI at randomization and survival. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis (from May 27, 2014, to October 13, 2015) of longitudinal data (3-6 years) from 1673 participants who started the National Institute of Neurological Disorders and Stroke Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1). This was a double-blind randomized placebo-controlled clinical trial of creatine monohydrate (10 g/d) that was performed at 45 sites throughout the United States and Canada. Participants with early (within 5 years of diagnosis) and treated (receiving dopaminergic therapy) PD were enrolled from March 2007 to May 2010 and followed up until September 2013. MAIN OUTCOMES AND MEASURES: Change across time in motor UPDRS score, change across time in total UPDRS score, and time to death. Generalized linear mixed models were used to estimate the effect of BMI on the change in motor and total UPDRS scores after controlling for covariates. Survival was analyzed using Cox proportional hazards models of time to death. A participant's BMI was measured at randomization, and BMI trajectory groups were classified according to whether participants experienced weight loss ("decreasing BMI"), weight stability ("stable BMI"), or weight gain ("increasing BMI") during the study. RESULTS: Of the 1673 participants (mean [SD] age, 61.7 [9.6] years; 1074 [64.2%] were male), 158 (9.4%) experienced weight loss (decreasing BMI), whereas 233 (13.9%) experienced weight gain (increasing BMI). After adjusting for covariates, we found that the weight-loss group's mean (SE) motor UPDRS score increased by 1.48 (0.28) (P < .001) more points per visit than the weight-stable group's mean (SE) motor UPDRS score. The weight-gain group's mean (SE) motor UPDRS score decreased by -0.51 (0.24) (P = .03) points per visit, relative to the weight-stable group. While there was an unadjusted difference in survival between the 3 BMI trajectory groups (log-rank P < .001), this was not significant after adjusting for covariates. CONCLUSIONS AND RELEVANCE: Change in BMI was inversely associated with change in motor and total UPDRS scores in the NET-PD LS-1. Change in BMI was not associated with survival; however, these results were limited by the low number of deaths in the NET-PD LS-1. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00449865.

18 Article Interprofessional education increases knowledge, promotes team building, and changes practice in the care of Parkinson's disease. 2016

Cohen, Elaine V / Hagestuen, Ruth / González-Ramos, Gladys / Cohen, Hillel W / Bassich, Celia / Book, Elaine / Bradley, Kathy P / Carter, Julie H / Di Minno, Mariann / Gardner, Joan / Giroux, Monique / González, Manny J / Holten, Sandra / Joseph, Ricky / Kornegay, Denise D / Simpson, Patricia A / Tomaino, Concetta M / Vandendolder, Richard P / Walde-Douglas, Maria / Wichmann, Rosemary / Morgan, John C. ·National Parkinson Foundation, Miami, FL, USA; Parkinson and Movement Disorders Center, New York University Langone School of Medicine, New York, NY, USA. Electronic address: elainevc14@gmail.com. · National Parkinson Foundation, Miami, FL, USA; Struthers Parkinson's Center, Golden Valley, Minneapolis, MN, USA. · National Parkinson Foundation, Miami, FL, USA; Silver School of Social Work at New York University, New York, NY, USA; Parkinson and Movement Disorders Center, New York University Langone School of Medicine, New York, NY, USA. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. · Department of Audiology, Speech-Language Pathology and Deaf Studies, Towson University, Towson, MD, USA. · Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, BC, Canada. · Department of Occupational Therapy, Georgia Regents University (Emeritus), Augusta, GA, USA. · Parkinson Center of Oregon, Oregon Health & Science University, Portland, OR, USA. · Parkinson's Disease Clinic and Research Center, University of California, San Francisco, CA, USA. · Struthers Parkinson's Center, Golden Valley, Minneapolis, MN, USA. · Movement and Neuroperformance Center of Colorado, Englewood, CO, USA. · Silberman School of Social Work at Hunter College, City University of New York, New York, NY, USA. · Department of Occupational Therapy, University of Texas Health Science Center, San Antonio, TX, USA. · Statewide Area Health Education Center, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA. · Simpson & Associates, Temple, TX, USA. · Institute for Music and Neurologic Function, CenterLight Health Systems, Bronx, NY, USA. · Movement and Cognitive Disorders Center, Medical College of Georgia at Georgia Regents University, Augusta, GA, USA. ·Parkinsonism Relat Disord · Pubmed #26620547.

