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Parkinson Disease: HELP
Articles from King's College
Based on 311 articles published since 2008
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These are the 311 published articles about Parkinson Disease that originated from King's College during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13
1 Guideline Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program. 2015

Odin, P / Ray Chaudhuri, K / Slevin, J T / Volkmann, J / Dietrichs, E / Martinez-Martin, P / Krauss, J K / Henriksen, T / Katzenschlager, R / Antonini, A / Rascol, O / Poewe, W / Anonymous2260838. ·Department of Neurology, Lund University Hospital, 221 85 Lund, Sweden; Klinikum-Bremerhaven, D-27574 Bremerhaven, Germany. Electronic address: per.odin@med.lu.se. · King's College London, and National Parkinson Foundation Centre of Excellence, Dept of Neurology, King's College Hospital, London, UK. · Department of Neurology, University of Kentucky College of Medicine, Kentucky Clinic L-445, 740 South Limestone Street, Lexington, KY 40536-0284, USA. · Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany. · Department of Neurology, Oslo University Hospital and University of Oslo, N-0424 Oslo, Norway. · National Center for Epidemiology and CIBERNED, ISCIII, Avenida Monforte de Lemos 5, 28029 Madrid, Spain. · Department of Neurosurgery, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. · University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 København, NV, Denmark. · Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost - Donauspital, 1220 Wien Langobardenstraße 122, Austria. · Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy. · Clinical Investigation Center 1436 and Department of Clinical Pharmacology, INSERM and University Hospital of Toulouse, Toulouse University, 37 alées Jules Giesde, 31000 Toulouse, France; Clinical Investigation Center 1436 and Department of Neurosciences, INSERM and University Hospital of Toulouse, Toulouse University, 37 alées Jules Giesde, 31000 Toulouse, France. · Innsbruck Medical University/University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria. ·Parkinsonism Relat Disord · Pubmed #26233582.

ABSTRACT: Navigate PD was an educational program established to supplement existing guidelines and provide recommendations on the management of Parkinson's disease (PD) refractory to oral/transdermal therapies. It involved 103 experts from 13 countries overseen by an International Steering Committee (ISC) of 13 movement disorder specialists. The ISC identified 71 clinical questions important for device-aided management of PD. Fifty-six experts responded to a web-based survey, rating 15 questions as 'critically important;' these were refined to 10 questions by the ISC to be addressed through available evidence and expert opinion. Draft guidance was presented at international/national meetings and revised based on feedback. Key take-home points are: • Patients requiring levodopa >5 times daily who have severe, troublesome 'off' periods (>1-2 h/day) despite optimal oral/transdermal levodopa or non-levodopa-based therapies should be referred for specialist assessment even if disease duration is <4 years. • Cognitive decline related to non-motor fluctuations is an indication for device-aided therapies. If cognitive impairment is mild, use deep brain stimulation (DBS) with caution. For patients who have cognitive impairment or dementia, intrajejunal levodopa infusion is considered as both therapeutic and palliative in some countries. Falls are linked to cognitive decline and are likely to become more frequent with device-aided therapies. • Insufficient control of motor complications (or drug-resistant tremor in the case of DBS) are indications for device-aided therapies. Levodopa-carbidopa intestinal gel infusions or subcutaneous apomorphine pump may be considered for patients aged >70 years who have mild or moderate cognitive impairment, severe depression or other contraindications to DBS.

2 Editorial A glimmer of light at the end of the tunnel? 2017

Jenner, Peter. ·Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Health Sciences and Medicine, King's College, London, United Kingdom. ·Mov Disord · Pubmed #28921664.

ABSTRACT: -- No abstract --

3 Editorial Novel evidence associates higher plasma α-synuclein levels and cognitive impairment in Parkinson's disease. 2017

Aarsland, Dag / Rajkumar, Anto P / Hye, Abdul. ·Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. · Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK. · NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation trust, London, UK. ·J Neurol Neurosurg Psychiatry · Pubmed #28607120.

ABSTRACT: -- No abstract --

4 Editorial Anatomo-functional basis of nonmotor symptoms in Parkinson disease. 2016

Mano, Tadaaki / Britton, Zelie / Britton, Thomas. ·From Gifu University of Medical Science (T.M.), Japan · Imperial College London (Z.B.) · and King's College Hospital (T.B), London, UK. ·Neurology · Pubmed #27856780.

