Jun 1, 2009 - ment of MD by neurologists with special interest and training in the sub- ...... national outcome measurement system (ASHA NOMS) swallowing.
Movement Disorders Vol. 27, Suppl. 1, 2012, pp. S1–S523 2012 Movement Disorder Society
POSTER SESSION 1 Sunday, June 17, 2012 12:30–14:00 Linear Park Marquee
S1 907-11460ppb(686666651.0). Concentration it relatively very high from Japanese standart and healthy peoples of Ulaanbaatar. Mercury accumulation demonsrated very low and that range from 43.683.88ppb(58624.7), whereas Japanese standart was 3830ppb. Conclusions: Exposure to heavy metal was associated with increased risk of Parkinson’s disease in Mongolian peoples.
Posters available for viewing 9:00–18:00 3
EPIDEMIOLOGY 1 The Parkinson’s disease in Africa collaboration project in Ghana: The story so far A. Akpalu, M. Cham, R. Cilia, G. Pezzoli (Accra, Ghana) Objective: The socio-demographic, epidemiologic, clinical features and genetic causes of Parkinson’s disease patients attending the Neurology out-patients clinic of the Korle Bu Teaching and Comboni hospitals are reviewed. Background: Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease thought to be rare in Africa. A colloborative project with the Parkinson’s Institute in Milan, Italy is ongoing in Ghana. Methods: Consecutive patients clinically diagnosed with Parkinson’s disease over the last year who were enrolled in the ‘‘Parkinson’s disease in Africa collaboration project’’ were recruited. A detailed personal, family and social history was taken followed by a neurological examination, complete Unified Parkinson’s Disease Rating Scale (UPDRS) assessment (part I to part IV), Hoehn and Yahr staging and initiation of treatment with Levodopa. Patients are reviewed at 3, 6 and 12 months. Brain imaging with a head CT scan is done were feasible. A saliva sample was collected after informed consent for analysis of the LRRK2-G2019S mutation amongst others. Results: 35 subjects with parkinsonism have been identified so far: Mean age at onset 65.7610.5 years; disease duration 7.4563.1 years; Hoehn and Yahr stage 2. Mean daily levodopa dosage 5201187mg. The LRRK2 exon 41 screening did not reveal the presence of any G2019S mutation in the Parkinson’s disease patients studied so far. Recruitment of more patients, follow up at 6 months and 12 months as well as completion of UPDRS data are the main thrust of the study now Conclusions: A good response to Levedopa is seen and further genetic analysis is required 2 Association of cumulative some heavy metal exposure with Parkinson’s disease U. Dashdorj, B. Tserensodnom, B. Bold, U. Chimedregzen, F. Komatsu, Y. Kagawa (Ulaanbaatar, Mongolia) Objective: We investigated the association between some heavy metal exposures(Al, Cd, Fe, Cu, Hg) and risk of PD. Background: The association between PD and exposure to metals has been intensely investigated. Welders exposed to multiple types of metals appear to be at increased risk of developing PD, particularly at an earlier age (Racette et al. 2001). Methods: The analysis was performed(Yasuda et al., 2010) in research laboratory the La Belle Vie Inc. Tokyo, Japan. As an indicator of chronic exposure heavy metal(Al, Cd, Hg, Cu, Fe), we measured concentrations of scalp hair using an inductively coupled plasma mass spectrometry method. Results: We enrolled 11PD patients(3 men, 8 woman) and average age 57.3. The levels of Cd(29.87ppb) and Fe(14614ppb) in scalp hair in PD patients showed such as 3 times high than from healthy peoples Japanese. Alumenium accumulation showed the range from
