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Parkinson Disease: HELP
Articles from Oregon
Based on 191 articles published since 2008
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These are the 191 published articles about Parkinson Disease that originated from Oregon during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Editorial Biomarkers for early detection of Parkinson disease: A scent of consistency with olfactory dysfunction. 2017

Bowman, Gene L. ·From the Department of Nutrition and Brain Health, Nestlé Institute of Health Sciences, Lausanne, Switzerland; and the Brain Institute, Department of Neurology, Oregon Health & Science University, Portland. gene.bowman@rd.nestle.com. ·Neurology · Pubmed #28878052.

ABSTRACT: -- No abstract --

2 Editorial Continuous levodopa infusion is better—for now. 2015

Nutt, John G. ·Oregon Health & Sciences University, Portland, USA. ·Mov Disord · Pubmed #25757898.

ABSTRACT: -- No abstract --

3 Editorial Who dropped the ball on L-DOPA? A patient's lament. 2014

Palfreman, Jon. ·School of Journalism and Communication, University of Oregon, OR, USA. ·J Parkinsons Dis · Pubmed #24946968.

ABSTRACT: -- No abstract --

4 Review Cortical activity during walking and balance tasks in older adults and in people with Parkinson's disease: A structured review. 2018

Stuart, Samuel / Vitorio, Rodrigo / Morris, Rosie / Martini, Douglas N / Fino, Peter C / Mancini, Martina. ·Oregon Health & Science University, Department of Neurology, Portland, OR, USA. · Universidade Estadual Paulista (UNESP), Instituto de Biociências, Campus Rio Claro, Brazil. · Oregon Health & Science University, Department of Neurology, Portland, OR, USA. Electronic address: mancinim@ohsu.edu. ·Maturitas · Pubmed #29903649.

ABSTRACT: An emerging body of literature has examined cortical activity during walking and balance tasks in older adults and in people with Parkinson's disease, specifically using functional near infrared spectroscopy (fNIRS) or electroencephalography (EEG). This review provides an overview of this developing area, and examines the disease-specific mechanisms underlying walking or balance deficits. Medline, PubMed, PsychInfo and Scopus databases were searched. Articles that described cortical activity during walking and balance tasks in older adults and in those with PD were screened by the reviewers. Thirty-seven full-text articles were included for review, following an initial yield of 566 studies. This review summarizes study findings, where increased cortical activity appears to be required for older adults and further for participants with PD to perform walking and balance tasks, but specific activation patterns vary with the demands of the particular task. Studies attributed cortical activation to compensatory mechanisms for underlying age- or PD-related deficits in automatic movement control. However, a lack of standardization within the reviewed studies was evident from the wide range of study protocols, instruments, regions of interest, outcomes and interpretation of outcomes that were reported. Unstandardized data collection, processing and reporting limited the clinical relevance and interpretation of study findings. Future work to standardize approaches to the measurement of cortical activity during walking and balance tasks in older adults and people with PD with fNIRS and EEG systems is needed, which will allow direct comparison of results and ensure robust data collection/reporting. Based on the reviewed articles we provide clinical and future research recommendations.

5 Review ANNIVERSARY REVIEW: 50 years since the discovery of bromocriptine. 2018

Michael Besser, G / Pfeiffer, Ronald F / Thorner, Michael O. ·Medicine, St Bartholomew's Hospital, London, UK. · Neurology, Oregon Health & Science University, Portland, Oregon, USA. · Medicine, University of Virginia, Charlottesville, Virginia, USA. ·Eur J Endocrinol · Pubmed #29752299.

ABSTRACT: Ergotism is the long-term ergot poisoning by ingestion of rye or other grains infected with the fungus

6 Review Management of Spinal Conditions in Patients With Parkinson Disease. 2017

Baker, Joseph F / McClelland, Shearwood / Hart, Robert A / Bess, R Shay. ·From the Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand (Dr. Baker), NYU Hospital for Joint Diseases, New York, NY (Dr. McClelland), the Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR (Dr. Hart), and the Department of Orthopaedic Surgery, Presbyterian/St. Luke's Medical Center, Denver, CO (Dr. Bess). ·J Am Acad Orthop Surg · Pubmed #28692583.

