Clinical characteristics of parkinsonism in frontotemporal dementia according to subtypes

Park, Hee Kyung,Park, Kee Hyung,Yoon, Bora,Lee, Jae-Hong,Choi, Seong Hye,Joung, Jee H.,Yoon, Soo Jin,Kim, Byeong C.,Kim, Seung Hyun,Kim, Eun-Joo,Na, Duk L.,Park, Kyung Won Elsevier Pub. Co 2017 Journal of the neurological sciences Vol.372 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>We investigated the prevalence of parkinsonism in frontotemporal dementia (FTD) subtypes and the cognitive and behavioral differences between FTD with and without parkinsonism in a well-structured, prospective cohort.</P> <P><B>Methods</B></P> <P>One hundred and ninety-one FTD patients were enrolled and all patients underwent comprehensive neurological evaluations, neuropsychological tests, and the Unified Parkinson's Disease Rating Scale.</P> <P><B>Results</B></P> <P>The prevalence of parkinsonism was 38.7% (74 patients), and included 33 (46.5%) behavioral variant FTD (bvFTD), 16 (24.2%) semantic dementia (SD), 19 (45.2%) progressive nonfluent aphasia (PNFA), and 6 (50%) FTD associated with motor neuron disease (FTD-MND). SD patients with parkinsonism had higher CDR sum of boxes scores (9.7±4.5 vs 6.2±4.5, <I>p</I> =0.024), frontal behavioral inventory total score (33.7±20.5 vs 24.3±14.5, <I>p</I> =0.045), and executive function score of frontal executive dysfunction, disinhibition, and apathy (28.9±13.7 vs 19.2±12.9, <I>p</I> =0.021) than those without parkinsonism. Seoul Instrumental Activities of Daily Living score (bvFTD: 23.5±11.7 vs 17.3±11.3, <I>p</I> =0.031, SD: 23.1±11.1 vs 11.3±9.3, <I>p</I> =0.005) was higher for bvFTD and SD with parkinsonism than for those without parkinsonism.</P> <P><B>Conclusions</B></P> <P>Parkinsonism is found to be more common in patients with bvFTD, PNFA, and FTD-MND patients than those with SD. Behavioral disturbances were more prominent in SD with parkinsonism than without. Additional studies are needed to determine the pathomechanism and optimal treatment of parkinsonism in different FTD subtypes.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Parkinsonism was present in about 40% of FTD and in all FTD subtypes. </LI> <LI> Global cognitive deficits did not differ between FTD with and without parkinsonism. </LI> <LI> Behavioral disturbances were more severe in SD patients with parkinsonism than in those without. </LI> <LI> Instrumental ADL index was more impaired in bvFTD and SD patients with parkinsonism than in those without. </LI> <LI> Parkinsonism may serve as an important clue to the diagnosis of FTD. </LI> </UL> </P>

Family Functioning and Communication in Spouses of Patients with Parkinsonism

강서영,양명화,이정아,장우영,이종식,김영식 대한가정의학회 2017 Korean Journal of Family Medicine Vol.38 No.1

Background: Patients with parkinsonism exhibit motor symptoms, cognitive impairment, and neuropsychiatric changes, and these symptoms increase caregiver burden. Family dynamics can be influenced by the presence of comorbidities, which is especially important in diseases causing caregiver burden. We investigated the effects of spousal parkinsonism on family functioning and communication.Methods: Couples without parkinsonism, who visited hospital-based family practices, were recruited by 28 family physicians from 22 hospitals between April 2009 and June 2011; patients with parkinsonism and their spouses were recruited from a single institution. The participants completed questionnaires on demographic characteristics, life-style factors, family functioning (the Korean version of the Family Adaptation and Cohesion Evaluation Scale [FAC-ES] III), and family communication (the Family Communication Scale of the FACES-IV). We compared family functioning and communication between spouses of the patients with and without parkinsonism.Results: The mean family adaptability and cohesion scores of the spouses of the patients with parkinsonism were 23.09±6.48 and 32.40±8.43, respectively, whereas those of the control group were 23.84±5.88 and 34.89±7.59, re-spectively. Family functioning and family communication were significantly different between the spouses of indi-viduals with and without parkinsonism. After adjusting for age, sex, income, and cardiovascular disease in the lo-gistic regression analysis, family functioning was found to significantly deteriorate in the spouses of patients with parkinsonism but not the control group. Family communication decreased significantly in spouses of patients with parkinsonism.Conclusion: Family functioning and family communication significantly deteriorated in spouses of patients with parkinsonism.

