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Parkinson Disease: HELP
Articles by Cindy Zadikoff
Based on 15 articles published since 2009
(Why 15 articles?)
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Between 2009 and 2019, C. Zadikoff wrote the following 15 articles about Parkinson Disease.
 
+ Citations + Abstracts
1 Clinical Trial Long-term safety and maintenance of efficacy of levodopa-carbidopa intestinal gel: an open-label extension of the double-blind pivotal study in advanced Parkinson's disease patients. 2015

Slevin, John T / Fernandez, Hubert H / Zadikoff, Cindy / Hall, Coleen / Eaton, Susan / Dubow, Jordan / Chatamra, Krai / Benesh, Janet. ·University of Kentucky Medical Center, Lexington, KY, USA. · Cleveland Clinic, Cleveland, OH, USA. · Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · AbbVie Inc., North Chicago, IL, USA. ·J Parkinsons Dis · Pubmed #25588353.

ABSTRACT: BACKGROUND: Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via intrajejunal percutaneous gastrostomy tube. OBJECTIVE: To examine long-term safety, efficacy and quality of life of LCIG in an open-label extension study. METHODS: Patients received 52 weeks of open-label LCIG treatment following a 12-week double-blind, double-dummy trial in which they were randomized to either LCIG or immediate-release oral levodopa-carbidopa. Patient cohort designation was by receipt of LCIG in the preceding trial randomization (continuing-LCIG vs. LCIG-naïve patients). RESULTS: Sixty-two of 66 subjects in the double-blind proceeded to the open-label extension. Most subjects (95%) reported ≥1 adverse event (AE); only 3 subjects (4.8%) discontinued due to AEs. AE incidence declined gradually over 52 weeks. Serious AEs were reported by 23%. LCIG-naïve patients (N = 29) showed a decrease in "Off" time and an increase in "On" time without troublesome dyskinesia (change from baseline to final visit in mean [SD] hours = -2.34 [2.78] P < 0.001 and 2.19 [3.70] P = 0.005, respectively), while continuing-LCIG patients (N = 33) showed sustained "Off" time duration and further improvement in "On" time without troublesome dyskinesia (-0.42 [2.67] P = 0.377 and 1.00 [2.58] P = 0.036, respectively). The majority of patients in both groups (LCIG-naïve, continuing-LCIG, respectively) were rated 'Much Improved' or 'Very Much Improved' at final visit on the Clinical Global Impression-Improvement scale (69.0%, 69.7%). CONCLUSIONS: Continuing-LCIG patients continued to derive benefit from LCIG while the magnitude of improvement among LCIG-naïve patients was similar to that observed for patients on LCIG in the preceding double-blind study. The overall AE profile was consistent with previous phase 3 clinical trials involving the LCIG system.

