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Parkinson Disease: HELP
Articles from Rhode Island
Based on 90 articles published since 2008

These are the 90 published articles about Parkinson Disease that originated from Rhode Island during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Neurotherapeutics: Recent Developments. 2018

Rizvi, Syed. ·Associate Professor of Clinical Neurosciences, Alpert Medical School of Brown University; Director, Rhode Island Hospital Multiple Sclerosis Center; Director, Neurology Outpatient Center. ·R I Med J (2013) · Pubmed #29490320.

ABSTRACT: -- No abstract --

2 Editorial MCI in Parkinson's disease. 2018

Friedman, Joseph H. ·Dept. of Neurology, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA; Dept. of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA. Electronic address: Joseph_friedman@brown.edu. ·Parkinsonism Relat Disord · Pubmed #29413123.

ABSTRACT: -- No abstract --

3 Editorial Editorial and introduction: Behavioral aspects of Parkinson's disease. 2017

Friedman, Joseph H / Bhidayasiri, Roongroj / Truong, Daniel D. ·Butler Hospital, Department of Neurology, Alpert Medical School of Brown University, RI, USA. · Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan. Electronic address: rbh@chulapd.org. · Truong Neuroscience Institute, Parkinson's and Movement Disorders Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA. ·J Neurol Sci · Pubmed #28087061.

ABSTRACT: -- No abstract --

4 Editorial Thoughts on fatigue in Parkinson's disease (and other disorders). 2017

Friedman, J H. ·Butler Hospital, Providence, RI, USA. · Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA. ·Eur J Neurol · Pubmed #27699949.

ABSTRACT: -- No abstract --

5 Editorial Editorial on: Pagonabarraga J, Martinez-Hora S, Fernandez de Bobadilla R et al. Minor hallucinations occur in drug-naïve Parkinson's disease patients even from the premotor phase. Movement Disorders 2015; Available from: DOI: 10.1002/mds.26432. 2016

Friedman, Joseph H. ·Movement Disorders Program, Butler Hospital, Providence, RI. · Department of Neurology, Warren Alpert School of Medicine of Brown University, Providence, RI. ·Mov Disord · Pubmed #26660462.

ABSTRACT: -- No abstract --

6 Editorial Can fall of blood pressure prevent falls in Parkinson disease? 2014

Hedera, Peter / Friedman, Joseph H. ·From the Department of Neurology (P.H.), Vanderbilt University, Nashville, TN · Movement Disorders Program (J.H.F.), Butler Hospital, Providence · and the Department of Neurology (J.H.F.), Alpert Medical School of Brown University, Providence, RI. ·Neurology · Pubmed #24682972.

ABSTRACT: -- No abstract --

7 Review Pharmacological interventions for psychosis in Parkinson's disease patients. 2018

Friedman, Joseph H. ·a Movement Disorders Program , Butler Hospital , Providence , RI , USA. · b Department of Neurology , Warren Alpert Medical School of Brown University , Providence , RI , USA. ·Expert Opin Pharmacother · Pubmed #29494265.

ABSTRACT: INTRODUCTION: Psychosis is a common problem for people treated for Parkinson's disease. The syndrome is quite stereotypic, with hallucinations being the most common, followed by delusions. While the hallucinations are usually not very bothersome, the delusions are typically paranoid in nature. Treatment is often, but not always, required. AREAS COVERED: This article reviews the therapeutic approaches of this syndrome focusing on drug treatments used once contributory factors have been removed. This includes a review of the evidence supporting the use of clozapine and, most recently, pimavanserin, the first drug with antipsychotic efficacy that has no effect on dopamine. Treatment with second generation antipsychotic drugs and cholinesterase inhibitors are also reviewed. EXPERT OPINION: Clozapine and pimavanserin have proven efficacy for Parkinson's disease psychosis (PDP), without impairing motor function. In clozapine's favor are its antipsychotic benefits seen within 1 week and its effectiveness in improving tremor in PD. However, this is counterbalanced by the need for blood monitoring, despite the extremely low doses used, and sedation. Pimanvanserin is well tolerated, without sedation or other significant side effects. Its onset of benefit, however takes 4-6 weeks. While quetiapine is also frequently used, its efficacy is not supported by double blinded, randomized trials.