ABSTRACT: OBJECTIVE: Examine outcomes for the National Parkinson Foundation (NPF) Allied Team Training for Parkinson (ATTP), an interprofessional education (IPE) program in Parkinson's disease (PD) and team-based care for medicine, nursing, occupational, physical and music therapies, physician assistant, social work and speech-language pathology disciplines. BACKGROUND: Healthcare professionals need education in evidence-based PD practices and working effectively in teams. Few evidence-based models of IPE in PD exist. METHODS: Knowledge about PD, team-based care, the role of other disciplines and attitudes towards healthcare teams were measured before and after a protocol-driven training program. Knowledge, attitudes and practice changes were again measured at 6-month post-training. Trainee results were compared to results of controls. RESULTS: Twenty-six NPF-ATTP trainings were held across the U.S. (2003-2013). Compared to control participants (n = 100), trainees (n = 1468) showed statistically significant posttest improvement in all major outcomes, including self-perceived (p < 0.001) and objective knowledge (p < 0.001), Understanding Role of Other Disciplines (p < 0.001), Attitudes Toward Health Care Teams Scale (p < 0.001), and the Attitudes Toward Value of Teams (p < 0.001) subscale. Despite some decline, significant improvements were largely sustained at six-month post-training. Qualitative analyses confirmed post-training practice changes. CONCLUSIONS: The NPF-ATTP model IPE program showed sustained positive gains in knowledge of PD, team strategies and role of other disciplines, team attitudes, and important practice improvements. Further research should examine longer-term outcomes, objectively measure practice changes and mediators, and determine impact on patient outcomes.

19 Article Effect of creatine monohydrate on clinical progression in patients with Parkinson disease: a randomized clinical trial. 2015

Anonymous2041224 / Kieburtz, Karl / Tilley, Barbara C / Elm, Jordan J / Babcock, Debra / Hauser, Robert / Ross, G Webster / Augustine, Alicia H / Augustine, Erika U / Aminoff, Michael J / Bodis-Wollner, Ivan G / Boyd, James / Cambi, Franca / Chou, Kelvin / Christine, Chadwick W / Cines, Michelle / Dahodwala, Nabila / Derwent, Lorelei / Dewey, Richard B / Hawthorne, Katherine / Houghton, David J / Kamp, Cornelia / Leehey, Maureen / Lew, Mark F / Liang, Grace S Lin / Luo, Sheng T / Mari, Zoltan / Morgan, John C / Parashos, Sotirios / Pérez, Adriana / Petrovitch, Helen / Rajan, Suja / Reichwein, Sue / Roth, Jessie Tatsuno / Schneider, Jay S / Shannon, Kathleen M / Simon, David K / Simuni, Tanya / Singer, Carlos / Sudarsky, Lewis / Tanner, Caroline M / Umeh, Chizoba C / Williams, Karen / Wills, Anne-Marie. ·University of Rochester, Rochester, New York. · University of Texas Health Science Center at Houston. · Medical University of South Carolina, Charleston. · National Institutes of Health, Bethesda, Maryland. · University of South Florida, Tampa. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · University of California, San Francisco. · State University of New York Downstate Medical Center, Brooklyn. · University of Vermont, Burlington. · University of Kentucky, Lexington. · University of Michigan, Ann Arbor. · University of Maryland School of Medicine, Baltimore. · University of Pennsylvania, Philadelphia. · University of Calgary, Calgary, Alberta, Canada. · University of Texas Southwestern Medical Center, Dallas. · University of Southern California, Los Angeles. · Ochsner Medical Center, New Orleans, Louisiana. · University of Colorado Denver, Aurora. · The Parkinson's Institute and Clinical Center, Sunnyvale, California. · Johns Hopkins University, Baltimore, Maryland. · Georgia Regents University, Augusta. · Struthers Parkinson's Center, Golden Valley, Minnesota. · Thomas Jefferson University, Philadelphia, Pennsylvania. · Rush University Medical Center, Chicago, Illinois. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Northwestern University, Chicago, Illinois. · University of Miami, Miami, Florida. · Brigham and Women's Hospital, Boston, Massachusetts. ·JAMA · Pubmed #25668262.