Prevalence of neurodegenerative parkinsonism in the isolated population of South-Eastern Moravia, Czech Republic K. Farnı´kova´, P. Kanovsky, L. Mikulicova, P. Jugas, J. Ovecka, M. Kaiserova (Olomouc, Czech Republic) Objective: To assess the prevalence of neurodegenerative parkinsonism in the small, isolated, rural population of far South-Eastern Moravia. Background: It has been recently described that the prevalence of neurodegenerative diseases in a small, isolated European communities might be higher than in the general population. We have observed this phenomenon also in the small village (population 1500) in the far south-east Moravia. Methods: To assess precisely this increased prevalence, we have used the three-stage ascertainment method. All villagers received a validated screening mail questionnaire for parkinsonism. In the second stage of the ascertainment method, trained primary care neurologists identified all persons with positive signs of parkinsonism among those screened positive. In the third stage, all identified persons were admitted to the tertiary movement disorders center to exclude or confirm the diagnosis of parkinsonism. Results: The response rate was 42%. There were 56 persons screened positive, and 19 of them were identified as manifesting signs of parkinsonism; the diagnosis has been confirmed in 16 of them. Conclusions: The prevalence rate of 1% is surprisingly high; it substantially differs from the estimated prevalence in the common CentralEuropean population. The next reserach will focus on the genetic background of the families in which has been parkinsonism identified. 4 Frequency and pattern of movement disorders in a Nigerian rural tertiary health care institution: A preliminary study M.B. Fawale (Ile Ife, Nigeria) Objective: To study the frequency and pattern of movement disorders with reference to other neurological disorders seen in the outpatients clinic of the Federal Medical Centre, Ido-Ekiti, Nigeria and to compare with observations from urban centres. Background: There is a need to generate data, which are currently scarce, regarding the epidemiology of movement disorders in Nigeria. Methods: A record of new patients presenting at the adult neurology out-patients clinic of the Federal Medical Centre, Ido-Ekiti was established in June 2009. Demographic and clinical data of all new patients were documented. The hospital frequency of movement disorders with reference to other neurological disorders was determined by comparing the total number of new movement disorder cases with the total number of new referrals to the neurology clinic over the same period (June 2009 to December 2011). Results: In the two and a half year period, a total 164 new referrals were received in the clinic, 24 of which were movement disorder cases. Three cases were not eligible for the study). This gives a hospital frequency of 14.8%. The frequency of parkinsonism was 6.2% (10/161) while that of tremor, chorea and dystonia was 3.7% (6/161), 2.5% (4/161) and 1.9% (3/161) respectively. All the patients with parkinsonism met diagnostic criteria for Parkinson’s disease (PD). The mean age 6 SD of the PD patients was 71.2 6 8.1 years and was significantly higher than that of the non-PD movement disorder patients (54.1 6 17.7 years) (p5.014) and the other neurological conditions (47.3 6 20.5 years) (p5.000). Male preponderance was the rule with ratios of 4:1, 1.8:1 and 1.7:1 for PD, other movement disorders and other neurologic conditions respectively. When com-
Movement Disorders, Vol. 27, Suppl. 1, 2012
S2
POSTER SESSION 1, SUNDAY, JUNE 17, 2012
pared with reports from earlier observations from an urban centre in the same region of the country, the frequency of Parkinson’s disease in this study is much higher (6.2% vs 1.47%). The magnitude of male preponderance (4:1) is slightly different from those reported in past urban studies in the same region (4.5:1 and 3.3:1 respectively). Conclusions: Although, these data may not be representative of the total population of persons with the disease, they suggest that movement disorders are common in this Nigerian rural center. Parkinson’s disease may be more common in rural south-western Nigeria than in urban centers. 