ABSTRACT: Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.

7 Review Management of Autonomic Dysfunction in Parkinson's Disease. 2017

Pfeiffer, Ronald F. ·Department of Neurology, Oregon Health and Science University, Portland, Oregon. ·Semin Neurol · Pubmed #28511258.

ABSTRACT: Autonomic dysfunction is a frequent and important nonmotor feature of Parkinson's disease (PD). Autonomic dysfunction in PD spans a broad clinical spectrum. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both the patient and the partner. Alterations in sweating and body temperature are not widely recognized, but often are present. The presence of effective treatment for at least some aspects of autonomic dysfunction makes it vitally important that the assessment of autonomic dysfunction be a regular component of the neurologic history and examination for individuals with PD.

8 Review Parkinson's disease and pregnancy: An updated review. 2017

Seier, Mara / Hiller, Amie. ·Northwest Parkinson Disease Research Education and Clinical Center, Portland VA Medical Center, Portland, OR, USA; Department of Neurology, Oregon Health Sciences University, Portland, OR, USA. ·Parkinsonism Relat Disord · Pubmed #28506531.

ABSTRACT: Pregnancy does not often occur in the setting of Parkinson's disease (PD) as the most common age of onset is beyond the childbearing years, yet management of these two conditions is crucial for the health of both mother and child. Here we review treatment data of PD during pregnancy, primarily from case reports and drug registries, and focus on available evidence regarding the pregnancy risks for patient and fetus. Historically, it was reported that many women had worsening of symptoms during pregnancy but this may be because anti-parkinsonian medications were not recommended or were under dosed. Levodopa has the best safety data for use in pregnancy and amantadine should be avoided in women who are pregnant or trying to become pregnant. The data for other pharmacological and surgical treatments is less clear. There is no evidence that women with PD have higher rates of birth or fetal complications.

9 Review Palliative care and Parkinson's disease: Meeting summary and recommendations for clinical research. 2017

Kluger, Benzi M / Fox, Siobhán / Timmons, Suzanne / Katz, Maya / Galifianakis, Nicholas B / Subramanian, Indu / Carter, Julie H / Johnson, Miriam J / Richfield, Edward W / Bekelman, David / Kutner, Jean S / Miyasaki, Janis. ·Department of Neurology, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E 17th Ave, Mail Stop B185, Aurora, CO 80045, USA. Electronic address: benzi.kluger@ucdenver.edu. · Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, The Bungalow, Block 13, St. Finbarr's Hospital, Douglas Road, Cork, Republic of Ireland. · Department of Neurology, University of California San Francisco, 4150 Clement St. #219G, San Francisco, CA 94143, USA. · Department of Neurology, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B200, Los Angeles, CA 90095, USA. · Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L226, Portland, OR 97239, USA. · Hull York Medical School, University of Hull, Hertford Building, Hull HU6 7RX, UK. · Department of Elderly Medicine, Leeds Teaching Hospitals Trust, UK. · Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Avenue, Mail Stop B180, Aurora, CO 80045, USA; Department of Medicine, VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, USA. · Department of Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Avenue, Mail Stop B180, Aurora, CO 80045, USA. · Division of Neurology, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta T6G 2R3, Canada. ·Parkinsonism Relat Disord · Pubmed #28108265.

ABSTRACT: INTRODUCTION: Palliative care is an approach to caring for patients and families affected by serious illnesses that focuses on the relief of suffering through the management of medical symptoms, psychosocial issues, advance care planning and spiritual wellbeing. Over the past decade there has been an emerging clinical and research interest in the application of palliative care approaches to Parkinson's disease (PD) and outpatient palliative care services are now offered by several movement disorders centers. METHODS: An International Working Group Meeting on PD and Palliative Care supported by the Parkinson's Disease Foundation was held in October 2015 to review the current state of the evidence and to make recommendations for clinical research and practice. RESULTS: Topics included: 1) Defining palliative care for PD; 2) Lessons from palliative care for heart failure and other chronic illnesses; 3) Patient and caregiver Needs; 4) Needs assessment tools; 5) Intervention strategies; 6) Predicting prognosis and hospice referrals; 7) Choice of appropriate outcome measures; 8) Implementation, dissemination and education research; and 9) Need for research collaborations. We provide an overview of these discussions, summarize current evidence and practices, highlight gaps in our knowledge and make recommendations for future research. CONCLUSIONS: Palliative Care for PD is a rapidly growing area which holds great promise for improving outcomes for PD patients and their caregivers. While clinical research in this area can build from lessons learned in other diseases, there is a need for observational, methodological and interventional research to address the unique needs of PD patients and caregivers.