Femur Fractures in Parkinsonism: Analysis of a National Sample Cohort in South Korea

안수정,이승환,이서영,권재우,이승준,김영주 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.4

Background and Purpose Falling with a femur fracture is a serious event that negatively affects the quality of life of elderly individuals as well as patients with parkinsonism. This study investigated the association between parkinsonism and femur fracture and compared the risk of femur fracture between subjects with and without parkinsonism. Methods This study examined a population-based matched cohort constructed using the National Sample Cohort data set, which comprises approximately one million subscribers to medical insurance and aid in South Korea. Subjects with parkinsonism during 2003–2013 were identified as the exposed group, and up to five individuals matched for age, sex, and index years were identified as the controls for each parkinsonism subject. The risk of femur fracture for parkinsonism was evaluated using Cox regression. Results The incidence of femur fracture according to age, sex, and body mass index varied significantly between subjects with parkinsonism and controls (p<0.001). The presence of parkinsonism was associated with a higher risk of femur fractures for males [hazard ratio (HR)= 2.85, 95% confidence interval [CI]=1.87–4.34], subjects younger than 65 years (HR=2.89, 95% CI=1.64–5.11), and underweight subjects (HR=3.90, 95% CI=1.82–8.35). The adjusted HR for femur fracture with parkinsonism was highest within 2 years of the disease diagnosis (HR= 3.10, 95% CI=2.12–4.53). Conclusions Our study found that the presence of parkinsonism is more strongly related to femur fracture in males, and increases the influence of traditional risk factors on femur fracture. It is necessary to consider how factors associated with the amount of ambulatory activity–even in an early diagnosed state–can play an important role in femur fracture in subjects with parkinsonism.

혈관성 파킨슨증의 경사에코 자기공명촬영 소견 : 환자-대조군 연구 A Case-Control Study

배희준,김병건,구자성,김현숙 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Background & objective : Changes of signal intensity in the various Structures of basal ganglia(BG), Which can be detected by gradient echo MRI(GE-MRI). have been reported in different kinds of parkinsonism Altered iron content in these structures may be a possible explanation of above phenomenon Vascular parkinsonism is a kind of parkinsonism syndrome and is common However. There have been no reports about the BG signal changes on GE-MRI in vascular parkinsonism Methods : We investigated the difference of signal intensity in various BG and midbrain structures between 36 patients with vascular parkinsonism. which was defined as clinical parkinsonism+evidence of relevant vascular lesion on MRI+poor or no response to levodopa, and age-& sex- matched controls. The intensity of BG on GE-MRI was graded as 0-3 relative to cortical gray matter Results : There were no significant differences in clinical characteristics between two groups Among patients with vascular parkinsonism, hypointensity was observed in globus pallidus in 94.4%. in putamen in 58.3% in head of caudate in 33.3%, in substantia nigra in 72.2%,& in red nucleus in 52.8% There was no significant linear trend in the association between signal intensity of above structures and the presence of vascular parkinsonism (p>0 05 on Mantel-Haenszel chi-square test) However, the correlation between the degree of white matter lesions and the presence of vascular parkinsonism was statistically significant (p=003). Conclusions : Our GE-MRI study fails to prove that iron content of various BG structures in patients with vascular parkinsonism is different from controls.

Astrocytoma in the Third Ventricle and Hypothalamus Presenting with Parkinsonism

Choi, Kang-Ho,Choi, Seong-Min,Nam, Tai-Seung,Lee, Min-Cheol The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.3

Parkinsonism secondary to intracranial mass lesions usually results from compression or distortion of the basal ganglia. Secondary parkinsonism due to midbrain infiltration or compression is rare and generally associated with other neurologic signs caused by pyramidal tract and/or cranial nerve involvement. We report a case of 30-year-old woman in whom mild parkinsonism was the major clinical manifestation of an astrocytoma in the anterior third ventricle and hypothalamus. She underwent surgical resection, ventriculoperitoneal shunt and radiation therapy. All symptoms of parkinsonism were completely recovered 3 months after the treatment. Brain tumors can be manifested only by the symptoms of parkinsonism. This case emphasizes the significance of neuroimaging in the evaluation of parkinsonism.

파킨슨 증후군 환자의 자세 불안정과 보행장애에 대한 한의치료의 효과

양승보(Seung-Bo Yang),김연진(Yeon-Jin Kim),이형민(Hyung-Min Lee),이상화(Sang-Hwa Lee),조승연(Seung-Yeon Cho),박정미(Jung-Mi Park),고창남(Chang-Nam Ko),박성욱(Seong-Uk Park) 대한한의학회 2017 대한한의학회지 Vol.38 No.3