2 Clinical Trial A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit. 2014

Anonymous1090789 / Beal, M Flint / Oakes, David / Shoulson, Ira / Henchcliffe, Claire / Galpern, Wendy R / Haas, Richard / Juncos, Jorge L / Nutt, John G / Voss, Tiffini Smith / Ravina, Bernard / Shults, Clifford M / Helles, Karen / Snively, Victoria / Lew, Mark F / Griebner, Brian / Watts, Arthur / Gao, Shan / Pourcher, Emmanuelle / Bond, Louisette / Kompoliti, Katie / Agarwal, Pinky / Sia, Cherissa / Jog, Mandar / Cole, Linda / Sultana, Munira / Kurlan, Roger / Richard, Irene / Deeley, Cheryl / Waters, Cheryl H / Figueroa, Angel / Arkun, Ani / Brodsky, Matthew / Ondo, William G / Hunter, Christine B / Jimenez-Shahed, Joohi / Palao, Alicia / Miyasaki, Janis M / So, Julie / Tetrud, James / Reys, Liza / Smith, Katharine / Singer, Carlos / Blenke, Anita / Russell, David S / Cotto, Candace / Friedman, Joseph H / Lannon, Margaret / Zhang, Lin / Drasby, Edward / Kumar, Rajeev / Subramanian, Thyagarajan / Ford, Donna Stuppy / Grimes, David A / Cote, Diane / Conway, Jennifer / Siderowf, Andrew D / Evatt, Marian Leslie / Sommerfeld, Barbara / Lieberman, Abraham N / Okun, Michael S / Rodriguez, Ramon L / Merritt, Stacy / Swartz, Camille Louise / Martin, W R Wayne / King, Pamela / Stover, Natividad / Guthrie, Stephanie / Watts, Ray L / Ahmed, Anwar / Fernandez, Hubert H / Winters, Adrienna / Mari, Zoltan / Dawson, Ted M / Dunlop, Becky / Feigin, Andrew S / Shannon, Barbara / Nirenberg, Melissa Jill / Ogg, Mattson / Ellias, Samuel A / Thomas, Cathi-Ann / Frei, Karen / Bodis-Wollner, Ivan / Glazman, Sofya / Mayer, Thomas / Hauser, Robert A / Pahwa, Rajesh / Langhammer, April / Ranawaya, Ranjit / Derwent, Lorelei / Sethi, Kapil D / Farrow, Buff / Prakash, Rajan / Litvan, Irene / Robinson, Annette / Sahay, Alok / Gartner, Maureen / Hinson, Vanessa K / Markind, Samuel / Pelikan, Melisa / Perlmutter, Joel S / Hartlein, Johanna / Molho, Eric / Evans, Sharon / Adler, Charles H / Duffy, Amy / Lind, Marlene / Elmer, Lawrence / Davis, Kathy / Spears, Julia / Wilson, Stephanie / Leehey, Maureen A / Hermanowicz, Neal / Niswonger, Shari / Shill, Holly A / Obradov, Sanja / Rajput, Alex / Cowper, Marilyn / Lessig, Stephanie / Song, David / Fontaine, Deborah / Zadikoff, Cindy / Williams, Karen / Blindauer, Karen A / Bergholte, Jo / Propsom, Clara Schindler / Stacy, Mark A / Field, Joanne / Mihaila, Dragos / Chilton, Mark / Uc, Ergun Y / Sieren, Jeri / Simon, David K / Kraics, Lauren / Silver, Althea / Boyd, James T / Hamill, Robert W / Ingvoldstad, Christopher / Young, Jennifer / Thomas, Karen / Kostyk, Sandra K / Wojcieszek, Joanne / Pfeiffer, Ronald F / Panisset, Michel / Beland, Monica / Reich, Stephen G / Cines, Michelle / Zappala, Nancy / Rivest, Jean / Zweig, Richard / Lumina, L Pepper / Hilliard, Colette Lynn / Grill, Stephen / Kellermann, Marye / Tuite, Paul / Rolandelli, Susan / Kang, Un Jung / Young, Joan / Rao, Jayaraman / Cook, Maureen M / Severt, Lawrence / Boyar, Karyn. ·Department of Neurology, Weill Cornell Medical College, New York Hospital, New York. · Department of Biostatistics, University of Rochester Medical Center, Rochester, New York. · Department of Neurology, Georgetown University, Washington, DC. · National Institutes of Health, Bethesda, Maryland. · Department of Neurosciences, University of California, San Diego, La Jolla. · Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia. · Department of Neurology, Oregon Health and Science University, Portland. · Merck, New Jersey. · Biogen Idec, Cambridge, Massachusetts. · Department of Neurosciences, University of California, San Diego, La Jolla10VA Medical Center, San Diego, California. · Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles. · Department of Biostatistics, University of Rochester Medical Center, Rochester, New York12Department of Neurology, University of Rochester, Rochester, New York. · Québec Memory and Motor Skills Disorders Research Center, Clinique Sainte-Anne, Québec, Canada. · Rush University Medical Center, Chicago, Illinois. · Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington. · London Health Sciences Centre, London, Ontario, Canada. · Overlook Medical Center, Atlantic Neuroscience Institute, Summit, New Jersey. · Department of Neurology, University of Rochester, Rochester, New York. · Columbia University Medical Center, Neurological Institute, New York, New York. · Department of Neurology, University of Texas Health Science Center at Houston. · Department of Neurology, Baylor College of Medicine, Houston, Texas. · Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. · The