10 Review Pharmacological treatment in Parkinson's disease: Effects on gait. 2016

Smulders, Katrijn / Dale, Marian L / Carlson-Kuhta, Patricia / Nutt, John G / Horak, Fay B. ·Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States. Electronic address: katrijn.smulders@gmail.com. · Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States. · Oregon Health & Science University, Department of Neurology, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States; VA Portland Health Care Systems, Department of Research, 3710 SW US Veteran Hospital Road, Portland, OR, 97230, United States. ·Parkinsonism Relat Disord · Pubmed #27461783.

ABSTRACT: Gait impairments are a hallmark of Parkinson's disease (PD), both as early symptom and an important cause of disability later in the disease course. Although levodopa has been shown to improve gait speed and step length, the effect of dopamine replacement therapy on other aspects of gait is less well understood. In fact, falls are not reduced and some aspects of postural instability during gait are unresponsive to dopaminergic treatment. Moreover, many medications other than dopaminergic agents, can benefit or impair gait in people with PD. We review the effects of pharmacological interventions used in PD on gait, discriminating, whenever possible, among effects on four components of everyday mobility: straight walking, gait initiation, turning, gait adaptability. Additionally, we summarize the effects on freezing of gait. There is substantial evidence for improvement of spatial characteristics of simple, straight-ahead gait with levodopa and levodopa-enhancing drugs. Recent work suggests that drugs aiming to enhance the acetylcholine system might improve gait stability measures. There is a lack of well-designed studies to evaluate effects on more complex, but highly relevant walking abilities such as turning and making flexible adjustments to gait. Finally, paucity in the literature exists on detrimental effects of drugs used in PD that are known to worsen gait and postural stability in the elderly population.

11 Review Motor subtype in Parkinson's disease: Different disorders or different stages of disease? 2016

Nutt, John G. ·Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA. ·Mov Disord · Pubmed #27226220.

ABSTRACT: -- No abstract --

12 Review Disability Rating Scales in Parkinson's Disease: Critique and Recommendations. 2016

Shulman, Lisa M / Armstrong, Melissa / Ellis, Terry / Gruber-Baldini, Ann / Horak, Fay / Nieuwboer, Alice / Parashos, Sotirios / Post, Bart / Rogers, Mark / Siderowf, Andrew / Goetz, Christopher G / Schrag, Anette / Stebbins, Glenn T / Martinez-Martin, Pablo. ·Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. lshulman@som.umaryland.edu. · Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Department of Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA. · Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Department of Neurology, Oregon Health and Science University and Portland VA Medical System, Portland, Oregon, USA. · Department of Rehabilitation Science, KU Leuven-University of Leuven, Heverlee, Belgium. · Struthers Parkinson's Center, Golden Valley, Minnesota, USA. · Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands. · Department of Physical Therapy & Rehabilitation, University of Maryland School of Medicine, Baltimore, Maryland, USA. · Avid Radiopharmaceuticals, Philadelphia, PA, USA. · Department of Neurology, Rush University Medical Center, Chicago, USA. · UCL Institute of Neurology, University College London, UK. · National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. ·Mov Disord · Pubmed #27193358.

