Hypokinetic dysarthria (HD) is a difficult-to-treat symptom affecting quality of life in patients with Parkinson's disease (PD). Levodopa may partially alleviate some symptoms of HD in PD, but the neural correlates of these effects are not fully understood. The aim of our study was to identify neural mechanisms by which levodopa affects articulation and prosody in patients with PD. Altogether 20 PD patients participated in a task fMRI study (overt sentence reading). Using a single dose of levodopa after an overnight withdrawal of dopaminergic medication, levodopa-induced BOLD signal changes within the articulatory pathway (in regions of interest; ROIs) were studied. We also correlated levodopa-induced BOLD signal changes with the changes in acoustic parameters of speech. We observed no significant changes in acoustic parameters due to acute levodopa administration. After levodopa administration as compared to the OFF dopaminergic condition, patients showed task-induced BOLD signal decreases in the left ventral thalamus (p = 0.0033). The changes in thalamic activation were associated with changes in pitch variation (R = 0.67, p = 0.006), while the changes in caudate nucleus activation were related to changes in the second formant variability which evaluates precise articulation (R = 0.70, p = 0.003). The results are in line with the notion that levodopa does not have a major impact on HD in PD, but it may induce neural changes within the basal ganglia circuitries that are related to changes in speech prosody and articulation.

• MeSH
• antiparkinsonika škodlivé účinky   MeSH
• dysartrie etiologie   komplikace   MeSH
• kvalita života MeSH
• levodopa * škodlivé účinky   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• Parkinsonova nemoc * komplikace   diagnostické zobrazování   farmakoterapie   MeSH
• poruchy řeči diagnostické zobrazování   etiologie   MeSH
• řeč fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The known impairments of the cardiovascular system in Parkinson ́s disease (PD) are caused by autonomic dysfunction and manifested mainly in postural hypotension, chronotropic insufficiency, and reduced heart rate variability. Other dysfunctions, mainly stress response, arrhythmia occurrence, and heart morphology changes, are still the subject of research. OBJECTIVES: To assess the heart rate and blood pressure reaction during exercise, advanced measurements of heart volumes and mass using cardiac magnetic resonance (CMR), and occurrence of arrhythmias in PD patients. METHODS: Thirty PD patients (19 men, mean age 57.5 years) without known cardiac comorbidities underwent bicycle ergometry, electrocardiogram Holter monitoring and CMR. Exercise and CMR parameters were compared with controls (24 subjects for ergometry, 20 for CMR). RESULTS: PD patients had lower baseline systolic blood pressure (SBP) (117.8 vs. 128.3 mmHg, p < 0.01), peak SBP (155.8 vs. 170.8 mmHg, p < 0.05), and lower heart rate increase (49.7 vs. 64.3 beats per minute, p < 0.01). PD patients had higher indexed left and right ventricular end-diastolic volumes (68.5 vs. 57.3, p = 0.003 and 73.5 vs. 61.0 mL/m2 , respectively) and also indexed left and right ventricular end-systolic volumes (44.1 vs. 39.0, p = 0.013 and 29.0 vs. 22.0 mL/m2 , p = 0.013, respectively). A high prevalence of atrial fibrillation (8 subjects, 26.7%) was found. CONCLUSIONS: This novel study combining functional and structural approaches showed that PD is linked with weaker blood pressure and heart rate reaction during exercise, increased myocardial mass and heart volumes compared to controls, and a high prevalence of atrial fibrillation.

• MeSH
• elektrokardiografie MeSH
• fibrilace síní * komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• Parkinsonova nemoc * komplikace   epidemiologie   MeSH
• srdce MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Creutzfeldtova­Jakobova nemoc (CJD) může mít velmi různorodou klinickou manifestaci. Zároveň stále přibývá neuropatologických důkazů o narůstajícím množství případů, jejichž obraz splňuje klinická diagnostická kritéria "možné" CJD, ale ve skutečnosti se o toto onemocnění nejedná; tyto tzv. fenokopie neboli "mimics" CJD jsou nejčastější příčinou diagnostických omylů. Diferenciální diagnostika CJD je široká a zahrnuje řadu potenciálně léčitelných stavů; může se jednat o nejrůznější autoimunitní, infekční, nádorová a toxicko­‐metabolická postižení CNS. Nejčastěji se s fenokopiemi CJD potkáváme v případě neurodegenerativních onemocnění, u kterých je tato atypická manifestace v drtivé většině případů spojena s přítomností tzv. "mixed pathology", smíšené patologie. I z tohoto důvodu se v budoucnosti nepochybně neobejdeme bez spolehlivých biomarkerů schopných detekce relevantních typů neurodegenerativních procesů v mozku.