Drug-Induced Parkinsonism

신혜원,정선주 대한신경과학회 2012 Journal of Clinical Neurology Vol.8 No.1

Drug-induced parkinsonism (DIP) is the second-most-common etiology of parkinsonism in the elderly after Parkinson’s disease (PD). Many patients with DIP may be misdiagnosed with PD because the clinical features of these two conditions are indistinguishable. Moreover, neurological deficits in patients with DIP may be severe enough to affect daily activities and may persist for long periods of time after the cessation of drug taking. In addition to typical antipsychotics, DIP may be caused by gastrointestinal prokinetics, calcium channel blockers, atypical antipsychotics, and antiepileptic drugs. The clinical manifestations of DIP are classically described as bilateral and symmetric parkinsonism without tremor at rest. However, about half of DIP patients show asymmetrical parkinsonism and tremor at rest, making it difficult to differentiate DIP from PD. The pathophysiology of DIP is related to drug-induced changes in the basal ganglia motor circuit secondary to dopaminergic receptor blockade. Since these effects are limited to postsynaptic dopaminergic receptors, it is expected that presynaptic dopaminergic neurons in the striatum will be intact. Dopamine transporter (DAT) imaging is useful for diagnosing presynaptic parkinsonism. DAT uptake in the striatum is significantly decreased even in the early stage of PD, and this characteristic may help in differentiating PD from DIP. DIP may have a significant and longstanding effect on patients’daily lives, and so physicians should be cautious when prescribing dopaminergic receptor blockers and should monitor patients’ neurological signs, especially for parkinsonism and other movement disorders.

Papillary Meningioma Presenting as Rapidly Progressive Dementia and Parkinsonism

박인석,나승희,김영도,송인욱,맹이소,양영순 대한치매학회 2013 Dementia and Neurocognitive Disorders Vol.12 No.3

There are a variety of different causes of parkinsonism including PD, secondary parkinsonism, and the parkinsonism plus syndromes. Secondary parkinsonism is caused by structural, toxic, metabolic, or infectious mechanisms. Among structural causes, intracranial neoplasms are a rare cause of secondary parkinsonism. Moreover, there are almost never case reports with intracranial space-occupying lesions resulting in parkinsonism associated with rapid cognitive impairment. Therefore, we report herein a 37-year-old woman diagnosed with papillary meningioma who presented with parkinsonism associated with rapidly progressive cognitive impairment mimicking diffuse Lewy body disease.

조등산(Diaoteng-san, Choto-san, 釣藤散)과 GB34(陽陵泉) 전침치료를 활용한 약인성파킨슨증후군 환자의 증례 1례

김은지,송호준,김현호,한양희,임정태,Kim, Eun-ji,Song, Ho-joon,Kim, Hyun-ho,Han, Yang-hee,Leem, Jung-tae 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.5

Drug-induced Parkinsonism is the most frequently observed type among the cases of secondary Parkinsonism. Besides typical parkinsonian symptoms, such as tremor, rigidity and bradykinesia, drug-induced Parkinsonism manifests with additional simultaneous symptoms like orobuccolingual dyskinesia, mixed type of tremor (resting, action), and symmetry of expressions. We present a case of drug-induced Parkinsonism, affected by taking the antiulcer drug cimetidine. Jodeung-san extract (Choto-san, Tsumura Co. 10) was administered for 7 days and acupuncture (electronic, auricular, pharmacopuncture) was conducted 3 times. The clinical outcomes were then evaluated through the patient's global impression of change, visual analogue scale, and Hoehn and Yahr stage. After the treatment, the clinical features, such as tremor and orobuccolingual dyskinesia, disappeared. The combination of Jodeung-san and electro-acupuncture at GB34 could therefore be a remedy for the patients with drug-induced Parkinsonism.

한방치료로 운동 기능장애와 실성증이 호전된 파킨슨증후군 환자 치험 1례

허혜민,이경화,황예채,전규리,조승연,박성욱,박정미,고창남,Hye-Min, Heo,Kyeong-Hwa, Lee,Ye-Chae, Hwang,Gyu-Ri, Jeon,Seung-Yeon, Cho,Seong-Uk, Park,Jung-Mi, Park,Chang-Nam, Ko 대한중풍순환신경학회 2022 대한중풍.순환신경학회지 Vol.23 No.1

■Objectives This case study is to report the effectiveness of Korean medicine in Parkinsonism patient's treatment. ■Methods We used the acupuncture, electro-acupuncture, moxibustion, cupping therapy, herbal medicine, especially Palmulgunja-tang to the Parkinsonism patient with motor disorder such as Postural Instability and Gait Difficulty(PIGD) and aphonia. Unified Parkinson's Disease Rating Scale(UPDRS), analysis of gait pattern, voice dB and self-evaluation of speed and volume were used to assess the change of symptoms. ■Results ‌After treatment, the UPDRS score decreased in overall category and the walking pattern has improved. In addition, the improvement was observed in voice volume and in self assessment of the patient. ■Conclusion This case suggests the effect of Korean medical treatment on motor disorder and aphonia in Parkinsonism.