ABSTRACT: INTRODUCTION: PD is associated with impairments that progress over time to disability. A large number of disability scales exist with little information on the best choice in PD. METHODS: Following methodology adopted by the International Parkinson and Movement Disorder Society Task Force, a review of disability scales used in PD was completed. Based on prespecified criteria, the review categorized scales into: "Recommended"; "Recommended with Further Validation in PD Required" when well-validated scales have not been specifically tested for clinimetric properties in PD; "Suggested"; and "Listed." RESULTS: Twenty-nine disability instruments were identified with nine scales fulfilling criteria for "Recommended" and 7 "Recommended with Further Validation in PD Required." Eight scales are "Suggested" and five scales are "Listed" for use in PD. The nine Recommended scales (Functional Status Questionnaire, Lawton-Brody Activities of Daily Living, Nottingham Activities of Daily Living, Schwab and England Activities of Daily Living, Self-Assessment PD Disability, Short Parkinson's Evaluation Scale/Scales for Outcomes in PD, Unified PD Rating Scale-II: Activities of Daily Living, Movement Disorders Society UPDRS Motor Experiences of Daily Living, PROMIS CONCLUSION: Many disability measures are available and recommended for application in PD. The Task Force does not recommend the development of a new scale. Selection of the most appropriate instrument for a particular objective requires consideration of the characteristics of each scale and the goals of the assessment. © 2016 International Parkinson and Movement Disorder Society.

13 Review Technology in Parkinson's disease: Challenges and opportunities. 2016

Espay, Alberto J / Bonato, Paolo / Nahab, Fatta B / Maetzler, Walter / Dean, John M / Klucken, Jochen / Eskofier, Bjoern M / Merola, Aristide / Horak, Fay / Lang, Anthony E / Reilmann, Ralf / Giuffrida, Joe / Nieuwboer, Alice / Horne, Malcolm / Little, Max A / Litvan, Irene / Simuni, Tanya / Dorsey, E Ray / Burack, Michelle A / Kubota, Ken / Kamondi, Anita / Godinho, Catarina / Daneault, Jean-Francois / Mitsi, Georgia / Krinke, Lothar / Hausdorff, Jeffery M / Bloem, Bastiaan R / Papapetropoulos, Spyros / Anonymous1111027. ·James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA. alberto.espay@uc.edu. · Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA. · Department of Neurosciences, University of California San Diego, La Jolla, CA, USA. · Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Tübingen, Germany. · DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany. · Davis Phinney Foundation for Parkinson's, Boulder, Colorado, USA. · Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. · Digital Sports Group, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. · Department of Neuroscience "Rita Levi Montalcini", Città della salute e della scienza di Torino, Torino, Italy. · Department of Neurology, Oregon Health & Science University, Portland VA Medical System, Portland, Oregon. · APDM, Inc., Portland, Oregon, USA. · Morton and Gloria Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Canada. · George-Huntington-Institute, Muenster, Germany. · Department of Radiology, University of Muenster, Muenster, Germany. · Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. · Great Lakes NeuroTechnologies, Cleveland, Ohio, USA. · Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium. · Global Kinetics Corporation & Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia. · Department of Mathematics, Aston University, Birmingham, UK. · Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA. · Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA. · Michael J Fox Foundation for Parkinson's Research, New York City, New York, USA. · Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary. · Center of Interdisciplinary Research Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal. · Apptomics LLC, Wellesley, Massachusetts, USA. · Medtronic Neuromodulation, Minneapolis, Minnesota, USA. · Sackler School of Medicine, Tel Aviv University and Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. · Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands. · Massachusetts General Hospital, Boston, Massachusetts, USA. ·Mov Disord · Pubmed #27125836.

ABSTRACT: The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the "big data" acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD. © 2016 International Parkinson and Movement Disorder Society.

14 Review Neural Control of Walking in People with Parkinsonism. 2016

Peterson, D S / Horak, F B. ·Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon petedani@ohsu.edu dspeterson8@gmail.com. · Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon. ·Physiology (Bethesda) · Pubmed #26889015.

ABSTRACT: People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.

15 Review Potential of APDM mobility lab for the monitoring of the progression of Parkinson's disease. 2016

Mancini, Martina / Horak, Fay B. ·a Veterans Affairs Portland Healthcare System (VAPORHCS) , Portland , OR , USA. · b Department of Neurology , Oregon Health & Science University , Portland , OR , USA. ·Expert Rev Med Devices · Pubmed #26872510.