ABSTRACT: IMPORTANCE: There are no treatments available to slow or prevent the progression of Parkinson disease, despite its global prevalence and significant health care burden. The National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson Disease program was established to promote discovery of potential therapies. OBJECTIVE: To determine whether creatine monohydrate was more effective than placebo in slowing long-term clinical decline in participants with Parkinson disease. DESIGN, SETTING, AND PATIENTS: The Long-term Study 1, a multicenter, double-blind, parallel-group, placebo-controlled, 1:1 randomized efficacy trial. Participants were recruited from 45 investigative sites in the United States and Canada and included 1741 men and women with early (within 5 years of diagnosis) and treated (receiving dopaminergic therapy) Parkinson disease. Participants were enrolled from March 2007 to May 2010 and followed up until September 2013. INTERVENTIONS: Participants were randomized to placebo or creatine (10 g/d) monohydrate for a minimum of 5 years (maximum follow-up, 8 years). MAIN OUTCOMES AND MEASURES: The primary outcome measure was a difference in clinical decline from baseline to 5-year follow-up, compared between the 2 treatment groups using a global statistical test. Clinical status was defined by 5 outcome measures: Modified Rankin Scale, Symbol Digit Modalities Test, PDQ-39 Summary Index, Schwab and England Activities of Daily Living scale, and ambulatory capacity. All outcomes were coded such that higher scores indicated worse outcomes and were analyzed by a global statistical test. Higher summed ranks (range, 5-4775) indicate worse outcomes. RESULTS: The trial was terminated early for futility based on results of a planned interim analysis of participants enrolled at least 5 years prior to the date of the analysis (n = 955). The median follow-up time was 4 years. Of the 955 participants, the mean of the summed ranks for placebo was 2360 (95% CI, 2249-2470) and for creatine was 2414 (95% CI, 2304-2524). The global statistical test yielded t1865.8 = -0.75 (2-sided P = .45). There were no detectable differences (P < .01 to partially adjust for multiple comparisons) in adverse and serious adverse events by body system. CONCLUSIONS AND RELEVANCE: Among patients with early and treated Parkinson disease, treatment with creatine monohydrate for at least 5 years, compared with placebo did not improve clinical outcomes. These findings do not support the use of creatine monohydrate in patients with Parkinson disease. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00449865.

20 Article Parkinson's disease severity and use of dopaminergic medications. 2015

Fang, John Y / Pérez, Adriana / Christine, Chadwick W / Leehey, Maureen / Aminoff, Michael J / Boyd, James T / Morgan, John C / Dhall, Rohit / Nicholas, Anthony P / Bodis-Wollner, Ivan / Zweig, Richard M / Goudreau, John L / Anonymous2560816. ·Department of Neurology, Vanderbilt University, 1161 21st Ave South, A-0118, Nashville, TN 37232, USA. Electronic address: john.y.fang@vanderbilt.edu. · UTHealth, The University of Texas School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA. · Department of Neurology, University of California at San Francisco, 400 Parnassus Ave, Box 0348, San Francisco, CA 94143, USA. · Department of Neurology, University of Colorado School of Medicine, Academic Office 1, Mail Stop B-185, 12631 East 17th Avenue, Aurora, CO 80045, USA. · Department of Neurology, School of Medicine, University of California at San Francisco, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143-0114, USA. · Department of Neurological Sciences, University of Vermont College of Medicine, 1 South Prospect Street, Burlington, VT 05401, USA. · Movement and Cognitive Disorders Center, Department of Neurology, Medical College of Georgia, Georgia Regents University, 1429 Harper Street, HF-1154, Augusta, GA 30912, USA. · Barrow Neurological Institute, 240 W Thomas Road, Suite 301, Phoenix, AZ 85013, USA. · Department of Neurology, University of Alabama at Birmingham and The Birmingham VA Medical Center, 1720 2nd Avenue South, Birmingham, AL 35294, USA. · Department of Neurology, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA; Department of Ophthalmology, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA. · Department of Neurology, LSU Health Sciences Center in Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA. · Department of Neurology, Michigan State University, 804 Service Rd, Room A217, USA. ·Parkinsonism Relat Disord · Pubmed #25541182.