5 Pan-American consortium on multiple system atrophy E. Gatto, C. Cosentino, P. Chana, J.L. Etcheverry, E. Gallin, M. Miranda, Y. Nun˜ez, V. Parisi, G. Persi, C. Vecchi, A. Sanguinetti, M. Rodriguez-Violante, J. Aparcana, L. Torres, I. Litvan (Buenos Aires, Argentina) Objective: To describe the clinical and epidemiological characteristics of a series of patients diagnosed with MSA from 6 different centers from North America and Latin America. Background: Multiple system atrophy (MSA) is an adult-onset and rapidly progressive, neurodegenerative condition that presents with autonomic dysfunction, parkinsonism, cerebellar ataxia and corticospinal deficit. Clinical, demographic and epidemiological data from different regions have provided valuable information concerning the natural history of MSA and have contributed to improved diagnostic criteria. Data of MSA in Latin American countries are limited. Methods: We retrospectively analyzed the clinical data of 112 patients with MSA recruited from 6 referral movement disorders centers from Argentina, Chile, Peru´, Mexico and the United States. Evaluations were performed according to the clinical and imagenologic criteria recently established. Results: 59 women and 53 men compose the sample, with a mean age of 65 years. Mean disease duration at examination was 5.52 years MSA-P variant was reported in 71.88% of overall population. Interestingly, MSA-C variant was identified in 40% of cases from Mexico and Chile, two countries with greater ‘‘mestizo’’ populations (admixture between Europeans, Indians, and Africans). The occurrence and distribution of autonomic dysfunction was: 80.7% mictional urgency, 72.8% orthostatism, 57.8%, ‘‘cold hands’’, 73.4% severe hypophonia and 58.8% dysphagia. REM behavior disorders were reported in 72.22% of cases. Response to levodopa was poor and transitory in 70.31% of patients. MR imaging showed putaminal atrophy in 26.4% of cases, hyperintense putaminal rims in 26.4% and the ‘‘hot cross bun’’ sign in 18.8%. The mean estimate survival was 5.52 years. Conclusions: This is the first reported series of MSA patients from Latin America and North America. Although, the present series shows a great ancestry variability, the present data were similar to other previously reported international series. 6 The prognosis of psychogenic (functional) motor symptoms: A systematic review J.M. Gelauff, A.J. Carson, J. Stone (Amsterdam, Netherlands) Objective: We aimed to systematically review all follow-up studies of psychogenic motor symptoms to examine what is known about symptom outcome, disability and prognostic factors. Background: Psychogenic (or functional) motor symptoms, refer to weakness or movement disorders that are genuine but do not relate to an underlying neurological disease. There is no systematic review of prognostic studies of these symptoms. Methods: We used a broad search strategy on PubMed to search for all studies of ten or more patients with psychogenic motor symptoms (or synonyms) reporting follow up data of longer than six months (excluding studies reporting specific treatments). We recorded symptom duration, physical and psychiatric comorbidity, disability,
Movement Disorders, Vol. 27, Suppl. 1, 2012
occupational functioning at follow-up and prognostic factors. Diagnostic change has been systematically reviewed elsewhere. [1] Results: The search strategy yielded 5874 articles; 24 were included. Heterogeneity was found regarding the number of included patients (n510-491), follow-up duration (6 months-19 years), clinical setting, and data availability. Most studies (n516) were retrospective, Reported symptom outcome was highly variable (10-90% improvement) but generally unfavorable. Levels of physical disability and psychological comorbidity at follow up were high when reported. Young age was a positive prognostic factor in only 3 of 11 studies when studied. Early diagnosis and satisfaction with care were positive factors in two studies. Gender had no apparent effect. Delayed diagnosis and personality disorder were negatively correlated with outcome. Prognostic factors that varied between studies included comorbid anxiety and depression, IQ, educational status, marital status and, pending litigation. Conclusions: Existing follow up studies of psychogenic motor symptoms give us some insights regarding outcome and prognostic factors but are limited by their largely retrospective and selective nature. Overall, prognosis appears unfavorable. The severity and chronicity of psychogenic motor symptoms argues for the importance of larger prospective studies including multiple prognostic factors at baseline in order to better understand their natural history. 1. Stone J et al. Systematic review of the misdiagnosis of conversion symptoms/hysteria.. BMJ 2005; 331:989.