Parkinson's Institute and Clinical Center, Sunnyvale, California. · Department of Neurology, University of Miami School of Medicine, Miami, Florida. · Institute for Neurodegenerative Disorders, New Haven, Connecticut. · Department of Neurology, Butler Hospital, Providence, Rhode Island26Alpert Medical School, Brown University, Providence, Rhode Island. · Department of Neurology, Butler Hospital, Providence, Rhode Island27Port City Neurology, Inc, Scarborough, Maine. · Department of Neurology, University of California, Davis, School of Medicine and Sacramento VA Medical Center, Sacramento. · Port City Neurology, Inc, Scarborough, Maine. · Colorado Neurological Institute, Englewood. · Milton S. Hershey Medical Center, Department of Neurology, Pennsylvania State Hershey College of Medicine, Hershey. · Ottawa Hospital Civic Site, Ottawa, Ontario, Canada. · Avid Radiopharmaceuticals, Philadelphia, Pennsylvania. · Department of Neurology, Emory University School of Medicine, Wesley Woods Center, Atlanta, Georgia33Atlanta VA Medical Center, Atlanta, Georgia. · Muhammad Ali Parkinson Center, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville. · Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada. · Department of Neurology, University of Alabama at Birmingham. · Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio. · Department of Neurology, Johns Hopkins University, Baltimore, Maryland. · Feinstein Institute for Medical Research, Center for Neurosciences, Manhasset, New York. · Department of Neurology, New York University Langone Medical Center, New York. · Department of Neurology, Boston University School of Medicine, Boston, Massachusetts. · The Parkinson's and Movement Disorder Institute, Fountain Valley, California. · State University of New York, Downstate Medical Center, Brooklyn, New York. · Department of Neurology, University of South Florida, Tampa. · Department of Neurology, University of Kansas Medical Center, Kansas City. · Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. · Department of Neurology, Georgia Health Science University, Augusta. · Department of Neurology, University of Louisville, Kentucky. · University of Cincinnati College of Medicine, Cincinnati, Ohio. · Department of Neurology, Medical University of South Carolina, Charleston. · Associated Neurologists, PC, Danbury, Connecticut. · Department of Neurology, Washington University in St Louis, Missouri. · Movement Disorders Center, Albany Medical Center, Albany, New York. · Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona. · Center for Neurological Health, University of Toledo, Toledo, Ohio. · Department of Neurology, Medical University of Ohio at Toledo. · Department of Neurology, University of Colorado Health Science Center, Denver. · Department of Neurology, University of California, Irvine Medical Center, Irvine. · Banner Sun Health Research Institute, Sun City, Arizona. · Department of Neurology, University of Saskatchewan, Royal University Hospital, Saskatchewan, Canada. · Department of Neurology, University of California, San Diego, La Jolla. · Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Neurology, Medical College of Wisconsin, Milwaukee. · Department of Neurology, Duke University, Durham, North Carolina. · State University of New York Upstate Medical Center and Syracuse VA Medical Center, Syracuse. · Department of Neurology, University of Iowa, Iowa City. · Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. · Department of Neurology, University of Vermont College of Medicine, Burlington. · Department of Neurology, Ohio State University, Columbus. · Department of Neurology, Indiana University School of Medicine, Indianapolis. · Department of Neurology, University of Tennessee Health Science Center, Memphis. · Department of Neurology, CHUM-Hôpital Notre-Dame, Montréal, Québec, Canada. · Department of Neurology, University of Maryland School of Science, Baltimore. · Department of Neurology, University of Sherbrooke, Québec, Canada. · Department of Neurology, Louisiana State University Health Science Center, Shreveport. · Lewis Hall Singletary Oncology Center, Thomasville, Georgia. · Parkinson and Movement Disorders Center of Maryland, Elkridge. · Department of Neurology, University of Minnesota, Minneapolis. · Department of Neurology, University of Chicago, Chicago, Illinois. · Department of Neurology, Ochsner Clinic Foundation, New Orleans, Louisiana. · Department of Neurology, Beth Israel Medical Center, New York, New York. ·JAMA Neurol · Pubmed #24664227.