ABSTRACT: APDM's Mobility Lab system provides portable, validated, reliable, objective measures of balance and gait that are sensitive to Parkinson's disease (PD). In this review, we describe the potential of objective measures collected with the Mobility Lab system for tracking longitudinal progression of PD. Balance and gait are among the most important motor impairments influencing quality of life for people with PD. Mobility Lab uses body-worn, Opal sensors on the legs, trunk and arms during prescribed tasks, such as the instrumented Get Up and Go test or quiet stance, to quickly quantify the quality of balance and gait in the clinical environment. The same Opal sensors can be sent home with patients to continuously monitor the quality of their daily activities. Objective measures have the potential to monitor progression of mobility impairments in PD throughout its course to improve patient care and accelerate clinical trials.

16 Review Precision Medicine: Clarity for the Complexity of Dementia. 2016

Cholerton, Brenna / Larson, Eric B / Quinn, Joseph F / Zabetian, Cyrus P / Mata, Ignacio F / Keene, C Dirk / Flanagan, Margaret / Crane, Paul K / Grabowski, Thomas J / Montine, Kathleen S / Montine, Thomas J. ·Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington. · Group Health Research Institute, Seattle, Washington. · Department of Neurology, Oregon Health and Science University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon. · Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Parkinson's Disease Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Neurology, University of Washington, Seattle, Washington. · Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Neurology, University of Washington, Seattle, Washington. · Department of Pathology, University of Washington, Seattle, Washington. · Department of Medicine, University of Washington, Seattle, Washington. · Department of Neurology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington. · Department of Pathology, University of Washington, Seattle, Washington. Electronic address: tmontine@uw.edu. ·Am J Pathol · Pubmed #26724389.

ABSTRACT: Three key elements to precision medicine are stratification by risk, detection of pathophysiological processes as early as possible (even before clinical presentation), and alignment of mechanism of action of intervention(s) with an individual's molecular driver(s) of disease. Used for decades in the management of some rare diseases and now gaining broad currency in cancer care, a precision medicine approach is beginning to be adapted to cognitive impairment and dementia. This review focuses on the application of precision medicine to address the clinical and biological complexity of two common neurodegenerative causes of dementia: Alzheimer disease and Parkinson disease.

17 Review Non-motor symptoms in Parkinson's disease. 2016

Pfeiffer, Ronald F. ·Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Electronic address: pfeiffro@ohsu.edu. ·Parkinsonism Relat Disord · Pubmed #26372623.

ABSTRACT: With the growing awareness of the presence of non-motor symptoms in Parkinson's disease (PD) has come the realization that these non-motor features play a tremendously important, and sometimes dominant, role in the management and even the diagnosis of the disorder. Despite this, a reluctance to formally address and treat the non-motor symptoms of PD remains and quality of life for PD patients suffers. This review provides an overview of the impact non-motor symptoms have on persons with PD, along with a brief description of some of the more common non-motor features of PD.

18 Review Gastrointestinal dysfunction in Parkinson's disease. 2015

Fasano, Alfonso / Visanji, Naomi P / Liu, Louis W C / Lang, Antony E / Pfeiffer, Ronald F. ·Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. Electronic address: alfonso.fasano@uhn.ca. · Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. · Division of Gastroenterology, Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada. · Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA. ·Lancet Neurol · Pubmed #25987282.

ABSTRACT: Our understanding of dysfunction of the gastrointestinal system in patients with Parkinson's disease has increased substantially in the past decade. The entire gastrointestinal tract is affected in these patients, causing complications that range from oral issues, including drooling and swallowing problems, to delays in gastric emptying and constipation. Additionally, small intestinal bacterial overgrowth and Helicobacter pylori infection affect motor fluctuations by interfering with the absorption of antiparkinsonian drugs. The multifaceted role of the gastrointestinal system in Parkinson's disease necessitates a specific and detailed assessment and treatment plan. The presence of pervasive α-synuclein deposition in the gastrointestinal tract strongly implicates this system in the pathogenesis of Parkinson's disease. Future studies elucidating the role of the gastrointestinal tract in the pathological progression of Parkinson's disease might hold potential for early disease detection and development of neuroprotective approaches.