ABSTRACT: -- No abstract --

5 Editorial Progression and biomarkers for Parkinson disease: Merging motor with nonmotor symptoms. 2016

Chaudhuri, K Ray. ·From the National Parkinson Foundation International Centre of Excellence, King's College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust; and The Maurice Wohl Clinical Neuroscience Institute, Kings College London, UK. ray.chaudhuri@kcl.ac.uk. ·Neurology · Pubmed #27164660.

ABSTRACT: -- No abstract --

6 Editorial Changing panoramas and new horizons in Parkinson's disease. 2014

Samuel, Michael / Ashkan, Keyoumars. ·Consultant Neurologist East Kent Hospitals NHS Foundation Trust Ashford, Kent King’s College Hospital NHS Foundation Trust King’s Health Partners London. · Consultant Neurosurgeon King’s College Hospital NHS Foundation Trust Department of Clinical Neurosciences Institute of Psychiatry King’s College London King’s Health Partners London. ·Br J Hosp Med (Lond) · Pubmed #24521799.

ABSTRACT: -- No abstract --

7 Review Molecular Imaging of the Serotonergic System in Parkinson's Disease. 2018

Pagano, Gennaro / Politis, Marios. ·Neurodegeneration Imaging Group, Department of Basic & Clinical Neuroscience, King's College London, London, United Kingdom. · Neurodegeneration Imaging Group, Department of Basic & Clinical Neuroscience, King's College London, London, United Kingdom. Electronic address: marios.politis@kcl.ac.uk. ·Int Rev Neurobiol · Pubmed #30314596.

ABSTRACT: In the last decades, the main focus of molecular imaging of Parkinson's disease has been on non-dopaminergic systems involved in the disease alongside the pathognomonic dopaminergic changes. Molecular imaging can detect, in vivo, both presynaptic and postsynaptic serotonergic changes in the brain and has played a key role in elucidating the pathophysiology of the serotonergic system in Parkinson's disease. Alterations in the serotonergic system may happen very early in the course of the disease and have shown a leading role in the development of tremor and dyskinesias, and in several non-motor symptoms, including sleep, cognitive and neuropsychiatric disturbances. These studies increasingly recognize that the regional topography of serotonergic brain areas associates with specific dysfunctions. In parallel with this trend, more recent molecular serotonergic imaging approaches are investigating serotonergic modulatory treatment and their contributions to the improvement of cognitive functions. In this review, we discussed post-mortem, preclinical and imaging evidence of serotonergic system changes in Parkinson's disease, and described how disease-specific serotonergic changes are relevant for motor and non-motor symptoms and complications. Future directions of serotonergic imaging have been also described alongside with the novel findings on the role of serotonergic system in asymptomatic LRRK2 carriers.

8 Review Molecular Imaging of the Dopaminergic System in Idiopathic Parkinson's Disease. 2018

de Natale, Edoardo R / Niccolini, Flavia / Wilson, Heather / Politis, Marios. ·Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom. · Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom. Electronic address: marios.politis@kcl.ac.uk. ·Int Rev Neurobiol · Pubmed #30314595.

ABSTRACT: Parkinson's disease (PD) is a neurodegenerative disease characterized by the degeneration of dopaminergic nigrostriatal connections which is recognized as the major pathophysiological event underlying the onset of motor symptoms. Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) imaging allow the study of these connections in vivo at a molecular level. Several radiotracers have been developed targeting the synthesis and metabolism of dopamine and dopaminergic receptors to investigate the nigrostriatal pathway in vivo. Molecular imaging has greatly increased our knowledge on the progression and natural history of PD, as well as the development of motor and non-motor symptoms. PET molecular imaging could be a reliable biomarker to aid earlier diagnosis and for monitoring disease progression. Furthermore, PET imaging could be used as outcome measure in the design of clinical trials testing novel pharmacological compounds aiming to slow, and ultimately halt, disease progression.

9 Review Risk factors for non-motor symptoms in Parkinson's disease. 2018

Marinus, Johan / Zhu, Kangdi / Marras, Connie / Aarsland, Dag / van Hilten, Jacobus J. ·Department of Neurology, Leiden University Medical Center, Leiden, Netherlands. Electronic address: j.marinus@lumc.nl. · Department of Neurology, Leiden University Medical Center, Leiden, Netherlands. · The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, University Health Network, University of Toronto, Toronto, ON, Canada. · Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Age-Related Medicine, Stavanger University, Stavanger, Norway. ·Lancet Neurol · Pubmed #29699914.