ABSTRACT: IMPORTANCE: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE: To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS: A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS: The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES: Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS: The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE: Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00740714.

3 Clinical Trial Tolerability of isradipine in early Parkinson's disease: a pilot dose escalation study. 2010

Simuni, Tanya / Borushko, Emily / Avram, Michael J / Miskevics, Scott / Martel, Audrey / Zadikoff, C / Videnovic, Aleksandar / Weaver, Frances M / Williams, Karen / Surmeier, D James. ·Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. tsimuni@nmff.org ·Mov Disord · Pubmed #20818667.

ABSTRACT: Recent data suggests that isradipine, a dihydropyridine calcium channel blocker, is neuroprotective in preclinical models of parkinsonism. Isradipine has not been systematically studied in patients with Parkinson's disease (PD). The aim of this study was to evaluate safety and tolerability of isradipine controlled release (CR) in patients with early PD. Qualified subjects (n = 31) received isradipine CR, titrated from 5 to 20 mg daily dose over 8 weeks as tolerated. Eighty-one percent of subjects completed the study. Tolerability of isradipine CR was dose dependent: 94% for 5 mg dose; 87% for 10 mg; 68% for 15 mg; and 52% for 20 mg. Isradipine had no significant effect on blood pressure or PD motor disability. The two most common reasons for dose reduction were leg edema (7) and dizziness (3). There was no difference in isradipine tolerability between subjects with and without dopaminergic treatment, or with and without hypertension.

4 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.

5 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.

6 Article Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. 2016

Lang, Anthony E / Rodriguez, Ramon L / Boyd, James T / Chouinard, Sylvain / Zadikoff, Cindy / Espay, Alberto J / Slevin, John T / Fernandez, Hubert H / Lew, Mark F / Stein, David A / Odin, Per / Fung, Victor S C / Klostermann, Fabian / Fasano, Alfonso / Draganov, Peter V / Schmulewitz, Nathan / Robieson, Weining Z / Eaton, Susan / Chatamra, Krai / Benesh, Janet A / Dubow, Jordan. ·Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. · University of Florida College of Medicine, Gainesville, Florida, USA. · University of Vermont College of Medicine, Burlington, Vermont, USA. · University of Montreal, Montreal, Quebec, Canada. · Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA. · University of Kentucky Medical Center, Lexington, Kentucky, USA. · Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA. · Keck/University of Southern California School of Medicine, Los Angeles, California, USA. · Quintiles, San Diego, California, USA. · Klinikim-Bremerhaven, Germany and Skane University Hospital, Lund, Sweden. · Westmead Hospital and Sydney Medical School, Sydney, Australia. · Charité-University Medicine Berlin, Berlin, Germany. · AbbVie Inc, North Chicago, Illinois, USA. ·Mov Disord · Pubmed #26695437.

ABSTRACT: BACKGROUND: Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy. METHODS: Safety data from 4 studies were summarized using 2 overlapping data sets, permitting the separation of procedure/device-associated (n = 395) from non-procedure/device adverse events (n = 412). RESULTS: At the data cutoff, median exposure to levodopa-carbidopa intestinal gel was 911 days (range, 1-1980 days) with 963 total patient-years of exposure. Procedure/device adverse events occurred in 300 patients (76%), and serious adverse events occurred in 68 (17%); most frequently reported procedure/device adverse events and serious adverse events were complications of device insertion (41% and 8%, respectively) and abdominal pain (36% and 4%, respectively). Non-procedure/device adverse events occurred in 92% (379), with most frequently reported being insomnia (23%) and falls (23%); 42% (171) had non-procedure/device serious adverse events, with most frequently reported being pneumonia (5%) and PD symptoms (2%). Adverse events led to discontinuation in 17% (72), most frequently because of complication of device insertion (2.4%). There were 34 treatment-emergent deaths (8.3%) in the overlapping data sets, 2 of which (0.5%) were considered "possibly related" to the treatment system. CONCLUSION: In the largest collection of levodopa-carbidopa intestinal gel safety data from prospective clinical studies, procedure/device events were frequently reported and occasionally life threatening. Most non-procedure/device events were typical for levodopa treatment and an elderly population. These factors combined with high treatment efficacy led to a relatively low discontinuation rate in advanced PD patients.