7 Plasma urate level associates the odds ration of Parkinson’s disease (PD): Out-patient-clinic analysis in the neurology department H. Iwaki, Y. Tamaki, T. Tsujii, N. Nishikawa, M. Nagai, M. Nomoto (Ehime, Japan) Objective: To determine whether the serum urate level is associated with the odds ratio of Parkinson’s disease (PD) on an out-patient clinic basis. Background: Urate, the major antioxidant in serum, has been shown to correlate with a lower incidence and slower development of PD in several studies. Methods: We conducted a trans-sectional analysis of serum urate and PD. All patients above the age of 40 visiting the out-patient clinic in the neurology department were included in the analysis. Other factors considered to be associated with serum urate levels such as sex, age, body weight and estimated glomerular filtration rate (eGFR) were recorded. The background data was compared between patients with and without PD using student t test. The odds ratio of PD was analyzed by logistic regression model. Results: 373 patients were included in the study. The number of female patients was 211, including 112 patients with PD and the number of male patients was 142, including 71 patients with PD. In both sex groups, age, body weight and eGFR were not statistically different. The mean serum urate concentration of female patients with PD was 4.2 (SD 1.3) mg/dL, which was significantly lower than the female patients without PD, 4.9 (SD 1.4) mg/dL (p50 years, Hoehn&Yahr55 years and is the most common cause of parkinsonism. Little is known about the epidemiology of PD in Cuba, and is greatly underestimated the frequency of PD in the eastern region of the country. Methods: We developed an active screening to estimate the frequency of PD in Holguı´n. Results: We identified 358 subjects afflicted with PD in Holguı´n situated in the eastern region of Cuba. The picture suggest a prevalence of PD 34.5*105 people. All these individuals belong to the 14 municipalities in Holguı´n with conspicuous concentration in Holguı´n where more than half were found. Atypical forms of Parkinson’s disease were ignored in the current study but are very frequent suggesting that parkinsonism in this region may reach comparable values to SCA2 (40.18 per 105) which reach the highest worldwide prevalence in the same region due to a founder effect. Age at onset averaged 58.05610.74yrs and Disease duration 8.6065.21yrs. Other regions in the eastern of Cuba with considerable frequency of PD were Camaguey, Tunas, Santiago de Cuba, Granma, and Guanta´namo.
Objective: To assess the prevalence and progression of mild parkinsonian signs (MPS) in the general population. Background: MPS are common in the elderly population. However, the overall progression of these signs is not well defined. Methods: Subjects of an ongoing prospective population-based study of carotid atherosclerosis and stroke risk (the Bruneck Study) underwent a baseline and 5-year follow up neurological assessment including the entire motor portion of the Unified Parkinson’s disease rating scale (UPDRS III). Diagnosis of Parkinson’s disease (PD) was based on UK Brain Bank Criteria, MPS were defined as follows: UPDRS III rating ‡ 2 points or presence of rest tremor (Louis et al. 2005). Results: From the 574 baseline-subjects aged 55-94 years, 86 subjects (15.1%, 95%CI [12.3-18.3]) showed MPS. At follow-up 488 subjects aged 60-97 years were re-evaluated and 159 subjects (32.6% [28.6-36.9]) were found with MPS. Hence, there was a significant increase in the prevalence of MPS over the time course of 5 years (Chi-square test, p10: 69.65). Executive function appeared to be compromised even from 0-5 years of disease as shown by the pie chart below [figure 1]. Specifically, performance on the COWA and the trail-making tests A and B were below average. Consistency, Vigilance, Focus, and speed were also below average. Further, patients showed deficits in the Wechsler Adult Intelligence Scale III block design test and Wechsler Memory Scale Visual Reproduction I test compared to average. Conclusions: In addition to executive dysfunction, test results were consistent with dysfunction in the parietal lobe (block design) and temporal lobe (WMS-III Visual Reproduction I). Further, cognitive deficits can be seen even at 0-5 years of disease duration. Physicians should consider running more extensive cognitive testing batteries on PD patients earlier in the disease process.