8 Review Parkinson's disease: A Quick Update. 2018

D'Abreu, Anelyssa. ·Associate Professor of Neurology, Alpert Medical School of Brown University. ·R I Med J (2013) · Pubmed #29490323.

ABSTRACT: Parkinson's disease is a neurodegenerative disorder characterized by motor and non-motor symptoms. Although the diagnosis still relies on the presence of motor signs, new diagnostic criteria have been proposed to incorporate recent observations in order to improve accuracy. The cornerstone of therapy remains dopamine replacement with L-Dopa. However, new therapies, with different modes of action, or administration have become available to improve management.

9 Review Dementia with Lewy Bodies and Parkinson Disease Dementia: It is the Same Disease! 2018

Friedman, Joseph H. ·Dept. of Neurology, Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA; Dept of Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02906, USA. Electronic address: joseph_friedman@brown.edu. ·Parkinsonism Relat Disord · Pubmed #28756177.

ABSTRACT: INTRODUCTION: The question whether DLB and PDD are distinct disorders has been debated in several forums. The two disorders, once parkinsonism is present in DLB, cannot be distinguished on clinical or pathological grounds. The conundrum exists for those DLB patients who do not yet have parkinsonism, and raises the parallel with patients who have Rapid Eye Movement Behavior Disorder but have not yet manifested parkinsonian signs. METHODS: A literature review was summarized to justify classification as a single disorder. RESULTS: Most clinical observations and trials point to these disorders, once parkinsonism is present in DLB, are identical. CONCLUSION: This article notes the advantage to clinical research and treatment by considering these two syndromes as the same so that medications approved for PDD and for PD psychosis can be extended to DLB patients and that resources for PD research and support can be also used for DLB.

10 Review Contribution of language studies to the understanding of cognitive impairment and its progression over time in Parkinson's disease. 2017

Auclair-Ouellet, Noémie / Lieberman, Philip / Monchi, Oury. ·Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada. Electronic address: noemie.auclairouellet@mcgill.ca. · Department of Cognitive, Linguistic & Psychological Sciences, Brown University, United States. · Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada. ·Neurosci Biobehav Rev · Pubmed #28782623.

ABSTRACT: Parkinson's disease is a frequent neurodegenerative disease that is mostly known for its motor symptoms. However, cognitive impairment is now recognised as an important part of the disease. Studies of cognitive impairment in Parkinson's disease reveal considerable heterogeneity in terms of which cognitive domains are impaired, and of how cognitive impairment progresses over time. In parallel, a growing body of research reports language difficulties in Parkinson's disease, more specifically in the domains of sentence processing and lexical-semantic processing. In this review, the performance of patients with Parkinson's disease in these domains of language will be reviewed with a focus on the links that they have with the rest of cognition and on how they could contribute to the earlier and more precise characterization and prediction of cognitive impairment in Parkinson's disease. More specifically, the potential for modulation of complexity and sensitivity of language tasks to mild deficits and difficulties that are predictive of further decline will be emphasized. Other motivations for studying language difficulties in this disease will also be discussed.