7 Article Circadian melatonin rhythm and excessive daytime sleepiness in Parkinson disease. 2014

Videnovic, Aleksandar / Noble, Charleston / Reid, Kathryn J / Peng, Jie / Turek, Fred W / Marconi, Angelica / Rademaker, Alfred W / Simuni, Tanya / Zadikoff, Cindy / Zee, Phyllis C. ·Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts2Department of Neurology, Northwestern University, Chicago, Illinois. · Department of Neurology, Northwestern University, Chicago, Illinois3Department of Physics, Lund University, Lund, Sweden. · Department of Neurology, Northwestern University, Chicago, Illinois. · Department of Preventive Medicine, Northwestern University, Chicago, Illinois. · Department of Neurobiology, Northwestern University, Chicago, Illinois. ·JAMA Neurol · Pubmed #24566763.

ABSTRACT: IMPORTANCE: Diurnal fluctuations of motor and nonmotor symptoms and a high prevalence of sleep-wake disturbances in Parkinson disease (PD) suggest a role of the circadian system in the modulation of these symptoms. However, surprisingly little is known regarding circadian function in PD and whether circadian dysfunction is involved in the development of sleep-wake disturbances in PD. OBJECTIVE: To determine the relationship between the timing and amplitude of the 24-hour melatonin rhythm, a marker of endogenous circadian rhythmicity, with self-reported sleep quality, the severity of daytime sleepiness, and disease metrics. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study from January 1, 2009, through December 31, 2012, of 20 patients with PD receiving stable dopaminergic therapy and 15 age-matched control participants. Both groups underwent blood sampling for the measurement of serum melatonin levels at 30-minute intervals for 24 hours under modified constant routine conditions at the Parkinson's Disease and Movement Disorders Center of Northwestern University. INTERVENTIONS: Twenty-four hour monitoring of serum melatonin secretion. MAIN OUTCOMES AND MEASURES: Clinical and demographic data, self-reported measures of sleep quality (Pittsburgh Sleep Quality Index) and daytime sleepiness (Epworth Sleepiness Scale), and circadian markers of the melatonin rhythm, including the amplitude, area under the curve (AUC), and phase of the 24-hour rhythm. RESULTS: Patients with PD had blunted circadian rhythms of melatonin secretion compared with controls; the amplitude of the melatonin rhythm and the 24-hour AUC for circulating melatonin levels were significantly lower in PD patients (P < .001). Markers of the circadian phase were not significantly different between the 2 groups. Compared with PD patients without excessive daytime sleepiness, patients with excessive daytime sleepiness (Epworth Sleepiness Scale score ≥10) had a significantly lower amplitude of the melatonin rhythm and 24-hour melatonin AUC (P = .001). Disease duration, Unified Parkinson's Disease Rating Scale scores, levodopa equivalent dose, and global Pittsburgh Sleep Quality Index score in the PD group were not significantly related to measures of the melatonin circadian rhythm. CONCLUSIONS AND RELEVANCE: Circadian dysfunction may underlie excessive sleepiness in PD. The nature of this association needs to be explored further in longitudinal studies. Approaches aimed to strengthen circadian function, such as timed exposure to bright light and exercise, might serve as complementary therapies for the nonmotor manifestations of PD.

8 Article Deep brain stimulation improves movement amplitude but not hastening of repetitive finger movements. 2013

Stegemöller, Elizabeth L / Zadikoff, Cindy / Rosenow, Joshua M / Mackinnon, Colum D. ·Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA. Electronic address: estegemoller@hhp.ufl.edu. ·Neurosci Lett · Pubmed #23941889.

ABSTRACT: External pacing cues, dopaminergic medication, and bilateral subthalamic nucleus deep brain stimulation (STN-DBS) improve repetitive movements performed at low rates. When the pacing rate is increased to frequencies near 2 Hz and above, both external pacing cues and Parkinson's medication were shown to be ineffective at improving repetitive finger movement performance. It remains unclear if STN-DBS improves the performance of repetitive finger movements at high pacing rates. This study examined the effects of STN-DBS on the amplitude and rate of repetitive finger movement across a range of external pacing rates. Nine participants with STN-DBS (OFF and ON stimulation) and nine matched healthy adults performed repetitive index finger flexion movements paced by an acoustic tone that increased from 1.0 to 3.0 Hz. OFF stimulation, most subjects moved at rates that were substantially higher (hastening pattern) or lower (bradykinesia pattern) than the tone rate, particularly at high pacing rates. ON stimulation, movement rate improved in subjects with the bradykinesia pattern, but not in those with the hastening pattern. Overall, STN-DBS did not significantly affect movement rate. In contrast, STN-DBS significantly (p<0.05) improved movement amplitude across all pacing rates. These findings demonstrate that STN-DBS improves movement amplitude, but had no effect on the rate of movement in participants with a hastening pattern. Separately testing movement amplitude and movement rate using both high and low rate externally paced cues in the clinical environment may aid in the diagnosis and treatment of people with Parkinson's disease.

