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Erro R.,University College London | Erro R.,University of Verona | Picillo M.,University of Naples Federico II | Amboni M.,IDC Hermitage Capodimonte | And 11 more authors.
Movement Disorders | Year: 2015

The variability in the clinical phenotype of Parkinson's disease (PD) suggests the existence of several subtypes of the disease. Motor heterogeneity of PD is well established, but not nonmotor heterogeneity. At present, we are unable to predict the rate of progression of PD based on robust biomarkers. We aimed to examine the heterogeneity of PD by attempting to identify nonmotor factors associated with the rate of motor progression and functional decline, as measured by the time to reach the need for levodopa therapy during the first 4 years from diagnosis in a cohort of de novo PD patients. The median time to introduction of l-dopa for patients with urinary symptoms was significantly shorter than that for those without (20 vs. 37 months; P=0.001). Cox's regression models showed that the urinary domain was associated with a higher probability of starting l-dopa (hazard ratio: 2.1; P=0.002). There was no influence of such confounders as sex, age, baseline motor features, use of dopamine agonists and/or monoamine oxidase B inhibitors, and total l-dopa equivalent daily dosage. Patients with urinary symptoms had higher baseline and follow-up motor and nonmotor disturbances than those without. Our study suggests the existence of a subgroup of patients who show urinary symptoms along with an overall higher motor and nonmotor burden. Such patients are prone to manifest a rapid functional decline over the first 4 years of the disease. Urinary symptoms might be a clinical marker of severity as well as a possible nonmotor subtype of PD. © 2015 International Parkinson and Movement Disorder Society. Source


Sanchez-Ferro A.,Hospital Universitario 12 Of Octubre | Sanchez-Ferro A.,Complutense University of Madrid | Sanchez-Ferro A.,Massachusetts Institute of Technology | Sanchez-Ferro A.,CIBER ISCIII | And 18 more authors.
Movement Disorders | Year: 2015

α-Synuclein inclusions have been identified in the brain and some parts of the enteric nervous system in Parkinson's disease cases. We aimed to assess these inclusions in gastric mucosa samples from patients with symptomatic Parkinson's disease. Random biopsies were performed by gastroscopy in 28 patients with Parkinson's disease and in 29 age- and sex-matched controls. Gastroscopy was performed to start enteral levodopa (l-dopa) therapy in cases and for diagnostic purposes in controls (gastroesophageal reflux, anemia, and abdominal pain were the main indications). The clinical definition of cases and controls was made a priori. Six controls had data suggestive of "mild presymptomatic parkinsonism". Biopsy specimens were immunostained for α-synuclein. The neuropathological diagnosis was established post hoc. No differences were found in the baseline characteristics of the groups. Positive fibers for the α-synuclein protein were observed in 17 of 28 (60.7%) Parkinson's disease patients, 1 of 23 controls (4.3%), and 1 of 6 (16.7%) cases of incident "mild presymptomatic parkinsonism." Neuropathological diagnosis based on α-synuclein immunostaining showed a sensitivity of 85% (95% confidence interval [CI] 62.1-96.8), specificity of 95% (95% CI 76.2-99.9) and area under the receiver operating characteristics curve (AUC) of 0.90 (95% CI 0.80-1.00). No adverse events occurred. Detection of α-synuclein inclusions in the gastric mucosa is a useful and safe tool providing in vivo evidence of the underlying neurodegenerative peripheral involvement linked to Parkinson's disease. Further studies are warranted to determine its pathophysiological implications. © 2014 International Parkinson and Movement Disorder Society. Source


Martin F.,Rey Juan Carlos University | Aguero C.E.,Rey Juan Carlos University | Canas J.M.,Rey Juan Carlos University | Valenti M.,Alzheimer Center Reina Sofia Foundation | Martinez-Martin P.,CIBER ISCIII
International Journal of Advanced Robotic Systems | Year: 2013

