Seasonal variations of nonmotor symptoms in patients with Parkinson's disease in Southeast China

Background:Studies suggest seasonal fluctuations of symptoms in Parkinson’s disease(PD)patients in Western countries.However,the association between seasonal change and variation in nonmotor symptoms(NMS)in Chinese PD patients is unclear.Here,we studied whether there is a change rule with annual cycle with severity of NMS for patients with PD in Southeast China.Methods:We studied 1005 PD patients between April 2008 and October 2020.Patients were classified into four seasons according to the 24 Chinese solar terms,based on assessment date.We compared comprehensive NMS scales and polysomnography parameters among groups and conducted further analysis of disease severity.Results:Among the 1005 patients studied,the mean age was 64.2±9.7 years and 569(56.6%)of them were men.Relative to the summer group,patients assessed during winter had higher Scales for Outcomes in Parkinson’s disease-Autonomic Dysfunction(SCOPA-AUT)scores(P=0.045).The sleep efficiency factor scores of Pittsburgh Sleep Quality Index in patients were higher during spring than summer(P=0.009).Among patients who completed polysomnography during the same period(n=135),compared with summer follow-ups,we observed a higher percentage of NREMS1 in winter and spring follow-ups(P=0.042,P=0.011),a higher NREMS1 time in spring follow-ups(P=0.0024),a lower NREMS2 time in winter follow-ups(P=0.007),and a higher percentage of phasic rapid eye movement(REM)-sleep without atonia in autumn and winter follow-ups(P=0.026 and P=0.020,respectively).In a subset of patients with PD and REM sleep behavior disorder(RBD;n=182),those visited during winter had higher scores for RBD questionnaire-Hong Kong and its factor 1(dream-related sub-score)than those visited during summer(P=0.034,P=0.020).We observed similar findings for SCOPA-AUT and sleep efficiency factor scores in early stage patients in subgroup analysis.Conclusions:PD patients assessed for follow-up during summer showed less severe symptoms of autonomic dysfunction and RBD symptoms than those assessed in winter,and less sleep disturbance than those in spring and winter,suggesting that seasonal change and NMS fluctuation are related,especially in patients with early stage PD.

Meta-analyses on prevalence of selected Parkinson’s nonmotor symptoms before and after diagnosis

Background:Nonmotor symptoms are common among patients with Parkinson’s disease(PD)and some may precede disease diagnosis.Methods:We conducted a meta-analysis on the prevalence of selected nonmotor symptoms before and after PD diagnosis,using random-effect models.We searched PubMed(1965 through October/November 2012)for the following symptoms:hyposmia,constipation,rapid eye movement sleep behavior disorder,excessive daytime sleepiness,depression,and anxiety.Eligible studies were publications in English with original data on one or more of these symptoms.Results:The search generated 2,373 non-duplicated publications and 332 met the inclusion criteria,mostly(n=320)on symptoms after PD diagnosis.For all symptoms,the prevalence was substantially higher in PD cases than in controls,each affecting over a third of the patients.Hyposmia was the most prevalent(75.5%in cases vs.19.1%in controls),followed by constipation(50%vs.17.7%),anxiety(39.9%vs.19.1%),rapid eye movement sleep behavior disorder(37.0%vs.7.0%),depression(36.6%vs.14.9%),and excessive daytime sleepiness(33.9%vs.10.5%).We observed substantial heterogeneities across studies and meta-regression analyses suggested that several factors might have contributed to this.However,the prevalence estimates were fairly robust in several sensitivity analyses.Only 20 studies had data on any symptoms prior to PD diagnosis,but still the analyses revealed higher prevalence in future PD cases than in controls.Conclusion:These symptoms are common among PD patients both before and after diagnosis.Further studies are needed to understand the natural history of nonmotor symptoms in PD and their etiological and clinical implications.

Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson＇s Disease

Objective： This review examines the evidence that deep brain stimulation （DBS） has extensive impact on nonmotor symptoms （NMSs） of patients with Parkinson＇s disease （PD）. Data Sources： We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus （GPi）, subthalamic nucleus （STN）, and ventral intermediate thalamic nucleus. Study Selection： We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs： Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups： those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. Results： In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS： The impact of DBS on behavioral addictions and dysphagia is still uncertain. Conclusions： As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.

Delusional parasitosis as premotor symptom of parkinson's disease:A case report

BACKGROUND Delusional parasitosis is characterized by a false belief of being infested with parasites,insects,or worms.This illness is observed in patients with Parkinson’s disease and is usually related to dopaminergic treatment.To our knowledge,no cases of delusional parasitosis have been reported as a premotor symptom or nonmotor symptom of Parkinson’s disease.CASE SUMMARY A 75-year-old woman presented with a complaint of itching that she ascribed to the presence of insects in her skin,and she had erythematous plaques on her trunk,arms,buttocks,and face.These symptoms started two months before the visit to the hospital.She took medication,including antipsychotics,with a diagnosis of delusional parasitosis,and the delusion improved after three months.A year later,antipsychotics were discontinued,and anxiety and depression were controlled with medication.However,she complained of bradykinesia,masked face,hand tremor,and mild rigidity,and we performed fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane positron emission tomography(PET),which showed mildly decreased DAT binding in the right anterior putamen and caudate nucleus.Parkinson’s disease was diagnosed on the basis of PET and clinical symptoms.CONCLUSION In conclusion,delusional parasitosis can be considered a non-motor sign of Parkinson’s disease along with depression,anxiety,and constipation.