11 Review The Emerging Role of Pimavanserin in the Management of Parkinson's Disease Psychosis. 2017

Hermanowicz, Neal / Alva, Gustavo / Pagan, Fernando / Espay, Alberto J / Patel, Amita / Madrid, Katya Cruz / Kremens, Daniel / Kenney, Jim / Arquette, Sheila / Tereso, Gary / Lopes, Maria / Farnum, Carolyn. ·1 Movement Disorders Program and Department of Neurology, University of California Irvine Health, Irvine, California. · 2 Chapman Global Medical Center, Orange, California; ATP Clinical Research, Costa Mesa, California; and University of California, Riverside, Orange, California. · 3 Department of Neurology; Movement Disorders Program; Georgetown University Hospital National Parkinsonism Foundation Center of Excellence; and Translational Neurotherapeutics Program, Georgetown University, Washington, DC. · 4 Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio. · 5 Institute for Psychiatric Education, Dayton Psychiatric Association, Dayton, Ohio. · 6 Academic Internal Medicine and Geriatrics, University of Illinois, and Jesse Brown Veterans' Center, Chicago, Illinois. · 7 Movement Disorders Program and Department of Neurology, Jefferson University, Philadelphia, Pennsylvania. · 8 Specialty and Pharmacy Contracts, Harvard Pilgrim Health Care, Quincy, Massachusetts. · 9 Pharmacy Services, Independent Health, Buffalo, New York. · 10 Health New England, Springfield, Massachusetts. · 11 Magellan Rx Management, Newport, Rhode Island. ·J Manag Care Spec Pharm · Pubmed #28636480.

ABSTRACT: A panel of experts drawn from neurology, psychiatry, geropsychiatry, geriatrics, and pharmacy representatives of 3 health plans convened in New York City on July 30, 2016, with the objective of sharing opinions, ideas, and information regarding the optimal management of Parkinson's disease psychosis (PDP). Three key points emerged from the discussion: (1) Because of the nature of Parkinson's disease and PDP, finding appropriate treatment can prove challenging; (2) emerging therapies may present an opportunity for effective disease management; and (3) moving forward, provider and patient education regarding PDP and available treatment options is essential for well-managed symptoms and better quality of life. The panel reviewed current practices and formulated recommendations on moving forward in the treatment of PDP. DISCLOSURES: This project and manuscript was funded by ACADIA Pharmaceuticals and developed by Magellan Rx Management. Lopes and Farnum are employees of Magellan Rx Management. Kremens has received consulting/speaker fees from Teva Pharmaceuticals, UCB, Sunovion, Impax, Lundbeck, ACADIA, USWorldMeds, Merz, Acorda, Kyowa, Neurocrine, and GE Healthcare. Pagan reports consulting/speaker fees from Teva Nanoscience, AbbVie, Impax, ACADIA, Medtronic, USWorldMeds, Merz, and Cynapsus and research and educational grants from USWorldMeds, Teva, and Medtronic. Patel has received consultant/speaker fees from ACADIA, Allergen, and Avanir. Alva reports research support from Accera, Allergan, Axovant, Eisai, Neurotrope, Genentech, Intra Cellular, Janssen, Lundbeck, Neurim, Novartis, Otsuka, Roche, Suven, and Trans Tech and consultant/speaker fees from ACADIA, Alkermes, Allergan, Avanir, Janssen, Lundbeck, Merck, Nestle, Otsuka, Sunovion, Takeda, and Vanda. The other authors report no potential conflicts of interest, financial or otherwise.

12 Review Nonmotor Symptoms in Parkinson's Disease. 2017

Akbar, Umer / D'Abreu, Anelyssa / Friedman, Joseph H. ·Department of Neurology, Brown University, Providence, Rhode Island. ·Semin Neurol · Pubmed #28511256.

ABSTRACT: Nonmotor symptoms (NMSs) in Parkinson's disease (PD) have become increasingly recognized as major determinants of quality of life across cultures worldwide. Behavioral symptoms include dementia, depression, anxiety, apathy, and fatigue. Somatic symptoms include hypotension, constipation, diaphoresis, and pain. However, somatic symptoms may also be intrinsic, such as dementia, and iatrogenic, such as compulsive disorders. The authors address some of the more common disorders, yet few have been the target of clinical trials.