Creutzfeldt-Jakob disease (CJD) may have very heterogeneous clinical manifestations. At the same time, there is increasingly more neuropathological evidence of a growing number of cases whose presentation meets the clinical diagnostic criteria for possible CJD, but it is, in fact, not this disease; these CJD phenocopies, or mimics, are the most frequent cause of diagnostic error. The differential diagnosis of CJD is broad, encompassing a number of potentially treatable conditions; they can include various autoimmune, infectious, cancerous, and toxic-metabolic CNS disorders. CJD phenocopies are most commonly encountered in the case of neurodegenerative diseases in which this atypical manifestation is associated, in the vast majority of cases, with the presence of mixed pathology. It is also for this reason that, in the future, we will certainly not do without reliable biomarkers capable of detecting relevant types of neurodegenerative processes in the brain.

• MeSH
• chybná diagnóza MeSH
• Creutzfeldtova-Jakobova nemoc * diagnóza   MeSH
• kognitivní dysfunkce etiologie   MeSH
• lidé MeSH
• Parkinsonova nemoc farmakoterapie   komplikace   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE: Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. MATERIAL AND METHODS: In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. RESULTS: The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 μs at the right side (STN) and 3.7 V, 130 Hz, 120 μs at the left side (GPi). This allowed the patient to return to his daily life activities. CONCLUSIONS: The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.

• MeSH
• elektrody MeSH
• hluboká mozková stimulace * metody   MeSH
• kvalita života MeSH
• lidé MeSH
• Parkinsonova nemoc * terapie   komplikace   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVES: To analyze REM sleep without atonia (RWA) metrics in patients with isolated REM sleep behavior disorder (iRBD), Parkinson's disease (PD) and healthy subjects and compare them in terms of degree of presumed brainstem damage. METHODS: Forty-nine iRBD patients, 62 PD patients and 38 healthy controls were included into the analysis. Detailed polysomnographic and clinical data including motor, olfactory, autonomic, and cognitive assessment were obtained in all participants and subsequently compared within groups without RBD (i.e., healthy controls, PD-RBD-) and with RBD (i.e., iRBD, PD-RBD+). SINBAR criteria were used to score RWA. RESULTS: Twenty-one PD patients (33.8 %) had RBD. When comparing PD-RBD-patients and controls, RWA tonic (p = 0.001) and RWA mixed (p = 0.03) were higher in PD-RBD-group. PD-RBD-patients had worse olfactory function than controls (p < 0.001); no significant difference in autonomic or cognitive function was registered. There were no significant differences in RWA parameters when comparing iRBD and PD-RBD + groups. iRBD patients had better olfactory function than PD-RBD+ (p = 0.006); no significant difference in autonomic or cognitive function was registered. PD-RBD + had worse autonomic (p = 0.006) and olfactory (p = 0.001) but not motor and cognitive function compared to PD-RBD-. CONCLUSIONS: Untreated de-novo PD patients without RBD have increased RWA metrics compared to healthy subjects indicating subclinical degeneration of brainstem nuclei responsible for RWA. iRBD patients do not differ in RWA metrics from untreated de-novo PD patients with premotor RBD suggesting a similar level of brainstem degeneration caudal to substantia nigra in both groups. Groups with RBD are associated with autonomic dysfunction.

• MeSH
• kognice MeSH
• lidé MeSH
• Parkinsonova nemoc * komplikace   MeSH
• polysomnografie MeSH
• porucha chování v REM spánku * MeSH
• svalová hypotonie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND PURPOSE: In our previous study, repeated sessions of repetitive transcranial magnetic stimulation (rTMS) over the auditory feedback area were shown to improve hypokinetic dysarthria (HD) in Parkinson's disease (PD) and led to changes in functional connectivity within the left-sided articulatory networks. We analyzed data from this previous study and assessed the effects of rTMS for HD in PD on the diffusion parameters of the left anterior arcuate fasciculus (AAF), which connects the auditory feedback area with motor regions involved in articulation. METHODS: Patients were assigned to 10 sessions of real or sham 1-Hz stimulation over the right posterior superior temporal gyrus. Stimulation effects were evaluated using magnetic resonance diffusion tensor imaging and by a speech therapist using a validated tool (Phonetics score of the Dysarthric Profile) at baseline, immediately after 2 weeks of stimulation, and at follow-up visits at Weeks 6 and 10 after the baseline. RESULTS: Altogether, data from 33 patients were analyzed. A linear mixed model revealed significant time-by-group interaction (p = 0.006) for the relative changes of fractional anisotropy of the AAF; the value increases were associated with the temporal evolution of the Phonetics score (R = 0.367, p = 0.028) in the real stimulation group. CONCLUSIONS: Real rTMS treatment for HD in PD as compared to sham stimulation led to increases of white matter integrity of the auditory-motor loop during the 2-month follow-up period. The changes were related to motor speech improvements.

