The Monthly Transmitter (July 08)
||Hot Off The Press
|The 2008 Consortium Conference is quickly approaching! This "meeting of the minds" will host representatives from the 47 Consortium Centers, the 6 PADRECCS, VA Central Office, and the PD non-profit community. We anticipate a dynamic and interactive program as we debate hot topics in the movement disorders field, review findings from the DBS cooperative study, and strategize the future direction of our national program. Please contact Dawn McHale, Consortium Coordinator, at firstname.lastname@example.org if you have not yet registered for the conference. We hope to see you in September for this exciting event!
Please keep in mind that the Outreach Program is an on-going initiative. Take advantage of this offering by contacting your local PADRECC to discuss your educational and training needs.
- (+) Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson's disease: a randomized, multicenter study (click here)
The study assesses the neuropsychiatric consequences of bilateral sub-thalamic-deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD) by utilizing an ancillary protocol as part of a randomized study that compared DBS with the best medical treatment. 123 patients with advanced PD, randomly assigned to receive STN-DBS (n= 60) or the best medical treatment (n=63), completed the study. The patients underwent neuropsychological and psychiatric examinations to assess the changes between baseline and after 6 months. The primary outcome was the comparison of the effect of DBS with the best medical treatment on overall cognitive functioning using the Mattis dementia rating scale (MDRS). Secondary outcomes were the effects on executive function, depression, anxiety, psychiatric status, manic symptoms, and quality of life. After 6 months, there was no significant difference in scores for overall cognition between the two groups, however DBS group showed impairment in executive function (difference of changes [DBS-best medical treatment] in verbal fluency [semantic] -4.50 points, 95% CI -8.07 to -0.93, Cohen's d=-;0.4; verbal fluency [phonemic] -3.06 points, -5.50 to -0.62, -0.5; Stroop 2 naming colour error rate -0.37 points, -0.73 to 0.00, -0.4; Stroop 3 word reading time -5.17 s, -8.82 to -1.52, -0.5; Stroop 4 colour naming time -13.00 s, -25.12 to -0.89, -0.4), irrespective of the improvement in quality of life (difference of changes in PDQ-39 10.16 points, 5.45 to 14.87, 0.6; SF-36 physical 16.55 points, 10.89 to 22.21, 0.9; SF-36 psychological 9.74 points, 2.18 to 17.29, 0.5). Anxiety scores were reduced in the DBS group compared to the best medical management group.
Hence in this study, bilateral STN-DBS was shown to selectively decrease frontal cognitive functions, without an overall change in cognition in a 6 month follow up. Additionally, improvement in anxiety was seen in the DBS group. The study provides additional evidence for frontal dysfunction as a consequence of bilateral STN-DBS, despite the author’s conclusion that "STN-DBS is safe with respect to neuropsychological and psychiatric effects in carefully selected patients during a 6-month follow-up period".
Lancet Neurol. 2008 Jul;7(7):605-14. Epub 2008 Jun 4. http://www.ncbi.nlm.nih.gov/pubmed/18538636?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_
- (+) Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. (click here)
The aim of the study was to compare three initial treatments for PD i-e L-dopa with decarboxylase inhibitor (DDCI),), L-dopa/DDCI plus selegiline, or a dopamine agonist bromocriptine with respect to mortality, disability and motor complications. 782 PD patients were recruited into an open pragmatic multicenter trial and were randomized to the above mentioned treatment groups. The main endpoints were mortality, disability, and motor complications. For final follow-up, health-related quality of life and mental function were also assessed.
Median duration of follow-up at final assessment was 14 years in the 166 (21%) surviving participants who could be contacted. After adjustment for baseline characteristics, patients in L-dopa group showed less disability than those in the bromocriptine arm (Webster: 16.6 vs 19.8; p = 0.03; Northwestern University Disability: 34.3 vs 30.0, p = 0.05). Physical functioning (difference 20.8; 95% CI 10.0, 31.6; p < 0.001) and physical summary scores (difference 5.2; 95% CI 0.7, 9.7; p = 0.03) on the 36-item short-form health survey were also superior on L-dopa. Differences in mortality rates and prevalence of dyskinesias, motor fluctuations, and dementia were not significantly different. Previously published ten-year follow-up results had also shown no long-term advantages to initiating treatment with bromocriptine compared with L-dopa in early Parkinson disease (PD). Increased mortality in patients on selegiline combined with L-dopa had led to premature termination of this arm after 6 years
Hence, based on this trial initial treatment with the dopamine agonist bromocriptine was not superior to L-Dopa with respect to mortality or motor disability or a sustained reduction in the frequency in motor complications. Authors found no evidence of a long-term benefit or clinically relevant disease-modifying effect with initial dopamine agonist treatment.