ABSTRACT: Non-motor symptoms (NMS) of Parkinson's disease can be predominant as the disease advances, thereby constituting a major source of disease burden for patients and caregivers. However, current understanding of NMS is incomplete, particularly as a result of the absence of standardisation of outcome definitions and the heterogeneity of the risk factors that are assessed. The best data on risk factors for NMS in Parkinson's disease come from longitudinal studies, with the strongest evidence identifying factors for cognitive impairment and dementia, hallucinations, depression, apathy, excessive daytime sleepiness, insomnia, and impulse-control disorders. Cognitive impairment, hallucinations, and depression have several common risk factors, and many other NMS share a few risk factors, showing the interdependence between NMS with advancing Parkinson's disease. Disease severity, sex, age, and antiparkinsonian medication might have roles in the development of different NMS, although only antiparkinsonian medication is potentially modifiable. Until disease-modifying therapies are developed, increased knowledge of risk factors could ameliorate early identification of patients who are at an increased risk of developing specific NMS and potentially allow improvement of symptom management or prevention of specific NMS.

10 Review Pain in Parkinson's disease: facts and uncertainties. 2018

Antonini, A / Tinazzi, M / Abbruzzese, G / Berardelli, A / Chaudhuri, K R / Defazio, G / Ferreira, J / Martinez-Martin, P / Trenkwalder, C / Rascol, O. ·University of Padua, Padua. · University of Verona, Verona. · University of Genoa, Genoa. · University of Rome, Rome. · IRCCS NEUROMED, Isernia, Italy. · Kings College London, London, UK. · University of Cagliari, Cagliari, Italy. · Hospital de Santa Maria, Lisbon, Portugal. · National Center of Epidemiology and CIBERNED, Madrid, Spain. · University Medical Center Goettingen, Goettingen, Germany. · Université de Toulouse, Toulouse, France. ·Eur J Neurol · Pubmed #29520899.

ABSTRACT: Pain is one of the most common and troublesome non-motor symptoms of Parkinson's disease (PD). It can appear at any time during the disease and is often present before diagnosis. However, there is little or no consensus on its definition. An expert group of clinicians with relevant research experience met to review the existing evidence and to identify gaps in our understanding leading towards AUTHOR: 'understanding towards' has been changed to 'understanding leading towards'. Please check and confirm that this is appropriate an optimized therapy of pain in PD. Key findings from epidemiologic, neurophysiologic, neuroimaging and clinical studies are reviewed. In each case, the evidence base is limited by wide variations in the definitions of pain applied, study methodologies and populations evaluated. Disease-related and medical conditions trigger spontaneous pain in patients with PD, which is then abnormally processed and results in painful manifestations in specific body parts. Dopaminergic medications, such as rotigotine, as well as opiate analgesics, such as oxycodone, have shown positive results but future studies with more detailed pain characterization at inclusion are warranted.

11 Review Comprehensive grading of Parkinson's disease using motor and non-motor assessments: addressing a key unmet need. 2018

Martinez-Martin, Pablo / Ray Chaudhuri, Kallol. ·a National Center of Epidemiology and CIBERNED , Carlos III Institute of Health , Madrid , Spain. · b National Parkinson Foundation International Centre of Excellence , King's College London and King's College Hospital , London , UK. · c The Maurice Wohl Clinical Neuroscience Institute , King's College London , London , UK. ·Expert Rev Neurother · Pubmed #29090594.

ABSTRACT: INTRODUCTION: Parkinson's disease (PD) is expressed through motor and non-motor symptoms (NMS) that differ considerably in presence and severity among patients and over time. Furthermore, the progression pattern of the NMS does not necessarily parallel the course of the motor impairment. Gradation of PD according to the motor impairment and burden of NMS is an unmet need for an appropriate management of patients. Areas covered: A review of the studies on clinical gradation methods applied to PD is carried out in this article. Studies have provided cut-off values for a pragmatic classification of scores from rating scales and questionnaires in mild, moderate, and severe PD, considering motor state, complications, disability, and NMS. Grading systems with Hoehn and Yahr staging, Clinical Impression of Severity Index for PD, NMS Scale, NMS Questionnaire, and MDS-UPDRS, are available. These systems are reviewed in detail and examples in format of simple cards are presented. Expert commentary: Patients can be adequately assessed and properly managed according to their specific needs. A comprehensive method for gradation of PD manifestations severity is, therefore, desirable. In the absence of objective in vivo biomarkers for quantitative standardized information, scale-based clinical gradation systems provide a suitable alternative.