ANOVA p50.054 p50.0687 p50.51 p50.03
30 Diurnal sleepiness and executive dysfunctions: A virtual and neuropsychological study in Parkinson’s disease and sleep apnea syndrome G. Albani, L. Priano, P. Cipresso, S. Raspelli, R. Pignatti, P. Ferronato, A. Liuzzi, G. Riva, A. Mauro (Piancavallo, Italy) Objective: Aim of this study was to evaluate the impact of sleep disturbances on decision making in non demented Parkinson’s disease (PD) patients compared with Sleep Apnea Syndrome patients (OSAS), by using a virtual immersion in a supermarket. Background: In PD, sleep disturbances are one of the most relevant symptoms in the premotor phase and often occurs even in denovo or early-middle stages, when, the daily amount of dopaminergic therapy is still low; in this clinical stage, executive functions may be mildly altered, and may appear normal by the neuropsychological tests. Also patients with OSAS may often complain attention and memory deficit, clinically correlated with diurnal sleepiness. Methods: We used a Virtual Reality version of the Multiple Errand Test (VMET) in order to evaluate decision making ability in 12 PD not-demented patients, 12 OSAS patients and 14 controls. The MET is an assessment of executive functions in daily life and consists to perform tasks according predefined rules, so that there are items to be bought and informations to be obtained. (www.neurovr.org). All three groups of patients performed a videopolysonnographyc study within a week after the VMET evaluation and a dedicated neuropsychological battery including FAB, Corsi, MMSE, Panda, Digit span forward and backward, Raven, Rey, Trail making test Token test. Results: In control subjects, neuropsychological tests resulted correlated with findings of VMET. By comparing with controls, while OSAS patients showed no significant differences, PD patients showed significant lower performances in the virtual strategies. Muchmore, the defective strategy in a virtual supermarket was significantly correlated with polysonnographyc abnormalities. Conclusions: In our study patients with OSAS showed a normal decision making in the virtual test. On the other side, our data suggest that in PD, the alteration of some executive functions may be correlated much more with the abnormal microstructure of sleep, than the deprivation of sleep ‘‘per se’’. Neurodegenerative process may involve common anatomofunctional pathways regulating REM and N-REM sleep structure and some executive functions.
31 Graded dual task benefits of cognitive tasks on cycling in Parkinson’s disease: Effects of kinesia paradoxa L.J.P. Altmann, E. Stegemo¨ller, A.A. Hazamy, J.P. Wilson, D. Bowers, C.M. Sapienza, M.S. Okun, C.J. Hass (Gainesville, FL, USA)
Fig. 1 (29).
Objective: To evaluate the effects of concomitant cognitive tasks of increasing difficulty on speed of cycling in people with Parkinson’s disease (PD).
Movement Disorders, Vol. 27, Suppl. 1, 2012
S10
POSTER SESSION 1, SUNDAY, JUNE 17, 2012
Background: Studies have demonstrated that compared to healthy older adults, people with PD show greater declines in motor performance (gait, balance) when simultaneously performing a second task, regardless of the domain of the second task (motor, cognitive, language). Cycling reduces fall risk and thus may better assess true dual task interactions. We predicted that there would be a direct and graded effect of cognitive task difficulty on cycling performance. Methods: 25 people diagnosed with idiopathic PD (Hoehn & Yahr 1-3) by fellowship-trained movement disorders specialists completed a battery of 14 cognitive tasks while sitting in a quiet room (single task) and while riding a stationary bicycle (dual task). Cycling speed (RPMs) was recorded with no cognitive task (baseline) and during each cognitive task. Cognitive tasks were chosen from 5 domains of increasing difficulty: processing speed, controlled processing, memory, executive function, and language. Results: Unexpectedly, in nearly all tasks, cycling performance (RPMs) improved in the dual task. Further, dual task benefits decreased as difficulty of the task increased (r5 -.69, r25.48, p