9 Article Impact of mild cognitive impairment on health-related quality of life in Parkinson's disease. 2013

Reginold, William / Duff-Canning, Sarah / Meaney, Christopher / Armstrong, Melissa J / Fox, Susan / Rothberg, Brandon / Zadikoff, Cindy / Kennedy, Nancy / Gill, David / Eslinger, Paul / Marshall, Fred / Mapstone, Mark / Chou, Kelvin L / Persad, Carol / Litvan, Irene / Mast, Benjamin / Tang-Wai, David / Lang, Anthony E / Marras, Connie. ·Toronto Western Hospital, Toronto, Ont., Canada. ·Dement Geriatr Cogn Disord · Pubmed #23774742.

ABSTRACT: BACKGROUND/AIMS: To assess the impact of mild cognitive impairment (MCI) or cognitive decline on health-related quality of life (HR-QOL) in Parkinson's disease (PD). METHODS: HR-QOL measured by the Parkinson Disease Quality of Life Questionnaire (PDQ-39), MCI according to Movement Disorder Society Task Force criteria and cognitive decline from premorbid baseline were assessed in non-demented PD patients at 6 movement disorder clinics. RESULTS: Among 137 patients, after adjusting for education, gender, disease duration, and Movement Disorder Society Unified Parkinson's Disease Rating Scale total score, MCI was associated with worse scores within the PDQ-39 dimension of communication (p = 0.008). Subjects were divided into tertiles of cognitive decline from premorbid level. Scores in the dimension of stigma were worst in the second tertile of cognitive decline (p = 0.03). MCI was associated with worse social support scores in the second tertile of cognitive decline (p = 0.008). CONCLUSION: MCI and cognitive decline from premorbid baseline are associated with reduced HR-QOL in communication, stigma, and social support domains. The cognitive decline from premorbid baseline modifies the association between MCI and HR-QOL in PD and knowing both will allow a better appreciation of difficulties patients face in daily life.

10 Article Implicit perceptual-motor skill learning in mild cognitive impairment and Parkinson's disease. 2013

Gobel, Eric W / Blomeke, Kelsey / Zadikoff, Cindy / Simuni, Tanya / Weintraub, Sandra / Reber, Paul J. ·Interdepartmental Neuroscience Program, Northwestern University, Evanston, IL, USA. ·Neuropsychology · Pubmed #23688213.

ABSTRACT: OBJECTIVE: Implicit skill learning is hypothesized to depend on nondeclarative memory that operates independent of the medial temporal lobe (MTL) memory system and instead depends on cortico striatal circuits between the basal ganglia and cortical areas supporting motor function and planning. Research with the Serial Reaction Time (SRT) task suggests that patients with memory disorders due to MTL damage exhibit normal implicit sequence learning. However, reports of intact learning rely on observations of no group differences, leading to speculation as to whether implicit sequence learning is fully intact in these patients. Patients with Parkinson's disease (PD) often exhibit impaired sequence learning, but this impairment is not universally observed. METHOD: Implicit perceptual-motor sequence learning was examined using the Serial Interception Sequence Learning (SISL) task in patients with amnestic Mild Cognitive Impairment (MCI; n = 11) and patients with PD (n = 15). Sequence learning in SISL is resistant to explicit learning and individually adapted task difficulty controls for baseline performance differences. RESULTS: Patients with MCI exhibited robust sequence learning, equivalent to healthy older adults (n = 20), supporting the hypothesis that the MTL does not contribute to learning in this task. In contrast, the majority of patients with PD exhibited no sequence-specific learning in spite of matched overall task performance. Two patients with PD exhibited performance indicative of an explicit compensatory strategy suggesting that impaired implicit learning may lead to greater reliance on explicit memory in some individuals. CONCLUSION: The differences in learning between patient groups provides strong evidence in favor of implicit sequence learning depending solely on intact basal ganglia function with no contribution from the MTL memory system.