12 Review Mitochondrial retrograde signaling in the nervous system. 2018

Hunt, Rachel J / Bateman, Joseph M. ·Wolfson Centre for Age-Related Diseases, King's College London, UK. ·FEBS Lett · Pubmed #29086414.

ABSTRACT: Mitochondria generate the majority of cellular ATP and are essential for neuronal function. Loss of mitochondrial activity leads to primary mitochondrial diseases and may contribute to neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Mitochondria communicate with the cell through mitochondrial retrograde signaling pathways. These signaling pathways are triggered by mitochondrial dysfunction and allow the organelle to control nuclear gene transcription. Neuronal mitochondrial retrograde signaling pathways have been identified in disease model systems and targeted to restore neuronal function and prevent neurodegeneration. In this review, we describe yeast and mammalian cellular models that have paved the way in the investigation of mitochondrial retrograde mechanisms. We then discuss the evidence for retrograde signaling in neurons and our current knowledge of retrograde signaling mechanisms in neuronal model systems. We argue that targeting mitochondrial retrograde pathways has the potential to lead to novel treatments for neurological diseases.

13 Review Advanced Parkinson's or "complex phase" Parkinson's disease? Re-evaluation is needed. 2017

Titova, Nataliya / Martinez-Martin, Pablo / Katunina, Elena / Chaudhuri, K Ray. ·Department of Neurology, Neurosurgery and Medical Genetics, Federal State Budgetary Educational Institution of Higher Education « N.I. Pirogov Russian National Research Medical University » of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. · National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. · National Parkinson Foundation International Centre of Excellence, Kings College Hospital and The Maurice Wohl Clinical Neuroscience Institute, Kings College, 5 Cutcombe Road, London, SE59RT, UK. ray.chaudhuri@nhs.net. ·J Neural Transm (Vienna) · Pubmed #29116411.

ABSTRACT: Holistic management of Parkinson's disease, now recognised as a combined motor and nonmotor disorder, remains a key unmet need. Such management needs relatively accurate definition of the various stages of Parkinson's from early untreated to late palliative as each stage calls for personalised therapies. Management also needs to have a robust knowledge of the progression pattern and clinical heterogeneity of the presentation of Parkinson's which may manifest in a motor dominant or nonmotor dominant manner. The "advanced" stages of Parkinson's disease qualify for advanced treatments such as with continuous infusion or stereotactic surgery yet the concept of "advanced Parkinson's disease" (APD) remains controversial in spite of growing knowledge of the natural history of the motor syndrome of PD. Advanced PD is currently largely defined on the basis of consensus opinion and thus with several caveats. Nonmotor aspects of PD may also reflect advancing course of the disorder, so far not reflected in usual scale based assessments which are largely focussed on motor symptoms. In this paper, we discuss the problems with current definitions of "advanced" PD and also propose the term "complex phase" Parkinson's disease as an alternative which takes into account a multimodal symptoms and biomarker based approach in addition to patient preference.

14 Review PET Molecular Imaging Research of Levodopa-Induced Dyskinesias in Parkinson's Disease. 2017

Pagano, Gennaro / Yousaf, Tayyabah / Politis, Marios. ·Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 125 Coldharbour Lane, London, Camberwell, SE5 9NU, UK. · Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 125 Coldharbour Lane, London, Camberwell, SE5 9NU, UK. marios.politis@kcl.ac.uk. ·Curr Neurol Neurosci Rep · Pubmed #28975571.