• MeSH
• bílá hmota * MeSH
• dysartrie terapie   MeSH
• lidé MeSH
• Parkinsonova nemoc * komplikace   MeSH
• transkraniální magnetická stimulace metody   MeSH
• zobrazování difuzních tenzorů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Parkinsonova nemoc (PN) je velmi častým progresivním onemocněním a řízení motorového vozidla je náročná a komplexní činnost, která vyžaduje souhru kognitivních a psychomotorických funkcí, správné plánování, dobrou paměť, pozornost a koordinaci oko­‐ruka­‐noha. Rozhodnutí o nezpůsobilosti řídit motorové vozidlo má pro pacienta zásadní význam, mějme ale na paměti i bezpečnost silničního provozu. Pacienti s PN mají vyšší výskyt kognitivních poruch a na řízení se rovněž podílí postižení hybnosti. Dalším problémem je výskyt nadměrné denní spavosti, která může být potencována medikací. Měli bychom se cíleně na denní spavost ptát. V současnosti neexistují jednotná právní kritéria, kterými bychom se mohli řídit.

Parkinson's disease (PD) is a very common progressive disease and driving is a demanding and complex activity that requires the interplay of cognitive and psychomotor functions, good planning, memory, attention and eye-hand-foot coordination. The decision to be unable to drive is of paramount importance to the patient, but we must also keep road safety in mind. Patients with PD have a higher incidence of cognitive impairment and impaired mobility is also involved in driving problems. In addition, the incidence of excessive daytime sleepiness, which can be potentiated by medication, is a problem. Daytime sleepiness should be specifically asked about. At present, there are no uniform legal criteria to follow.

• MeSH
• hluboká mozková stimulace metody   MeSH
• lidé MeSH
• nežádoucí účinky léčiv MeSH
• Parkinsonova nemoc * farmakoterapie   komplikace   MeSH
• poruchy nadměrné spavosti diagnóza   etiologie   terapie   MeSH
• posuzování zdravotní způsobilosti MeSH
• řízení motorových vozidel psychologie   zákonodárství a právo   MeSH
• Check Tag
• lidé MeSH

The neurodegenerative synucleinopathies, including Parkinson's disease and dementia with Lewy bodies, are characterized by a typically lengthy prodromal period of progressive subclinical motor and non-motor manifestations. Among these, idiopathic REM sleep behaviour disorder is a powerful early predictor of eventual phenoconversion, and therefore represents a critical opportunity to intervene with neuroprotective therapy. To inform the design of randomized trials, it is essential to study the natural progression of clinical markers during the prodromal stages of disease in order to establish optimal clinical end points. In this study, we combined prospective follow-up data from 28 centres of the International REM Sleep Behavior Disorder Study Group representing 12 countries. Polysomnogram-confirmed REM sleep behaviour disorder subjects were assessed for prodromal Parkinson's disease using the Movement Disorder Society criteria and underwent periodic structured sleep, motor, cognitive, autonomic and olfactory testing. We used linear mixed-effect modelling to estimate annual rates of clinical marker progression stratified by disease subtype, including prodromal Parkinson's disease and prodromal dementia with Lewy bodies. In addition, we calculated sample size requirements to demonstrate slowing of progression under different anticipated treatment effects. Overall, 1160 subjects were followed over an average of 3.3 ± 2.2 years. Among clinical variables assessed continuously, motor variables tended to progress faster and required the lowest sample sizes, ranging from 151 to 560 per group (at 50% drug efficacy and 2-year follow-up). By contrast, cognitive, olfactory and autonomic variables showed modest progression with higher variability, resulting in high sample sizes. The most efficient design was a time-to-event analysis using combined milestones of motor and cognitive decline, estimating 117 per group at 50% drug efficacy and 2-year trial duration. Finally, while phenoconverters showed overall greater progression than non-converters in motor, olfactory, cognitive and certain autonomic markers, the only robust difference in progression between Parkinson's disease and dementia with Lewy bodies phenoconverters was in cognitive testing. This large multicentre study demonstrates the evolution of motor and non-motor manifestations in prodromal synucleinopathy. These findings provide optimized clinical end points and sample size estimates to inform future neuroprotective trials.

• MeSH
• biologické markery MeSH
• demence s Lewyho tělísky * diagnóza   MeSH
• lidé MeSH
• Parkinsonova nemoc * komplikace   diagnóza   MeSH
• porucha chování v REM spánku * diagnóza   MeSH
• prodromální symptomy MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