11 Article Measuring mild cognitive impairment in patients with Parkinson's disease. 2013

Marras, Connie / Armstrong, Melissa J / Meaney, Christopher A / Fox, Susan / Rothberg, Brandon / Reginold, William / Tang-Wai, David F / Gill, David / Eslinger, Paul J / Zadikoff, Cindy / Kennedy, Nancy / Marshall, Fred J / Mapstone, Mark / Chou, Kelvin L / Persad, Carol / Litvan, Irene / Mast, Benjamin T / Gerstenecker, Adam T / Weintraub, Sandra / Duff-Canning, Sarah. ·Toronto Western Hospital Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto, Ontario, Canada. cmarras@uhnresearch.ca ·Mov Disord · Pubmed #23520128.

ABSTRACT: We examined the frequency of Parkinson disease with mild cognitive impairment (PD-MCI) and its subtypes and the accuracy of 3 cognitive scales for detecting PD-MCI using the new criteria for PD-MCI proposed by the Movement Disorders Society. Nondemented patients with Parkinson's disease completed a clinical visit with the 3 screening tests followed 1 to 3 weeks later by neuropsychological testing. Of 139 patients, 46 met Level 2 Task Force criteria for PD-MCI when impaired performance was based on comparisons with normative scores. Forty-two patients (93%) had multi-domain MCI. At the lowest cutoff levels that provided at least 80% sensitivity, specificity was 44% for the Montreal Cognitive Assessment and 33% for the Scales for Outcomes in Parkinson's Disease-Cognition. The Mini-Mental State Examination could not achieve 80% sensitivity at any cutoff score. At the highest cutoff levels that provided specificity of at least 80%, sensitivities were low (≤44%) for all tests. When decline from estimated premorbid levels was considered evidence of cognitive impairment, 110 of 139 patients were classified with PD-MCI, and 103 (94%) had multi-domain MCI. We observed dramatic differences in the proportion of patients who had PD-MCI using the new Level 2 criteria, depending on whether or not decline from premorbid level of intellectual function was considered. Recommendations for methods of operationalizing decline from premorbid levels constitute an unmet need. Among the 3 screening tests examined, none of the instruments provided good combined sensitivity and specificity for PD-MCI. Other tests recommended by the Task Force Level 1 criteria may represent better choices, and these should be the subject of future research.

12 Article Amantadine for freezing of gait in patients with Parkinson disease. 2012

Malkani, Roneil / Zadikoff, Cindy / Melen, Onur / Videnovic, Aleksandar / Borushko, Emily / Simuni, Tanya. ·Department of Neurology, Northwestern University, Chicago, IL, USA. r-malkani@fsm.northwestern.edu ·Clin Neuropharmacol · Pubmed #23123688.

ABSTRACT: BACKGROUND: Freezing of gait (FOG) is a common symptom in patients with advanced Parkinson's disease (PD) representing a major cause of disability and falls. Although the pathophysiology of FOG remains poorly understood, nondopaminergic pathways have been implicated. Treatment studies of levodopa and selegiline have shown limited benefit for FOG. Limited data suggest that amantadine, an N-methyl-D-aspartate receptor antagonist, may be beneficial for FOG in PD. OBJECTIVE: To examine the relationship between treatment with oral amantadine and FOG in patients with PD. METHODS: We conducted a retrospective chart review of PD patients who received amantadine specifically for FOG and had a follow-up assessment of FOG. The primary outcome measure was self-reported effectiveness of amantadine (improvement, worsening, or no change in FOG) based on records from the follow-up assessment. RESULTS: Eleven patients with PD with median age of PD onset of 67 years (range, 51-84 years) and median Hoehn and Yahr stage 3 (range, 2-4) met the study population selection criteria. Ten of 11 patients reported improvement in FOG after initiation of amantadine, whereas FOG worsened in one patient. Median amantadine dosage was 100 mg twice daily, and treatment duration was 20 months (range, 6-66 months). Four patients reported reduction in benefit after 4 months. Three patients reported adverse effects, including blurred vision, visual hallucinations, and peripheral edema; the latter 2 effects resulted in discontinuation of amantadine. CONCLUSION: Amantadine is associated with self-reported improvement in FOG in PD, but this effect may be transient. Further studies, including a randomized placebo-controlled trial, are needed to better evaluate this association.

13 Article The pill questionnaire in a nondemented Parkinson's disease population. 2012

Reginold, William / Armstrong, Melissa J / Duff-Canning, Sarah / Lang, Anthony / Tang-Wai, David / Fox, Susan / Rothberg, Brandon / Zadikoff, Cindy / Kennedy, Nancy / Gill, David / Eslinger, Paul / Mapstone, Mark / Chou, Kelvin / Persad, Carol / Litvan, Irene / Mast, Benjamin / Marras, Connie. ·Toronto Western Hospital Movement Disorders Centre, and the Edmond J. Safra Program in Parkinson's Disease, Toronto, Ontario, Canada. ·Mov Disord · Pubmed #22865587.

ABSTRACT: We assessed the Pill Questionnaire as a screen for mild cognitive impairment in nondemented Parkinson's disease patients. The relationship between ability to remember medications for Parkinson's disease in the Pill Questionnaire, mild cognitive impairment, and deficits on neuropsychological tests performed 2-3 weeks later blind to Pill Questionnaire results was assessed in movement disorders clinic patients. In 109 subjects, inaccurate medication reporting on the Pill Questionnaire was associated with lower scores on the Montreal Cognitive Assessment, Scales for Outcomes in Parkinson's Disease-Cognition and with deficits in memory, attention, executive function-inhibitory control, processing speed, visuospatial function, and language. Inaccurate medication reporting was also associated with an adjusted odds ratio of 2.4 (95% CI, 0.91-5.88; P = .06) for mild cognitive impairment, with a specificity of 80% and sensitivity of 41%. The Pill Questionnaire is neither sensitive nor specific enough to be used as the sole screening or diagnostic tool for mild cognitive impairment. However, inaccurate medication reporting is associated with deficits spanning many cognitive domains and should alert a clinician to a higher likelihood of cognitive impairment.

14 Article Suppression of deep brain stimulation artifacts from the electroencephalogram by frequency-domain Hampel filtering. 2010

Allen, David P / Stegemöller, Elizabeth L / Zadikoff, Cindy / Rosenow, Joshua M / Mackinnon, Colum D. ·Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL IL 60611,, USA. dp_allen@ieee.org ·Clin Neurophysiol · Pubmed #20362499.

ABSTRACT: OBJECTIVE: Currently, electroencephalography (EEG) cannot be used to record cortical activity during clinically effective DBS due to the presence of large stimulation artifact with components that overlap the useful spectrum of the EEG. A filtering method is presented that removes these artifacts whilst preserving the spectral and temporal fidelity of the underlying EEG. METHODS: The filter is based on the Hampel identifier that treats artifacts as outliers in the frequency domain and replaces them with interpolated values. Performance of the filter was tested with a synthesized DBS signal and actual data recorded during bilateral monopolar DBS. RESULTS: Mean increases in signal-to-noise ratio of 7.8dB for single-frequency stimulation and 13.8dB for dual-frequency stimulation are reported. Correlation analysis between EEG with synthesized artifacts and artifact-free EEG reveals that distortion to the underlying EEG in the filtered signal is negligible (r(2)>0.99). CONCLUSIONS: Frequency-domain Hampel filtering has been shown to remove monopolar DBS artifacts under a number of common stimulation conditions used for the treatment of Parkinson's disease. SIGNIFICANCE: Application of frequency-domain Hampel filtering will allow the measurement of EEG in patients during clinically effective DBS and thus may increase our understanding of the mechanisms of action of this important therapeutic intervention.

15 Minor The meaning of a "hippo" response on the Montreal Cognitive Assessment in Parkinson's disease. 2013

Armstrong, Melissa J / Duff-Canning, Sarah / Tang-Wai, David F / Fox, Susan / Zadikoff, Cindy / Kennedy, Nancy / Gill, David / Eslinger, Paul J / Mapstone, Mark / Chou, Kelvin L / Persad, Carol / Litvan, Irene / Mast, Benjamin T / Marras, Connie. · ·Parkinsonism Relat Disord · Pubmed #23036511.

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