ABSTRACT: PURPOSE OF REVIEW: To review the current status of positron emission tomography (PET) molecular imaging research of levodopa-induced dyskinesias (LIDs) in Parkinson's disease (PD). RECENT FINDINGS: Recent PET studies have provided robust evidence that LIDs in PD are associated with elevated and fluctuating striatal dopamine synaptic levels, which is a consequence of the imbalance between dopaminergic and serotonergic terminals, with the latter playing a key role in mishandling presynaptic dopamine release. Long-term exposure to levodopa is no longer believed to solely induce LIDs, as studies have highlighted that PD patients who go on to develop LIDs exhibit elevated putaminal dopamine release before the initiation of levodopa treatment, suggesting the involvement of other mechanisms, including altered neuronal firing and abnormal levels of phosphodiesterase 10A. Dopaminergic, serotonergic, glutamatergic, adenosinergic and opioid systems and phosphodiesterase 10A levels have been shown to be implicated in the development of LIDs in PD. However, no system may be considered sufficient on its own for the development of LIDs, and the mechanisms underlying LIDs in PD may have a multisystem origin. In line with this notion, future studies should use multimodal PET molecular imaging in the same individuals to shed further light on the different mechanisms underlying the development of LIDs in PD.

15 Review Effect and Mechanism of Chinese Herbal Medicine on Parkinson's Disease. 2017

Zeng, Bai-Yun. ·Neurodegenerative Disease Research Group, Institute of Pharmaceutical Science, Faculty of Life Science & Medicine, King's College, London, United Kingdom. Electronic address: b.zeng@kcl.ac.uk. ·Int Rev Neurobiol · Pubmed #28807165.

ABSTRACT: Parkinson's disease is a progressive neurodegenerative disorder. Although both genetic and environmental factors are implicated in the development of Parkinson's disease, the cause of the disease is still unclear. So far conventional treatments to Parkinson's are symptomatic relief and focused mainly on motor symptoms. Chinese herbal medicine has been used to treat many conditions in China, Korea, Japan, and many Southeast Asian countries for 1000 years. During past a few decades, Chinese herbal medicine has gained wider and increasing acceptance within both public and medical profession due to its effectiveness on many conditions in western countries. In this chapter, mechanisms of action of many Chinese herbal compounds/extracts and Chinese herb formulas on the models of Parkinson's were reviewed. Further, reports of effectiveness of Chinese herb formulas on patients with Parkinson's were summarized. It was shown that both Chinese herbal compounds/extracts and herb formulas have either specific target mechanisms of action or multitargets mechanisms of action, as antioxidant, antiinflammatory, and antiapoptosis agents. Clinical studies showed that Chinese herb formulas as an adjunct improved both motor and nonmotor symptoms, and reduced dose of dopaminergic drugs and occurrence of dyskinesia. The evidence from the studies suggests that Chinese herb medicine has potential, acting as neuroprotective to slow down the progression of Parkinson's, and it is able to simultaneously treat both motor and nonmotor symptoms of Parkinson's. More studies are needed to explore the new compounds/extracts derived from Chinese herbs, in particular, their mechanisms of action. It is hopeful that new drugs developed from Chinese herb compounds/extracts and Chinese herb formulas will lead to better and complimentary therapy to PD.

16 Review Sexual Dysfunctions in Parkinson's Disease: An Underrated Problem in a Much Discussed Disorder. 2017

Bhattacharyya, Kalyan B / Rosa-Grilo, Miguel. ·RG Kar Medical College & Hospital, Kolkata, India. Electronic address: kalyanbrb@gmail.com. · National Parkinson Foundation (NPF) International Center of Excellence at King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, Institute of Psychology, Psychiatry and Neurosciences, King's College London, London, United Kingdom. Electronic address: miguel.grilo@kcl.ac.uk. ·Int Rev Neurobiol · Pubmed #28805586.

ABSTRACT: Sexual dysfunctions (SDs) are one of the most neglected nonmotor symptoms in Parkinson's disease (PD). A number of reasons including social and cultural factors might explain, at least partially, why SD is still one of the most underrecognized aspects of the condition after 200 years since the very first description by James Parkinson. SD has not been extensively investigated, however, a number of studies have shown a high prevalence of decreased libido, orgasmic dysfunction in both men and women with PD, and erectile dysfunction in male subjects. Moreover, SD in PD also comprises the increasingly recognized hypersexuality that is often associated with PD treatment. Taken together, SD in PD includes a remarkable range of symptoms and conditions that often require a multidisciplinary approach regarding assessment, investigation, and treatment.