ABSTRACT: BACKGROUND: The effects of dopaminergic therapy in parkinson's disease (PD) can vary depending on the class of medication selected. OBJECTIVE: The aim of this post hoc study was to determine if the class of dopaminergic therapy correlated with disease severity in persons with early, treated PD. METHODS: A non-parametric global statistical test (GST) was used to assess the status of participants treated with dopamine agonist (DA) monotherapy, levodopa (LD) monotherapy or combined LD and DA therapy on multiple PD outcomes encompassing motor, cognitive, psychiatric and autonomic function, as well as disability and quality of life. RESULTS: The outcomes measured at the beginning of the study showed lower disease burden for participants on initial DA monotherapy compared to those taking combined LD and DA therapy after controlling for age, education, taking cog-meds and amantadine. CONCLUSION: This observation suggests that clinicians treating early PD patients favor combined LD and DA therapy in patients with more disabling features over DA monotherapy. As such, studies of PD progression in treated PD patients may be affected by the class of symptomatic dopaminergic therapy.

21 Article Validation of an ambulatory capacity measure in Parkinson disease: a construct derived from the Unified Parkinson's Disease Rating Scale. 2015

Parashos, Sotirios A / Elm, Jordan / Boyd, James T / Chou, Kelvin L / Dai, Lin / Mari, Zoltan / Morgan, John C / Sudarsky, Lewis / Wielinski, Catherine L. ·Struthers Parkinson's Center, Golden Valley, MN, USA. · Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA. · Department of Neurological Sciences, University of Vermont, Burlington, VT, USA. · Department of Neurology and Neurosurgery, University of Michigan, Ann Arbor, MI, USA. · Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA. · Department of Neurology, Georgia Regents University, Augusta, GA, USA. · Department of Neurology, Brigham & Women's Hospital, Boston, MA, USA. ·J Parkinsons Dis · Pubmed #25311202.

ABSTRACT: BACKGROUND: A construct calculated as the sum of items 13-15, 29, 30 of the Unified Parkinson's Disease Rating Scale (UPDRS) has been used as an "Ambulatory Capacity Measure" (ACM) in Parkinson disease (PD). Its construct validity has never been examined. A similar construct, consisting of the mean value of the same UPDRS items has been used under the acronym PIGD as a measure of postural instability and gait disorder in PD. OBJECTIVE: To examine the construct validity of the ACM and PIGD in PD. METHODS: We analyzed data in an existing database of 340 PD patients, Hoehn and Yahr stages (HYS) 1-5 who participated in a study of falls. Number of falls (NOF) was recorded over 4 weeks, and UPDRS (mental, ADL, and motor subscales), HYS, Activities Based Confidence Scale (ABC), Freezing of Gait Questionnaire (FOG), Five Times Sit-to-Stand (FTSS), Timed Up-and Go (TUG), Gait Velocity (GV), and Berg Balance Scale (BBS) evaluations were performed. Internal consistency was assessed by Cronbach's alpha. Construct validity was assessed through correlations of the ACM and PIGD to these measures and to their summed-ranks. A coefficient of determination was calculated through linear regression. RESULTS: Mean age was 71.4, mean age at diagnosis 61.4 years; 46% were women; mean UPDRS subscale scores were: Mental 3.7; ADL 15.7; motor: 27.1; mean ACM was 6.51, and mean PIGD 1.30. Cronbach's alpha was 0.78 for both ACM and PIGD. Spearman correlation coefficients between the ACM/PIGD and ABC, FOG, TUG, GV and BBS were 0.69, 0.72, 0.67, 0.58, and 0.70 respectively. Correlation between the ACM/PIGD and summed-ranks of HYS, NOF, ABC, FOG, FTSS, TUG, GV and BBS was high (Spearman r = 0.823, p < 0.0001); 68% of the variability in the summed-ranks was explained by ACM/PIGD. CONCLUSION: The ACM and the PIGD are valid global measures and accurately reflect the combined effects of the various components of ambulatory capacity in PD patients with HY stages 1-4.