Neurology 2008 Jun 25. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/18579806?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_
- (+) Mild cognitive impairment is common in Parkinson's disease patients with normal Mini-Mental State Examination (MMSE) scores. (click here)
This project explored the sensitivity of Mini-Mental State Examination (MMSE) in the assessment of cognitive impairment in Parkinson's disease. The authors studied the frequency and characteristics of cognitive deficits in Parkinson’s disease (PD) patients, with normal (MMSE) scores. One hundred and six PD patients with normal MMSE scores (mean [SD] score=29.1 [1.1]) underwent standardized neuropsychological testing assessing memory, executive function, and attention. Impairment on a cognitive domain was a low score (i.e., >/=1.5 SD below the published normative mean) on at least two measures or tests (for memory and executive abilities) or a single measure (for attention). Mild cognitive impairment was seen in 29.2% of PD patients. 17.9% demonstrated impairment in single domain while 11.3% had multiple domain deficiencies. Memory and attention impairment were the most common (15.1% and 17.0%, respectively), followed by executive impairment (8.5%). Advancing age and disease severity, anti-anxiety medication use, and possibly increasing severity of daytime sleepiness were noted as independent predictors of cognitive impairment. Authors concluded that cognitive deficits are common in PD patients with a normal score on MMSE, suggesting that MMSE is an insensitive screening test for cognitive impairment in this patient population. The study also suggested a probably higher prevalence of MCI in PD, since MMSE is a commonly used screening instrument. Additionally, psychiatric medication use and daytime sleepiness may be reversible or treatable contributors to cognitive impairment in PD.
Parkinsonism Relat Disord. 2008 Jun 30. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/18595765?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_
|Dates To Remember
|July 28th-31st, 2008
18th Annual Course
for the Clinical
August 7th-9th, 2008
6th Annual Young
September 3rd-5th, 2008
September 6-7, 2008
Parkinson's West Coast,
Sager, CA www.valleyparkinsons.org/events.html
September 12, 2008
September 15, 2008
Michael J. Fox
Annual PD Therapeutics
October 3-4, 2008
APDA 3rd Annual PD
October 11, 2008
Annual PD Community
October 11, 2008
Surgical Advance: DBS
and PD Live Webcast
PDF and Northwest
November 7-9, 2008
March 15, 2009
2009 PAN Forum
April 4, 2009
Quality of Life & PD,
PDF and Houston Area
||Clinical Care Committee
- Standardization of Care: The Clinical Care committee is currently working on standardizing DBS education and screening forms across the PADRECCs and established Consortium Centers.
- PADRECC Transmitter: The Clinical Care committee continues to provide reviews of recent movement disorder publications that are included in the PADRECC Transmitter.
- Research: Currently exploring opportunities to develop a PADRECC wide drug study.
- EES/PADRECC Educational Series The Education subcommittee is pursuing support through the Employee Education System to develop national teleconferences for VA providers. Proposal for this project is being developed for submission to EES as well as a needs assessment which will be survey doctors, nurses, therapists or other health provides interested in PD and related movement disorder throughout the PADRECC service areas to determine areas of interest and time availability for teleconference.
- Federal Practitioner Supplement: The PADRECCs were asked to write a supplement on Parkinson's Disease for the Federal Practitioner as part of an unrestricted educational grant being submitted by Quadrant Medical Education. This project is currently pending grant approval
- 2008 National Conference: Registration is now being accepted for the conference as well as submissions for poster and case series presentations. If interested in attending and presenting a poster and/or case series, please contact Dawn McHale at 215-823-5800 x2238 or email@example.com
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