13 Review Impulse control disorders and levodopa-induced dyskinesias in Parkinson's disease: an update. 2017

Voon, Valerie / Napier, T Celeste / Frank, Michael J / Sgambato-Faure, Veronique / Grace, Anthony A / Rodriguez-Oroz, Maria / Obeso, Jose / Bezard, Erwan / Fernagut, Pierre-Olivier. ·Department of Psychiatry and Behavioural and Clinical Neurosciences Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. Electronic address: vv247@cam.ac.uk. · Departments of Pharmacology and Psychiatry, Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL, USA. · Department of Cognitive, Linguistic and Psychological Sciences and Department of Psychiatry and Human Behavior, Brown Institute for Brain Science, Providence, RI, USA. · Institut des Sciences Cognitives Marc Jeannerod, CNRS, Bron, France; Université Claude Bernard Lyon 1, Villeurbanne, France. · Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA. · Biodonostia Health Research Institute, University Hospital Donostia, and Basque Center on Cognition, Brain and Language, San Sebastián, Spain; Ikerbasque-Basque Foundation for Science, Bilbao, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto Carlos III, Spain. · Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto Carlos III, Spain; HM Centro Integral de Neurociencias, HM Puerta del Sur, Mostoles and Centro de Estudios Universitarios-San Pablo University, Madrid, Spain. · Université de Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, France; Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Bordeaux, France. ·Lancet Neurol · Pubmed #28229895.

ABSTRACT: Dopaminergic medications used in the treatment of patients with Parkinson's disease are associated with motor and non-motor behavioural side-effects, such as dyskinesias and impulse control disorders also known as behavioural addictions. Levodopa-induced dyskinesias occur in up to 80% of patients with Parkinson's after a few years of chronic treatment. Impulse control disorders, including gambling disorder, binge eating disorder, compulsive sexual behaviour, and compulsive shopping occur in about 17% of patients with Parkinson's disease on dopamine agonists. These behaviours reflect the interactions of the dopaminergic medications with the individual's susceptibility, and the underlying neurobiology of Parkinson's disease. Parkinsonian rodent models show enhanced reinforcing effects of chronic dopaminergic medication, and a potential role for individual susceptibility. In patients with Parkinson's disease and impulse control disorders, impairments are observed across subtypes of decisional impulsivity, possibly reflecting uncertainty and the relative balance of rewards and losses. Impairments appear to be more specific to decisional than motor impulsivity, which might reflect differences in ventral and dorsal striatal engagement. Emerging evidence suggests impulse control disorder subtypes have dissociable correlates, which indicate that individual susceptibility predisposes towards the expression of different behavioural subtypes and neurobiological substrates. Therapeutic interventions to treat patients with Parkinson's disease and impulse control disorders have shown efficacy in randomised controlled trials. Large-scale studies are warranted to identify individual risk factors and novel therapeutic targets for these diseases. Mechanisms underlying impulse control disorders and dyskinesias could provide crucial insights into other behavioural symptoms in Parkinson's disease and addictions in the general population.

14 Review Misperceptions and Parkinson's disease. 2017

Friedman, Joseph H. ·Butler Hospital, Dept of Neurology, Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, USA. Electronic address: joseph_friedman@brown.edu. ·J Neurol Sci · Pubmed #28073433.

ABSTRACT: Most of the neurobehavioral aspects of Parkinson's disease have been well established and studied, but many are not well known, and hardly studied. This article focuses on several behavioral abnormalities that are common, and frequently cause difficulty for the patient and family due to lack of recognition as part of the disease. While it is well known that L-Dopa dyskinesias are frequently not recognized or under appreciated by patients, a similar lack of recognition may affect the patient's own speech volume, where their center of gravity is located, whether they are tilted to one side, and their under-recognition of others' emotional displays. In addition, PD patients are often misperceived by others incorrect impression of their emotional and cognitive state based purely on facial expression. These changes and others are briefly reviewed.

15 Review Perioperative management of Parkinson's disease. 2017

Akbar, Umer / Kurkchubasche, Arlet G / Friedman, Joseph H. ·a Department of Neurology , Brown University, Rhode Island Hospital , Providence , RI , USA. · b Department of Surgery and Pediatrics , Brown University, Hasbro Children's Hospital , Providence , RI , USA. · c Department of Neurology , Brown University, Butler Hospital , Providence , RI , USA. ·Expert Rev Neurother · Pubmed #27677316.