22 Article Upregulation of GPR109A in Parkinson's disease. 2014

Wakade, Chandramohan / Chong, Raymond / Bradley, Eric / Thomas, Bobby / Morgan, John. ·Department of Physical Therapy, Georgia Regents University, Augusta, Georgia, United States of America. · Department of Pharmacology & Toxicology and Neurology, Georgia Regents University, Augusta, Georgia, United States of America. · Department of Neurology, Georgia Regents University, Augusta, Georgia, United States of America. ·PLoS One · Pubmed #25329911.

ABSTRACT: BACKGROUND: Anecdotal animal and human studies have implicated the symptomatic and neuroprotective roles of niacin in Parkinson's disease (PD). Niacin has a high affinity for GPR109A, an anti-inflammatory receptor. Niacin is also thought to be involved in the regulation of circadian rhythm. Here we evaluated the relationships among the receptor, niacin levels and EEG night-sleep in individuals with PD. METHODS AND FINDINGS: GPR109A expression (blood and brain), niacin index (NAD-NADP ratio) and cytokine markers (blood) were analyzed. Measures of night-sleep function (EEG) and perceived sleep quality (questionnaire) were assessed. We observed significant up-regulation of GPR109A expression in the blood as well as in the substantia nigra (SN) in the PD group compared to age-matched controls. Confocal microscopy demonstrated co-localization of GPR109A staining with microglia in PD SN. Pro and anti-inflammatory cytokines did not show significant differences between the groups; however IL1-β, IL-4 and IL-7 showed an upward trend in PD. Time to sleep (sleep latency), EEG REM and sleep efficiency were different between PD and age-matched controls. Niacin levels were lower in PD and were associated with increased frequency of experiencing body pain and decreased duration of deep sleep. CONCLUSIONS: The findings of associations among the GPR109A receptor, niacin levels and night-sleep function in individuals with PD are novel. Further studies are needed to understand the pathophysiological mechanisms of action of niacin, GPR109A expression and their associations with night-sleep function. It would be also crucial to study GPR109A expression in neurons, astrocytes, and microglia in PD. A clinical trial to determine the symptomatic and/or neuroprotective effect of niacin supplementation is warranted.

23 Article Mobility, mood and site of care impact health related quality of life in Parkinson's disease. 2014

Nutt, J G / Siderowf, A D / Guttman, M / Schmidt, P N / Zamudio, J I / Wu, S S / Okun, M S / Simuni, T / Parashos, S A / Dahodwala, N A / Davis, T L / Giladi, N / Gurevich, T / Hauser, R A / Jankovic, J / Lyons, K E / Marsh, L / Miyasaki, J M / Morgan, J C / Santiago, A J / Tarsy, D / Mari, Z / Malaty, I A / Nelson, E C / Anonymous990774. ·Oregon Health & Science University, USA. Electronic address: nuttj@ohsu.edu. · University of Pennsylvania, USA. · University of Toronto, USA. · National Parkinson Foundation, USA. · University of Florida, USA. · National Parkinson Foundation, USA; University of Florida, USA. · Northwestern University, USA. · Struthers Parkinson Center, USA. · Vanderbilt University, USA. · Tel Aviv Sourasky Medical Center, USA. · University of South Florida, USA. · Baylor College of Medicine, USA. · University of Kansas, USA. · DeBakey Veterans Affairs Medical Center, USA. · Toronto Western University, USA. · Georgia Regents University, USA. · Muhammad Ali Parkinson Center, USA; Barrow Neurological Institute, USA. · Beth Israel Medical Center, USA. · Johns Hopkins Medical Center, USA. · Dartmouth-Hitchcock Medical Center, USA. ·Parkinsonism Relat Disord · Pubmed #24182524.