19 Review A review of vitamin D and Parkinson's disease. 2014

Peterson, Amie L. ·Oregon Health Sciences University, Mail Code: OP32, 3181, SW Sam Jackson Park Road, Portland, OR 97239, USA; Portland VA, 3710 SW US Veterans Hospital Road, Mail Code: P3PADRECC, Portland, OR 97239, USA. Electronic address: peterami@ohsu.edu. ·Maturitas · Pubmed #24685289.

ABSTRACT: The role of vitamin D in bone health has been known for over a century. More recent research has suggested that vitamin D may play a role in the muscular, immune, endocrine, and central nervous systems. Animal research suggests that vitamin D may have some protective effects against toxic insults that are known to damage dopamine cells, the primary cells to degenerate in PD. Persons with PD tend to have lower vitamin D levels than persons of similar ages without PD. Vitamin D levels are generally associated with bone mineral density (BMD) in persons with PD, but simply giving vitamin D does not appear to improve BMD. Results of genetic studies examining polymorphism of the vitamin D receptor and PD risk, severity, or age at onset have shown variable results, with FokI CC seeming to possibly carry some increased risk of PD. Amount of sun exposure and vitamin D levels in earlier life may influence the risk of developing PD. Cross-sectional research suggests a relationship between vitamin D levels and severity of PD symptoms. A single intervention study did show some improvement in PD with vitamin D supplementation. Vitamin D may have effects on PD symptoms and perhaps even on the risk of disease development or disease progression. More well designed intervention studies are needed to confirm the effect of vitamin D on PD symptoms. Human neuroprotection studies are needed, but probably not feasible until better biomarkers are established.

20 Review Objective biomarkers of balance and gait for Parkinson's disease using body-worn sensors. 2013

Horak, Fay B / Mancini, Martina. ·Department of Neurology, Oregon Health & Science University, Portland, Oregon. ·Mov Disord · Pubmed #24132842.

ABSTRACT: Balance and gait impairments characterize the progression of Parkinson's disease (PD), predict the risk of falling, and are important contributors to reduced quality of life. Advances in technology of small, body-worn, inertial sensors have made it possible to develop quick, objective measures of balance and gait impairments in the clinic for research trials and clinical practice. Objective balance and gait metrics may eventually provide useful biomarkers for PD. In fact, objective balance and gait measures are already being used as surrogate endpoints for demonstrating clinical efficacy of new treatments, in place of counting falls from diaries, using stop-watch measures of gait speed, or clinical balance rating scales. This review summarizes the types of objective measures available from body-worn sensors. The metrics are organized based on the neural control system for mobility affected by PD: postural stability in stance, postural responses, gait initiation, gait (temporal-spatial lower and upper body coordination and dynamic equilibrium), postural transitions, and freezing of gait. However, the explosion of metrics derived by wearable sensors during prescribed balance and gait tasks, which are abnormal in individuals with PD, do not yet qualify as behavioral biomarkers, because many balance and gait impairments observed in PD are not specific to the disease, nor have they been related to specific pathophysiologic biomarkers. In the future, the most useful balance and gait biomarkers for PD will be those that are sensitive and specific for early PD and are related to the underlying disease process.

21 Review Framework for understanding balance dysfunction in Parkinson's disease. 2013

Schoneburg, Bernadette / Mancini, Martina / Horak, Fay / Nutt, John G. ·Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; Portland VA Medical Center, Portland, Oregon, USA. ·Mov Disord · Pubmed #23925954.

ABSTRACT: People with Parkinson's disease (PD) suffer from progressive impairment in their mobility. Locomotor and balance dysfunction that impairs mobility in PD is an important cause of physical and psychosocial disability. The recognition and evaluation of balance dysfunction by the clinician are an essential component of managing PD. In this review, we describe a framework for understanding balance dysfunction in PD to help clinicians recognize patients who are at risk for falling and impaired mobility.

22 Review The long-duration response to levodopa: phenomenology, potential mechanisms and clinical implications. 2011

Anderson, Elise / Nutt, John. ·Department of Neurology, Oregon Health & Science University, Parkinson Disease Research, Education and Clinical Center, Portland VA, OR 97239, USA. andereli@ohsu.edu ·Parkinsonism Relat Disord · Pubmed #21530356.