ABSTRACT: INTRODUCTION: Guidelines for the management of Parkinson's disease (PD) patients in the perioperative setting are lacking. Areas covered: Here we review potential problems that may arise when PD patients are undergoing an operation. We also review the literature, where available, and provide our expert opinion and recommendations based on experience. Expert commentary: Elderly patients with PD are especially prone to complications in the perioperative setting. Extreme caution must be used to ensure appropriate medication administration, transition to non-oral agents, if indicated, and early mobilization to achieve rapid recovery after surgery.

16 Review Motor symptoms in Parkinson's disease: A unified framework. 2016

Moustafa, Ahmed A / Chakravarthy, Srinivasa / Phillips, Joseph R / Gupta, Ankur / Keri, Szabolcs / Polner, Bertalan / Frank, Michael J / Jahanshahi, Marjan. ·Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, United States; School of Social Sciences and Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia; Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia. Electronic address: a.moustafa@westernsydney.edu.au. · Department of Biotechnology, Indian Institute of Technology, Madras, Chennai, India. · School of Social Sciences and Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia. · Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary; Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary; Department of Physiology, Faculty of Medicine, University of Szeged, Hungary. · Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary; Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary. · Department of Cognitive, Linguistic Sciences and Psychological Sciences, Brown Institute for Brain Science, Brown University, Providence RI 02912, USA. · Cognitive Motor Neuroscience Group and Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery London, UK. ·Neurosci Biobehav Rev · Pubmed #27422450.

ABSTRACT: Parkinson's disease (PD) is characterized by a range of motor symptoms. Besides the cardinal symptoms (akinesia and bradykinesia, tremor and rigidity), PD patients show additional motor deficits, including: gait disturbance, impaired handwriting, grip force and speech deficits, among others. Some of these motor symptoms (e.g., deficits of gait, speech, and handwriting) have similar clinical profiles, neural substrates, and respond similarly to dopaminergic medication and deep brain stimulation (DBS). Here, we provide an extensive review of the clinical characteristics and neural substrates of each of these motor symptoms, to highlight precisely how PD and its medical and surgical treatments impact motor symptoms. In conclusion, we offer a unified framework for understanding the range of motor symptoms in PD. We argue that various motor symptoms in PD reflect dysfunction of neural structures responsible for action selection, motor sequencing, and coordination and execution of movement.

17 Review Parkinson's disease-related fatigue: A case definition and recommendations for clinical research. 2016

Kluger, Benzi M / Herlofson, Karen / Chou, Kelvin L / Lou, Jau-Shin / Goetz, Christopher G / Lang, Anthony E / Weintraub, Daniel / Friedman, Joseph. ·Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA. · Department of Neurology, Sorlandet Hospital Arendal, Norway. · Departments of Neurology and Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA. · Department of Neurology, University of North Dakota School of Medicine and Health Science, Department of Neurology, Sanford Health, Fargo, North Dakota, USA. · Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA. · Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada. · Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA. · Department of Neurology, Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA. ·Mov Disord · Pubmed #26879133.

ABSTRACT: Fatigue is one of the most common and disabling symptoms in Parkinson's disease (PD). Since fatigue was first described as a common feature of PD 20 years ago, little progress has been made in understanding its causes or treatment. Importantly, PD patients attending the 2013 World Parkinson Congress voted fatigue as the leading symptom in need of further research. In response, the Parkinson Disease Foundation and ProjectSpark assembled an international team of experts to create recommendations for clinical research to advance this field. The working group identified several areas in which shared standards would improve research quality and foster progress including terminology, diagnostic criteria, and measurement. Terminology needs to (1) clearly distinguish fatigue from related phenomena (eg, sleepiness, apathy, depression); (2) differentiate subjective fatigue complaints from objective performance fatigability; and (3) specify domains affected by fatigue and causal factors. We propose diagnostic criteria for PD-related fatigue to guide participant selection for clinical trials and add rigor to mechanistic studies. Recommendations are made for measurement of subjective fatigue complaints, performance fatigability, and neurophysiologic changes. We also suggest areas in which future research is needed to address methodological issues and validate or optimize current practices. Many limitations in current PD-related fatigue research may be addressed by improving methodological standards, many of which are already being successfully applied in clinical fatigue research in other medical conditions (eg, cancer, multiple sclerosis). © 2016 International Parkinson and Movement Disorder Society.