ABSTRACT: OBJECTIVE: Examine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs). BACKGROUND: Improving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery. METHODS: This cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL. RESULTS: The variability in the PDQ-39 summary index score correlated with H&Y stage (R(2) = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL. CONCLUSIONS: We confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices.

24 Article Nintendo Wii rehabilitation ("Wii-hab") provides benefits in Parkinson's disease. 2013

Herz, Nathan B / Mehta, Shyamal H / Sethi, Kapil D / Jackson, Paula / Hall, Patricia / Morgan, John C. ·Movement Disorders Program, Department of Neurology, Georgia Regents University, 1429 Harper Street, HF-1154, Augusta, GA 30912, USA. ·Parkinsonism Relat Disord · Pubmed #23968649.

ABSTRACT: Parkinson's disease (PD) impairs both activities of daily living (ADLs) and motor function and has adverse effects on mood in many patients. While dopaminergic medications are quite helpful for motor and ADLs impairments in PD, complementary therapies are also important in helping patients achieve maximum benefits and quality of life. We hypothesized that the Nintendo Wii (Wii) is a useful tool in improving motor and non-motor aspects in patients with PD, given its ability to drive functional movements and interactive nature. We enrolled twenty subjects with early to mid-stage PD in an open-label within-subjects study design where each subject was evaluated at baseline and then re-evaluated after playing the Wii three times per week for four weeks. Subjects were then re-evaluated one month later after not playing the Wii for a month to see if effects carried over. Subjects demonstrated significant improvements in the primary outcome measure (Nottingham Extended Activities of Daily Living Test (NEADL)), quality of life (PDQ-39) and motor function (UPDRS), and a trend toward improved mood (HAM-D) after four weeks of Wii therapy. Follow-up assessments one month later showed continued improvement for quality of life and UPDRS scores. The results demonstrate that Wii therapy provides short-term motor, non-motor, and quality of life benefits in PD. Further studies are needed to determine if there are long-term benefits of Wii therapy in PD.

25 Article Diagnosis of pheochromocytoma in the setting of Parkinson disease. 2009

Mehta, Shyamal H / Prakash, Rajan / Prisant, L Michael / Isales, Carlos M / Morgan, John C / Williams, Hadyn / Sethi, Kapil D. ·Movement Disorders Program, Department of Neurology, Medical College of Georgia, 1429 Harper Street, Augusta, GA 30912, USA. shmehta@mcg.edu ·Nat Rev Neurol · Pubmed #19498437.

ABSTRACT: BACKGROUND: A 59-year-old man with a 7-year history of Parkinson disease (PD) presented with episodes of sudden, severe headaches with neck pain, tachycardia, sweating and pallor. During these episodes, the patient showed marked elevations in blood pressure, regardless of posture. This was unusual, given that he had no prior history of hypertension. The array of symptoms raised suspicions of pheochromocytoma, but diagnosis was challenging, as the standard diagnostic biochemical tests were confounded by dopaminergic medications. Further work-up revealed left adrenal medullary hyperplasia. Several reports exist of pseudopheochromocytoma in patients on dopaminergic therapy, but this is the first documented case of pheochromocytoma syndrome due to adrenal medullary hyperplasia in a patient with PD. This case highlights the challenges of performing a diagnostic work-up in a PD patient with symptoms suggestive of pheochromocytoma, and illustrates the utility of (123)I-metaiodobenzylguanidine ((123)I-MIBG) single-photon emission CT in making a diagnosis.Investigations. Physical examination, laboratory tests, abdominal MRI scan, abdominal (123)I-MIBG scan, abdominal (18)F-fluorodeoxyglucose PET scan. DIAGNOSIS: Pheochromocytoma syndrome due to adrenal medullary hyperplasia.Management. Surgical excision of the left adrenal gland.