ABSTRACT: The antiparkinsonian response to levodopa is characterized by an immediate motor improvement lasting hours and a more sustained response lasting days. These two responses have been referred to as the short-duration response (SDR) and the long-duration response (LDR). The LDR represents a substantial component of the clinical effect of levodopa and has been clinically recognized for several decades, but it remains poorly understood. This review will focus on the LDR phenomenology and theories about its origin, with the goal of promoting inquiry into this important but as yet poorly understood aspect of levodopa therapy for PD.

23 Review Neuroimaging and cognition in Parkinson's disease dementia. 2010

Silbert, Lisa C / Kaye, Jeffrey. ·Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA. silbertl@ohsu.edu ·Brain Pathol · Pubmed #20522090.

ABSTRACT: The prevalence of cognitive impairment and dementia in Parkinson's disease (PD) is high and can potentially occur as the result of multiple differing pathologies. Neuroimaging has provided evidence of decreased cortical volume, increased white matter diffusion changes, and decreased resting metabolic activity that appears to begin prior to the onset of dementia in PD patients. Cognitive impairment has been found to be associated with multiple neurotransmitter transmission deficiencies, including dopamine and acetylcholine, indicating a widespread neurotransmitter dysfunction in PD-related dementia. Findings of increased Pittsburgh Compound B (PiB) binding in subjects with Lewy Body Disease (LBD) compared with Parkinson's disease and dementia (PDD) may explain phenotype differences in the spectrum of Dementia with Lewy Bodies (DLB), and show promise in guiding future therapeutic trials aimed at this disease. Advances in neuroimaging now allow for the detection of volumetric, pharmacologic, and pathological changes that may assist in the diagnosis and prediction of cognitive impairment in Parkinson's patients so that better evaluation of disease progression and treatment can be obtained.

24 Review Cognitive impairment and dementia in patients with Parkinson disease. 2009

Leverenz, James B / Quinn, Joseph F / Zabetian, Cyrus / Zhang, Jing / Montine, Kathleen S / Montine, Thomas J. ·Mental Illness Research, Education, and Clinical Centers of Veterans Administration, Department of Neurology, Oregon Health & Sciences University, Portland, OR, USA. ·Curr Top Med Chem · Pubmed #19754405.

ABSTRACT: Parkinson disease (PD) is an already prevalent neurodegenerative disease that is poised to at least double over the next 25 years. Although best known for its characteristic movement disorder, PD is now appreciated commonly to cause cognitive impairment, including dementia, and behavioral changes. Dementia in patients with PD is consequential and has been associated with reduced quality of life, shortened survival, and increased caregiver distress. Here we review clinical presentation and progression, pathological bases, identification of genetic risk factors, development of small molecule biomarkers, and emerging treatments for cognitive impairment in patients with PD.

25 Review Physical and mental fatigue in Parkinson's disease: epidemiology, pathophysiology and treatment. 2009

Lou, Jau-Shin. ·Oregon Health & Science University, Portland, Oregon, USA. Louja@ohsu.edu ·Drugs Aging · Pubmed #19358616.

ABSTRACT: Fatigue is one of the most common non-motor complaints of Parkinson's disease (PD) patients and is associated with reduced activity and poorer quality of life. Fatigue can be experienced as a state of being tired or weary (subjective fatigue) or as a process of becoming tired or fatigued (fatigability). Subjective mental and physical fatigue are evaluated using self-report questionnaires such as the Multidimensional Fatigue Inventory. Physical fatigability is studied in a laboratory setting using physical exercise protocols and transcranial magnetic stimulation. Mental fatigability is evaluated by measuring attention over time using a reaction-time paradigm called the Attention Network Test (ANT). PD patients report more subjective physical and mental fatigue than controls on a variety of fatigue questionnaires. PD patients have increased physical fatigability in force generation and finger tapping. Levodopa and modafinil improve physical fatigability in PD subjects. Methylphenidate is useful for treating subjective physical fatigue. PD subjects have greater mental fatigability than control subjects and display abnormal performance in all three attention networks in the ANT. Therapies targeting the neurotransmitter systems involved in attention may be helpful for treating mental fatigability. Future fatigue research should focus on developing gold standards for fatigue measurement and developing treatments for fatigue and fatigability in PD.

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