18 Review Oral Hygiene in Patients with Parkinson's Disease. 2015

Batista, Leonardo M / Portela de Oliveira, Millena Teles / Magalhaes, Wilrama B / Bastos, Poliana Lima. ·Rhode Island Hospital, Department of Psychiatry, Brown University, Providence, RI. · School of Dentistry, Federal University of Ceara, Sobral, Brazil. · University of Fortaleza, Fortaleza, Brazil. ·R I Med J (2013) · Pubmed #26517254.

ABSTRACT: Parkinson's disease is a chronic progressive neurodegenerative disorder with a multifactorial etiology. The symptoms are characterized by motor disorders - tremor, rigidity, bradykinesia and postural instability, which hinder oral hygiene. Oral and dental health in Parkinson's disease has been under-documented and findings are conflicting. Moreover, a number of dentists have limited experience regarding the management of these patients. This article reviews literature published within the last fifteen years, to better understand the impact of this disease in oral health. A literature search (MEDLINE and PUBMED), using keywords Parkinson Disease and Oral Hygiene, yielded 27 articles, from which 20 were selected. All of the articles were published in English in the last 15 years.

19 Review Recognition and treatment of neuropsychiatric disturbances in Parkinson's disease. 2015

Akbar, Umer / Friedman, Joseph H. ·a Department of Neurology, Brown University, Providence, RI, USA. ·Expert Rev Neurother · Pubmed #26289491.

ABSTRACT: The non-motor symptoms of Parkinson's disease (PD) have been attracting increasing attention due to their ubiquitous nature and their often devastating effects on the quality of life. Behavioral problems in PD include dementia, depression, apathy, fatigue, anxiety, psychosis, akathisia, personality change, sleep disorders and impulse control disorders. Some of these are intrinsic to the neuropathology while others occur as an interplay between pathology, psychology and pharmacology. While few data exist for guiding therapy, enough is known to guide therapy in a rational manner.

20 Review Evidence-based treatment of voice and speech disorders in Parkinson disease. 2015

Mahler, Leslie A / Ramig, Lorraine O / Fox, Cynthia. ·aDepartment of Communicative Disorders, University of Rhode Island, Kingston, Rhode Island bUniversity of Colorado, Boulder, Colorado cColumbia University, New York, New York dNational Center for Voice and Speech, Denver, Colorado, USA. ·Curr Opin Otolaryngol Head Neck Surg · Pubmed #25943966.

ABSTRACT: PURPOSE OF REVIEW: Voice and speech impairments are present in nearly 90% of people with Parkinson disease and negatively impact communication and quality of life. This review addresses the efficacy of Lee Silverman Voice Treatment (LSVT) LOUD to improve vocal loudness (as measured by vocal sound pressure level vocSPL) and functional communication in people with Parkinson disease. The underlying physiologic mechanisms of Parkinson disease associated with voice and speech changes and the strength of the current treatment evidence are discussed with recommendations for best clinical practice. RECENT FINDINGS: Two randomized control trials demonstrated that participants who received LSVT LOUD were significantly better on the primary outcome variable of improved vocSPL posttreatment than alternative and no treatment groups. Treatment effects were maintained for up to 2 years. In addition, improvements have been demonstrated in associated outcome variables, including speech rate, monotone, voice quality, speech intelligibility, vocal fold adduction, swallowing, facial expression and neural activation. Advances in technology-supported treatment delivery are enhancing treatment accessibility. SUMMARY: Data support the efficacy of LSVT LOUD to increase vocal loudness and functional communication in people with Parkinson disease. Timely intervention is essential for maximizing quality of life for people with Parkinson disease.

21 Review Apathy in Neurodegenerative Diseases: Recommendations on the Design of Clinical Trials. 2015

Cummings, Jeffrey / Friedman, Joseph H / Garibaldi, George / Jones, Martin / Macfadden, Wayne / Marsh, Laura / Robert, Philippe H. ·Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA cumminj@ccf.org. · Department of Neurology, Movement Disorders Program, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA. · Clinical Development, Neurosciences, F. Hoffman-La Roche AG, Basel, Switzerland. · Bridge Medical Consulting Ltd, London, United Kingdom. · Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · CoBTeK, Research Memory Center CMRR CHU, University of Sophia Antipolis, Nice, France. ·J Geriatr Psychiatry Neurol · Pubmed #25809634.

ABSTRACT: Apathy is a common feature of neurodegenerative disorders but is difficult to study in a clinical trial setting due to practical and conceptual barriers. Principal challenges include a paucity of data regarding apathy in these disorders, an absence of established diagnostic criteria, the presence of confounding factors (eg, coexisting depression), use of concomitant medications, and an absence of a gold-standard apathy assessment scale. Based on a literature search and ongoing collaboration among the authors, we present recommendations for the design of future clinical trials of apathy, suggesting Alzheimer disease and Parkinson disease as models with relevance across a wider array of neuropsychiatric disorders. Recommendations address clarification of the targeted study population (apathy diagnosis and severity at baseline), confounding factors (mood/cognition, behavior, and treatment), outcome measures, study duration, use of comparators and considerations around environment, and the role of the caregiver and patient assent. This review contributes to the search for an optimal approach to study treatment of apathy in neuropsychiatric disorders.

22 Review Encapsulated cell therapy for neurodegenerative diseases: from promise to product. 2014

Emerich, Dwaine F / Orive, Gorka / Thanos, Christopher / Tornoe, Jens / Wahlberg, Lars U. ·NsGene, Inc., Providence, RI, USA. Electronic address: dwaine.emerich@gmail.com. · Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country, Vitoria, Spain; Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine, CIBER-BBN, SLFPB-EHU, Vitoria-Gasteiz, Spain. · Cytosolve, Inc., Povidence, RI, USA. · NsGene, Inc., Providence, RI, USA. ·Adv Drug Deliv Rev · Pubmed #23880505.

ABSTRACT: Delivering therapeutic molecules, including trophic factor proteins, across the blood brain barrier to the brain parenchyma to treat chronic neurodegenerative diseases remains one of the great challenges in biology. To be effective, delivery needs to occur in a long-term and stable manner at sufficient quantities directly to the target region in a manner that is selective but yet covers enough of the target site to be efficacious. One promising approach uses cellular implants that produce and deliver therapeutic molecules directly to the brain region of interest. Implanted cells can be precisely positioned into the desired region and can be protected from host immunological attack by encapsulating them and by surrounding them within an immunoisolatory, semipermeable capsule. In this approach, cells are enclosed within a semiporous capsule with a perm selective membrane barrier that admits oxygen and required nutrients and releases bioactive cell secretions while restricting passage of larger cytotoxic agents from the host immune defense system. Recent advances in human cell line development have increased the levels of secreted therapeutic molecules from encapsulated cells, and membrane extrusion techniques have led to the first ever clinical demonstrations of long-term survival and function of encapsulated cells in the brain parenchyma. As such, cell encapsulation is capable of providing a targeted, continuous, de novo synthesized source of very high levels of therapeutic molecules that can be distributed over significant portions of the brain.

23 Review Pimavanserin for the treatment of Parkinson's disease psychosis. 2013

Friedman, Joseph H. ·Movement Disorders Program, Butler Hospital , 345 Blackstone Blvd, Providence, RI 02906 , USA. ·Expert Opin Pharmacother · Pubmed #24016069.

ABSTRACT: INTRODUCTION: Parkinson's disease (PD) is a neurobehavioral disorder defined by its motor features. Its treatment is frequently complicated by the presence of psychotic symptoms, most prominently hallucinations and delusions. These cause major distress and are the primary cause for nursing home placement. Current treatment requires either a reduction in medications for mobility or the addition of atypical antipsychotics, none of which are approved in the United States, and which are associated with major potential drawbacks. AREAS COVERED: Information from extensive personal experience, a Pubmed literature search plus a direct request to Acadia Pharmaceuticals was used for this review. A brief review of the clinical problem and its current state of treatment will be followed by a discussion of pimavanserin and its potential role in treating PD psychosis (PDP). Several observations have implicated serotonin in the physiology of psychotic symptoms. Lysergic acid diethylamide, phencyclidine, and similar drugs that activate 5HT2A serotonin receptors produce psychotic syndromes, and almost all antipsychotic neuroleptics share the property of blocking the 5HT2A receptor as well as the dopamine D2 receptor. The reduced motor side effects of the second-generation antipsychotics have been ascribed to these drugs having greater 5HT2A antagonism than the first generation. Studies in animal models of psychosis have suggested benefits from drugs blocking the 5HT2A receptor alone without the motor side effects seen with D2 receptor antagonism. EXPERT OPINION: Pimavanserin, a 5HT2A inverse agonist, has no motor side effects, and a remarkable safety profile that is comparable to placebo. Its antipsychotic effects coupled with its lack of motor side effects could make it an ideal drug for treating psychotic symptoms in PD, a major unmet need. One Phase III trial in PDP has demonstrated excellent tolerability and significant benefit. The FDA agreed to the filing of a planned new drug approval (NDA) for an indication in the treatment of PDP.

24 Review Parkinson disease psychosis: Update. 2013

Friedman, J H. ·Movement Disorders Program, Butler Hospital, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA. Tel.: +1 401 455 6669; Fax: +1 401 455 6670; E-mail: Joseph_Friedman@Brown.edu. ·Behav Neurol · Pubmed #23242358.

ABSTRACT: Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in nature, occur in about 5%. These problems, particularly the delusions, cause great distress for patient and caregivers, and are among the most important precipitants for nursing home placement. Psychotic symptoms carry a poor prognosis. They often herald dementia, and are associated with increased mortality. These symptoms often abate with medication reductions, but this may not be tolerated due to worsened motor function. Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not. While quetiapine has been recommended by the American Academy of Neurology for "consideration," double blind placebo controlled trials have demonstrated safety but not efficacy. Other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited. PDP remains a serious problem with limited treatment options.

25 Review Atypical antipsychotic drugs in the treatment of Parkinson's disease. 2011

Friedman, Joseph H. ·Department of Neurology, Movement Disorders Program, Butler Hospital, Alpert Medical School of Brown University, Providence, RI 02906, USA. joseph_friedman@brown.edu ·J Pharm Pract · Pubmed #22095576.

ABSTRACT: Parkinson's disease (PD) patients often develop psychotic symptoms that severely affect quality of life and limit the use of medications to ameliorate motor symptoms. Psychotic symptoms are a major cause for nursing home placement. While these symptoms do not always require treatment, they often do but antipsychotic drugs all share the common pharmacological mechanism of blocking dopamine D2 receptors which may worsen motor problems in this very vulnerable population. Double blind, placebo controlled trials (DBPCT) have shown that clozapine is effective at controlling the psychotic symptoms at doses far below those used in schizophrenia, without worsening motor function, even improving tremor. DBPCT have demonstrated that olanzapine worsens motor function without improving psychosis. Quetiapine has been shown in DBPCT to be free of motor side effects in PD patients but not effective, whereas many open label studies have indicated that quetiapine is effective. The other atypical have been the subjects of conflicting open label reports. The effects of the atypicals in PD psychosis is reviewed.