17 Review Nonmotor Parkinson's and Future Directions. 2017

Titova, Nataliya / Chaudhuri, K Ray. ·Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. · National Parkinson Foundation International Centre of Excellence, King's College London and King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom. Electronic address: ray.chaudhuri@nhs.net. ·Int Rev Neurobiol · Pubmed #28805581.

ABSTRACT: Nonmotor symptoms (NMS) of Parkinson's disease (PD) are integral to the condition largely regarded as a motor syndrome. A range of NMS underpin the prodromal stage of Parkinson's and are present with variable frequency, range, and nature across the whole journey of a patient with Parkinson's from the onset of the motor disease to palliative stage. These symptoms also are key determinants of quality of life of the patient as well as the carer. Despite this, recognition management and focused treatment of NMS of PD remain poor. Future would, therefore, need to focus on better definition and management of NMS of PD. This would include development of robust animal models of specific NMS such as cognitive, sleep, and autonomic dysfunctions as well as pain to understand the mechanistic pathways of these symptoms. In turn this will lead to better drug development using a bench to bedside model. Nonmotor clinical subtypes of PD have also been described and, in future, proper biomarkers will consolidate these findings in addition to defining the natural history of the subtypes. Revised versions of established scales and questionnaires will enable the adoption of good clinical practice with recognition of these subtypes in clinic. This will enhance the delivery of true subtype-specific therapies. Drug development should also include nondopaminergic and cell replacement restorative therapies with a nonmotor focus. An additional key area of future research would be the formalizing of true personalized medicine for PD. Personalized medicine pathways should concentrate on the role of exercise, complementary medicine as well as age, body weight, ethnicity on various NMS of PD. Genetics and pharmacogenetic developments in PD will add to the precision of the individualized approach.

18 Review Personalized Medicine and Nonmotor Symptoms in Parkinson's Disease. 2017

Titova, Nataliya / Chaudhuri, K Ray. ·Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. · National Parkinson Foundation International Centre of Excellence, King's College London and King's College Hospital and The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom. Electronic address: ray.chaudhuri@nhs.net. ·Int Rev Neurobiol · Pubmed #28805572.

ABSTRACT: Parkinson's disease (PD) is a multineurotransmitter dysfunction related disorder resulting in a range of motor and nonmotor symptoms. Phenotypic heterogeneity is pronounced in PD and nonmotor symptoms dominant subtypes have been described. These endophenotypes may be underpinned by considerable nondopaminergic dysfunction; however, conventional treatment of PD continues to be mostly reliant on dopamine replacement strategy or manipulation of brain dopaminergic pathways. Consequently, treatment of many nondopaminergic nonmotor and some motor symptoms remains a key unmet need. It is also recognized that treatment strategies for PD are influenced by a number of nondrug-related issues. These include factors such as age, personality, and preferences for treatment, cultural beliefs, lifestyle, pharmacoeconomics, pharmacogenetics as well as comorbidity. Therefore, the success of clinical therapy will rest on how much these factors are considered to develop a truly holistic treatment plan. Personalized medicine is the modern way of delivering this holistic strategy for treatment of PD. Personalized medicine thus encompasses several strands of treatment. From the pharmaceutical point of view, it should involve dopaminergic and nondopaminergic strategies. In addition, there are substrategies involving precision and tailored medicine to suit the needs and requirements of individual patients. Precision medicine would be relevant for patients who may be at risk of developing the clinical syndrome of Parkinson's as identified by specific gene mutations. Precision medicine in this scenario will attempt to be preventive. Tailored medicine would address the "single multifactorial" complex nature of PD and address symptoms as well subtype-specific strategies. Personalized medicine is now practiced for other conditions such as oncology as well as diabetes. In this chapter, we discuss the rationale and the need to develop strategies for personalized medicine for PD.

19 Review Palliative Care and Nonmotor Symptoms in Parkinson's Disease and Parkinsonism. 2017

Titova, Nataliya / Chaudhuri, K Ray. ·Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. · The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, Kings College Hospital, London, United Kingdom. Electronic address: ray.chaudhuri@nhs.net. ·Int Rev Neurobiol · Pubmed #28805571.