Cieľ: Cieľom tejto práce bolo overenie psychometrických charakteristík slovenskej verzie Mattisovej škály demencie (Dementia Rating Scale-2; DRS-2), preskúmanie jej diagnostickej presnosti v populácii pacientov s Parkinsonovou chorobou (PCh) a stanovenie predbežného hraničného skóre pre diagnostiku miernej kognitívnej poruchy (mild cognitive impairment; MCI). Súbor a metodika: Klinická populácia bola zložená z 30 pacientov s PCh, s priemernou dĺžkou trvania ochorenia 5,53 ± 3,92 rokov. U 11 pacientov bola diagnostikovaná MCI. Kontrolnú skupinu zdravých ľudí bez neurologického ochorenia tvorilo 43 vekovo a vzdelanostne príbuzných participantov. Všetkým participantom bola administrovaná slovenská verzia DRS-2 merajúca pozornosť, pamäť, iniciáciu/perseveráciu, konštrukčné schopnosti a konceptualizáciu. Na posúdenie konvergentnej validity bola využitá komplexná neuropsychologická batéria. Výsledky: Korelácie skóre DRS-2 so skríningovými nástrojmi a analogickými testami neuropsychologickej batérie poukazujú na dobrú konvergentnú validitu nástroja (s výnimkou subtestu konštrukcia). Najsilnejšie vzťahy sme zistili pre subtesty iniciácia/perseverácia a pamäť. Objektivizovali sme dobrú diskriminačnú silu pri pacientoch s PCh bez kognitívneho deficitu a pacientoch s MCI so stanovením optimálneho cut-off skóre 134 bodov (senzitivita 81,80 % a špecificita 89,50 %). Záver: Slovenská verzia Mattisovej škály demencie je nástrojom s vyhovujúcimi psychometrickými vlastnosťami a možno ju potenciálne použiť na testovanie kognície u zdravej populácie a pacientov s Parkinsonovou chorobou.

Aim: Aims of this study were to verify the psychometric characteristics of the Slovak version of the Mattis Dementia Rating Scale-2 (DRS-2), examine its diagnostic accuracy in the population of patients with Parkinson‘s disease (PD), and establish a preliminary cut-off score for the diagnosis of mild cognitive impairment (MCI). Sample and methods: The clinical population consisted of 30 patients with PD with an average duration of the disease of 5.53 ± 3.92 years. Eleven patients were diagnosed with MCI. The control group of healthy people without neurological disease consisted of 43 participants who were age and education matched. All participants were administered the Slovak version of the DRS-2 measuring attention, memory, initiation/perseveration, construction skills and conceptualization. A comprehensive neuropsychological battery was used to assess convergent validity. Results: Correlations of DRS-2 scores with a screening tools and analogous tests of the neuropsychological battery indicate good convergent validity of the tool (with the exception of the construction subtest). We found the strongest relationships for the initiation/perseveration and memory subtests. Furthermore, we objectified a good discriminative power in patients with PD without cognitive deficits and patients with MCI with the determination of an optimal cut-off score of 134 points (sensitivity 81.80% and specificity 89.50%). Conclusion: The Slovak version of the DRS-2 is an instrument with satisfactory psychometric properties and can potentially be used to test cognition in the healthy population and patients with Parkinson‘s disease.

• Klíčová slova
• Mattisova škála demence,
• MeSH
• demence diagnóza   MeSH
• klinická studie jako téma MeSH
• kognice MeSH
• lidé MeSH
• Parkinsonova nemoc diagnóza   komplikace   psychologie   MeSH
• psychometrie metody   MeSH
• testy pro posouzení mentálních funkcí a demence * MeSH
• Check Tag
• lidé MeSH

AIM: To investigate the presence and relationship of temporal speech and gait parameters in patients with postural instability/gait disorder (PIGD) and tremor-dominant (TD) motor subtypes of Parkinson's disease (PD). METHODS: Speech samples and instrumented walkway system assessments were acquired from a total of 60 de-novo PD patients (40 in TD and 20 in PIGD subtype) and 40 matched healthy controls. Objective acoustic vocal assessment of seven distinct speech timing dimensions was related to instrumental gait measures including velocity, cadence, and stride length. RESULTS: Compared to controls, PIGD subtype showed greater consonant timing abnormalities by prolonged voice onset time (VOT) while also shorter stride length during both normal walking and dual task, while decreased velocity and cadence only during dual task. Speaking rate was faster in PIGD than TD subtype. In PIGD subtype, prolonged VOT correlated with slower gait velocity (r = -0.56, p = 0.01) and shorter stride length (r = -0.59, p = 0.008) during normal walking, whereas relationships were also found between decreased cadence in dual task and irregular alternating motion rates (r = -0.48, p = 0.04) and prolonged pauses (r = -0.50, p = 0.03). No correlation between speech and gait was detected in TD subtype. CONCLUSION: Our findings suggest that speech and gait rhythm disorder share similar underlying pathomechanisms specific for PIGD subtype.

• MeSH
• chůze (způsob) MeSH
• chůze MeSH
• lidé MeSH
• neurologické poruchy chůze * etiologie   MeSH
• Parkinsonova nemoc * komplikace   MeSH
• posturální rovnováha MeSH
• řeč MeSH
• tremor MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH