| 1. |
- Brundin, Patrik, et al.
(författare)
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Bilateral caudate and putamen grafts of embryonic mesencephalic tissue treated with lazaroids in Parkinson's disease
- 2000
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Ingår i: Brain. - 1460-2156. ; 123, s. 1380-1390
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Tidskriftsartikel (refereegranskat)abstract
- Five parkinsonian patients were transplanted bilaterally into the putamen and caudate nucleus with human embryonic mesencephalic tissue from between seven and nine donors. To increase graft survival, the lipid peroxidation inhibitor tirilazad mesylate was administered to the tissue before implantation and intravenously to the patients for 3 days thereafter. During the second postoperative year, the mean daily L-dopa dose was reduced by 54% and the UPDRS (Unified Parkinson's Disease Rating Scale) motor score in 'off' phase was reduced by a mean of 40%. At 10-23 months after grafting, PET showed a mean 61% increase of 6-L-[(18)F]fluorodopa uptake in the putamen, and 24% increase in the caudate nucleus, compared with preoperative values. No obvious differences in the pattern of motor recovery were observed between these and other previously studied cases with putamen grafts alone. The amount of mesencephalic tissue implanted in each putamen and caudate nucleus was 42 and 50% lower, respectively, compared with previously transplanted patients from our centre. Despite this reduction in grafted tissue, the magnitudes of symptomatic relief and graft survival were very similar. These findings suggest that tirilazad mesylate may improve survival of grafted dopamine neurons in patients, which is in agreement with observations in experimental animals.
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| 2. |
- de Roos, Paul, et al.
(författare)
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A Consensus Set of Outcomes for Parkinson's Disease from the International Consortium for Health Outcomes Measurement
- 2017
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Ingår i: Journal of Parkinson's Disease. - : IOS Press. - 1877-7171 .- 1877-718X. ; 7:3, s. 533-543
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative condition that is expected to double in prevalence due to demographic shifts. Value-based healthcare is a proposed strategy to improve outcomes and decrease costs. To move towards an actual value-based health care system, condition-specific outcomes that are meaningful to patients are essential.OBJECTIVE: Propose a global consensus standard set of outcome measures for PD.METHODS: Established methods for outcome measure development were applied, as outlined and used previously by the International Consortium for Health Outcomes Measurement (ICHOM). An international group, representing both patients and experts from the fields of neurology, psychiatry, nursing, and existing outcome measurement efforts, was convened. The group participated in six teleconferences over a six-month period, reviewed existing data and practices, and ultimately proposed a standard set of measures by which patients should be tracked, and how often data should be collected.RESULTS: The standard set applies to all cases of idiopathic PD, and includes assessments of motor and non-motor symptoms, ability to work, PD-related health status, and hospital admissions. Baseline demographic and clinical variables are included to enable case mix adjustment.CONCLUSIONS: The Standard Set is now ready for use and pilot testing in the clinical setting. Ultimately, we believe that using the set of outcomes proposed here will allow clinicians and scientists across the world to document, report, and compare PD-related outcomes in a standardized fashion. Such international benchmarks will improve our understanding of the disease course and allow for identification of 'best practices', ultimately leading to better informed treatment decisions.
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| 3. |
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| 5. |
- Hagell, Peter, et al.
(författare)
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Sequential bilateral transplantation in Parkinson's disease: effects of the second graft
- 1999
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Ingår i: Brain. - : Oxford University Press (OUP). - 1460-2156. ; 122:6, s. 1121-1132
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Tidskriftsartikel (refereegranskat)abstract
- Five parkinsonian patients who had received implants of human embryonic mesencephalic tissue unilaterally in the striatum 10-56 months earlier were grafted with tissue from four to eight donors into the putamen (four patients) or the putamen plus the caudate nucleus (one patient) on the other side, and were followed for 18-24 months. After 12-18 months, PET showed a mean 85% increase in 6-L-[18F]fluorodopa uptake in the putamen with the second graft, whereas there was no significant further change in the previously transplanted putamen. Two patients exhibited marked additional improvements after their second graft: 'on-off' fluctuations virtually disappeared, movement speed increased, and L-dopa could be withdrawn in one patient and reduced by 70% in the other. The improvement in one patient was moderate. Two patients with atypical features, who responded poorly to the first graft, worsened following the second transplantation. These findings indicate that sequential transplantation in patients does not compromise the survival and function of either the first or the second graft. Moreover, putamen grafts that restore fluorodopa uptake to normal levels can give improvements of major therapeutic value.
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| 6. |
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| 7. |
- Hagell, Peter, et al.
(författare)
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The non-motor symptoms questionnaire and non-motor symptoms scale for use in Sweden
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To translate the Non-Motor Symptoms Questionnaire (NMSQ) and the Non-Motor Symptoms Scale (NMSS) into Swedish, and test their linguistic validity and user-friendliness. Background: Non-motor symptoms (NMS) are common but under recognized among people with Parkinson’sdisease (PwPD). The NMSQ and NMSS were developed to ease NMS detection and assessment. The NMSQ is a patient-reported checklist regarding the presence of 30 NMS. The NMSS is a clinician-administered interview based rating scale regarding the frequency and severity of 30 NMS. Both are widely used, but Swedish versions have been lacking. Methods: The English NMSQ and NMSS were translated into Swedish in two stages. First, Swedish translations were produced by a professional translator and 3 bilingual PD-clinicians. Second, translations were reviewed by 3 independent PD-clinicians, resulting in minor revisions. The subsequent Swedish versions were then field-tested by 4 PD-clinicians on 5 PwPD each (n=20; 15 men; mean age and PD duration67.6 and 9 years; HY stages II-IV). Evaluations included user burden (completion time), content relevance, and easiness to understand and use. Results: PwPD completed the NMSQ in a mean (range) of 4.8 (2-8) minutes. NMSQ content was considered relevant by 19 PwPD; 19 found instructions easy to understand and 17 found items easy to understand and respond to. The NMSS was completed in 13 (8-25) minutes. All 4 clinicians considered NMSS contents as relevant and instructions easy to understand; 1 considered items easy to rate. Two clinicians reported NMSS items as easy to understand for PwPD, and 1 clinician reported items as easy to answer for PwPD. Two clinicians considered theNMSS “very much” or “moderately”, and 2 considered it “a little” useful for clinical research. One clinician considered the NMSS “moderately”, and 3 considered it “a little” useful for clinical practice, but none would use it themselves. Translators, reviewers and field-test clinicians highlighted ambiguities with the NMSS not related to the translation. Conclusions: The NMSQ and NMSS were translated into Swedish and the linguistic validity of both translations was supported. There was also support for the user-friendliness of the NMSQ, but not for the NMSS. Issues detected with the NMSS do not appear to be specific for the Swedish version. Further evaluations of the NMSS in larger samples are needed.
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| 8. |
- Lindholm, Beata, et al.
(författare)
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Clinical usefulness of retropulsion tests in persons with mild to moderate parkinson’s disease
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI Multidisciplinary Digital Publishing Institute. - 1661-7827 .- 1660-4601. ; 18:23, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- People with Parkinson’s disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistentlyperformed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.
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| 9. |
- Lindholm, Beata, et al.
(författare)
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Gait and balance among people with de novo vs. mild to moderate Parkinson’s disease
- 2022
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Konferensbidrag (refereegranskat)abstract
- We have investigated how a de novo cohort of people with Parkinson’s disease (PD) differs in terms of balance and gait function as well as frequency of near falls and falls in comparison to a cohort with mild to moderate PD that has been medicated for several years. Preliminary results (Table 1) showed that people with de novo PD have balance and gait impairments and that some have also experienced near falls and falls. On the contrary, the cohort with more advanced disease has significantly fewer motor symptoms, as shown in the UPDRS motor score, compared to those newly diagnosed. This is probably related to successful symptomatic medication in the more advanced cohort. Despite less motor symptoms, those with a more advanced disease performed significantly worse on the balance-demanding tests (i.e., Timed Up and Go, Tandem Gait) and reported more near falls and falls. These results are consistent with previous studies reporting that dopaminergic medication improves motor symptoms, but has less effects on mobility and balance in PD. This indicates a need for balance-promoting efforts from an early stage of the disease.
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| 10. |
- Lindholm, Beata, et al.
(författare)
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Longitudinal prediction of falls and near falls frequencies in Parkinson's disease : a prospective cohort study
- 2021
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Ingår i: Journal of Neurology. - : D. Steinkopff-Verlag. - 0340-5354 .- 1432-1459. ; 268:3, s. 997-1005
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND OBJECTIVE: Several prediction models for falls/near falls in Parkinson's disease (PD) have been proposed. However, longitudinal predictors of frequency of falls/near falls are poorly investigated. Therefore, we aimed to identify short- and long-term predictors of the number of falls/near falls in PD. METHODS: A prospective cohort of 58 persons with PD was assessed at baseline (mean age and PD duration, 65 and 3.2 years, respectively) and 3.5 years later. Potential predictors were history of falls and near falls, comfortable gait speed, freezing of gate, dyskinesia, retropulsion, tandem gait (TG), pain, and cognition (Mini-Mental State Exam, MMSE). After each assessment, the participants registered a number of falls/near falls during the following 6 months. Multivariate Poisson regression was used to identify short- and long-term predictors of a number of falls/near falls. RESULTS: Baseline median (q1-q3) motor (UPDRS) and MMSE scores were 10 (6.75-14) and 28.5 (27-29), respectively. Historyof falls was the only significant short-time predictor [incidence rate ratio (IRR), 15.17] for the number of falls/near falls during 6 months following baseline. Abnormal TG (IRR, 3.77) and lower MMSE scores (IRR, 1.17) were short-term predictors 3.5 years later. Abnormal TG (IRR, 7.79) and lower MMSE scores (IRR, 1.49) at baseline were long-term predictors of the number of falls/near falls 3.5 years later. CONCLUSION: Abnormal TG and MMSE scores predict the number of falls/near falls in short and long term, and may be indicative of disease progression. Our observations provide important additions to the evidence base for clinical fall prediction in PD.
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