ABSTRACT: The term palliative care (PC) is defined as a collection of interventions and strategies that helps to improve and sustain the quality of life of patients and caregivers in situations and scenarios associated with life-threatening illness. This is usually implemented by means of early identification and treatment of relevant motor and nonmotor issues such as pain, sleep, and autonomic dysfunction, dementia, and depression. In addition, a holistic PC program also includes delivery of physical, psychosocial, and spiritual support. PC as a specific discipline, as well as a treatment strategy for long-term neurological conditions such as Parkinson's disease (PD), is relatively new, but very important as neurodegenerative disorders in the United Kingdom alone affects approximately 10 million people and there are over 130,000 people with PD. With longer life expectancy, the burden of long duration and late stage PD is even more evident, bringing in focus the need for PC. However, the concept of PC in PD is still poorly defined and although there are pockets of excellence, the strategy is poorly implemented into routine clinical practice. The variable progressive nature of the disease, the heterogeneity of clinical subtypes, and also the burden of nonmotor symptoms create challenges for effective PC delivery in PD, but recent clinical trials have started addressing PC in PD and are to be welcomed.

20 Review Speech, Voice, and Communication. 2017

Johnson, Julia A. ·Kings College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: juliajohnson@nhs.net. ·Int Rev Neurobiol · Pubmed #28805569.

ABSTRACT: Communication changes are an important feature of Parkinson's and include both motor and nonmotor features. This chapter will cover briefly the motor features affecting speech production and voice function before focusing on the nonmotor aspects. A description of the difficulties experienced by people with Parkinson's when trying to communicate effectively is presented along with some of the assessment tools and therapists' treatment options. The idea of clinical heterogeneity of PD and subtyping patients with different communication problems is explored and suggestions are made on how this may influence clinicians' treatment methods and choices so as to provide personalized therapy programmes. The importance of encouraging and supporting people to maintain social networks, employment, and leisure activities is stated as the key to achieving sustainability. Finally looking into the future, the emergence of new technologies is seen as providing further possibilities to support therapists in the goal of helping people with Parkinson's to maintain good communication skills throughout the course of the disease.

21 Review Non-Motor Symptoms Assessed by Non-Motor Symptoms Questionnaire and Non-Motor Symptoms Scale in Parkinson's Disease in Selected Asian Populations. 2017

Sauerbier, Anna / Jitkritsadakul, Onanong / Titova, Nataliya / Klingelhoefer, Lisa / Tsuboi, Yoshio / Carr, Harry / Kumar, Hrishikesh / Banerjee, Rebecca / Erro, Roberto / Bhidayasiri, Roongroj / Schrag, Anette / Zis, Panagiotis / Lim, Shen-Yang / Al-Hashel, J Y / Kamel, Walaa A / Martinez-Martin, Pablo / Ray Chaudhuri, K. ·Neurology, King's College Hospital, London, UK. ·Neuroepidemiology · Pubmed #28803229.

ABSTRACT: BACKGROUND: Ethnic variations have been described in medical conditions, such as hypertension, diabetes, and multiple sclerosis. Whether ethnicity plays a role in Parkinson's disease (PD), particularly with regard to non-motor symptoms (NMS), remains unclear. Existing literature is diverse, controversial, and inadequately documented. This review aims to analyse and report the currently available literature on NMS, specifically in Asian PD patients. SUMMARY: We conducted a literature review using PubMed, searching for articles and currently available publications that reference and assess NMS in PD patients living in Asia using the validated NMS Questionnaire (NMS Quest) and NMS Scale (NMSS). In total, 24 articles were included: 12 using the NMS Quest and 12 using the NMSS. Symptoms of constipation, memory impairment, and nocturia were the most frequently self-reported symptoms (NMS Quest) in selected Asian populations, while symptoms within the domains sleep/fatigue, attention/memory, and mood/apathy were most prevalent when applying the health-professional completed NMSS. Key Messages: NMS are generally prevalent and highly burdensome within selected Asian PD populations living in countries included in this review. Our review suggests that NMS-driven phenotypic heterogeneity is present in Asian patients, and compared to Western PD populations there might be variations in assessed NMS.

22 Review Nonmotor Symptoms in Experimental Models of Parkinson's Disease. 2017

Titova, Nataliya / Schapira, Anthony H V / Chaudhuri, K Ray / Qamar, Mubasher A / Katunina, Elena / Jenner, Peter. ·Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia. Electronic address: nattitova@yandex.ru. · UCL Institute of Neurology, London, United Kingdom. · National Parkinson Foundation International Centre of Excellence, King's College London and King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, National Institute for Health Research (NIHR) South London and Maudsley NHS Foundation Trust and King's College London, London, United Kingdom. · Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom. ·Int Rev Neurobiol · Pubmed #28802936.

ABSTRACT: Nonmotor symptoms of Parkinson's disease (PD) range from neuropsychiatric, cognitive to sleep and sensory disorders and can arise from the disease process as well as from drug treatment. The clinical heterogeneity of nonmotor symptoms of PD is underpinned by a wide range of neuropathological and molecular pathology, affecting almost the entire range of neurotransmitters present in brain and the periphery. Understanding the neurobiology and pathology of nonmotor symptoms is crucial to the effective treatment of PD and currently a key unmet need. This bench-to-bedside translational concept can only be successful if robust animal models of PD charting the genesis and natural history of nonmotor symptoms can be devised. Toxin-based and transgenic rodent and primate models of PD have given us important clues to the underlying basis of motor symptomatology and in addition, can provide a snapshot of some nonmotor aspects of PD, although the data are far from complete. In this chapter, we discuss some of the nonmotor aspects of the available experimental models of PD and how the development of robust animal models to understand and treat nonmotor symptoms needs to become a research priority.

23 Review Depression and Anxiety in Parkinson's Disease. 2017

Schrag, Anette / Taddei, Raquel N. ·UCL Institute of Neurology, London, United Kingdom. Electronic address: a.schrag@ucl.ac.uk. · King's College Hospital, London, United Kingdom. ·Int Rev Neurobiol · Pubmed #28802935.

ABSTRACT: Depression and anxiety are some of the most common comorbidities arising in patients with Parkinson's disease. However, their timely recognition and diagnosis are often hindered by overlap with other somatic features and a low rate of self-report. There is a need for greater awareness and for better assessment and treatment options are highly required. Currently available scales can serve as tools to monitor change over time and the effect of interventional strategies. Development of new therapeutic strategies, including nonpharmacological approaches such as transcranial magnetic stimulation and deep brain stimulation, may provide alternatives to currently available treatment approaches. In this chapter we will give an overview of the most recent advances in the diagnosis and treatment of these important nonmotor symptoms.

24 Review Psychosis in Parkinson's Disease. 2017

Ffytche, Dominic H / Aarsland, Dag. ·Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom. Electronic address: dominic.ffytche@kcl.ac.uk. · Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway. ·Int Rev Neurobiol · Pubmed #28802934.

ABSTRACT: Although illusions, hallucinations and delusions did not play a prominent role in James Parkinson's original clinical descriptions, the longitudinal view of disease progression he advocated has important lessons for the study of such symptoms today. A focus on longitudinal progression rather than individual symptoms led to the concept of PD psychosis-a spectrum of positive symptoms in Parkinson's disease. The publication of criteria for PD psychosis in 2007 helped unify the disparate set of symptoms, raising their profile and resulting in a rapid expansion of literature focussing on clinical aspects, mechanisms, and treatment. Here we review this literature and the evolving view of PD psychosis. Adding to previous evidence of a prospective risk for dementia and the move to supervised care, key recent developments include: recognition of prevalence increase with disease duration; a broadening of symptoms included in PD psychosis; better characterization of higher visual and cognitive dysfunction risk factors; structural, functional, and neurotransmitter imaging biomarker evidence; and approval of pimavanserin in the United States for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research that promise a better understanding of the clinical management of PD psychosis and its role as a biomarker for PD stage and progression.

25 Review Nonmotor Subtyping in Parkinson's Disease. 2017

Sauerbier, Anna / Rosa-Grilo, Miguel / Qamar, Mubasher A / Chaudhuri, K Ray. ·Parkinson's Centre of Excellence, King's College Hospital Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom. ·Int Rev Neurobiol · Pubmed #28802928.

ABSTRACT: Nonmotor symptoms are integral to Parkinson's disease. Several subtypes dominated by specific nonmotor symptoms have emerged. In this chapter, the rationale behind nonmotor subtyping and currently proposed nonmotor subgroups within Parkinson's disease based on data-driven cluster analysis and clinical observations will be summarized. Furthermore, the concept of seven clinical nonmotor subtypes will be discussed in detail including the clinical presentation, potential biomarkers, and the clinical relevance. In future, nonmotor subtypes will possibly play a major role within the aim to achieve personalized medicine.

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