Humanoids have increasingly become the focus of attention in robotics research in recent years, especially in service and personal assistance robotics. This paper presents the application developed for humanoid robots in the therapy of dementia patients as a cognitive stimulation tool. The behaviour of the robot during the therapy sessions is visually programmed in a session script that allows music to play, physical movements (dancing, exercises, etc.), speech synthesis and interaction with the human monitor. The application includes the control software on board the robot and some tools like the visual script generator or a monitor to supervise the robot behaviour during the sessions. The robot application's impact on the patient's health has been studied. Experiments with real patients have been performed in collaboration with a centre of research in neurodegenerative diseases. Initial results show a slight or mild improvement in neuropsychiatric symptoms over other traditional therapy methods. © 2013 Martín et al.; licensee InTech. Source


Valenti Soler M.,Carlos III Institute of Health | Aguera-Ortiz L.,Carlos III Institute of Health | Aguera-Ortiz L.,CIBERSAM Carlos III Institute of Health Madrid | Olazaran Rodriguez J.,Carlos III Institute of Health | And 14 more authors.
Frontiers in Aging Neuroscience | Year: 2015

Aims: Testing the effect of the experimental robot-based therapeutic sessions for patients with dementia in: a controlled study of parallel groups of nursing home patients comparing the effects of therapy sessions utilizing a humanoid robot (NAO), an animal-shaped robot (PARO), or a trained dog (DOG), with conventional therapy (CONTROL) on symptoms of dementia; and an experience for patients who attend a day care center, comparing symptom prevalence and severity before and after sessions utilizing NAO and PARO. Methods: In the nursing home, patients were randomly assigned by blocks, based on dementia severity, to one of the 3 therapeutic groups to compare: CONTROL, PARO and NAO (phase 1) and CONTROL, PARO and DOG (phase 2). In the day care center, all patients received therapy with NAO (phase 1) and PARO (phase 2). Therapy sessions were held 2 days/week for 3 months. Evaluation at baseline and follow-up was carried out by blind raters using: the Global Deterioration Scale (GDS), the Severe Mini Mental State Examination (sMMSE), the Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), the Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH), the Apathy Inventory (AI) and the Quality of Life Scale (QUALID). Statistical analysis included descriptive statistics and non parametric tests performed by a blinded investigator. Results: In the nursing home, 101 patients (phase 1) and 110 patients (phase 2) were included. There were no significant differences at baseline. The relevant changes at follow-up were: (phase 1) patients in the robot groups showed an improvement in apathy; patients in NAO group showed a decline in cognition as measured by the MMSE scores, but not the sMMSE; the robot groups showed no significant changes between them; (phase 2) QUALID scores increased in the PARO group. In the day care center, 20 patients (phase 1) and 17 patients (phase 2) were included. The main findings were: (phase 1) improvement in neuropsychiatric symptoms, especially irritability, as measured by scores on the NPI irritability item and the NPI total score; (phase 2) no differences were observed at follow-up. © 2015 Valentí_soler, Agüera-ortiz, Olazarán_rodríguez, Mendoza_rebolledo, Pérez_muñoz, Rodríguez_pérez, Osa_ruiz, Barrios_sánchez, Herrero_cano, Carrasco_chillón, Felipe_ruiz, López_alvarez, León_salas, Cañas_plaza, Martín_rico and Martínez_martín. Source


Heller S.,Carlos III Institute of Health | Rebolledo C.M.,Alzheimer Center Reina Sofia Foundation | Blazquez C.R.,CIBER ISCIII | Chillon L.C.,Alzheimer Center Reina Sofia Foundation | And 3 more authors.
Journal of Neurology | Year: 2015

The multimodal assessment of capacities in severe dementia (MAC-SD), a novel cognitive and functional assessment, was developed for use with patients with severe dementia. Its psychometric attributes were examined in a unicenter, open, observational study. The MAC-SD along with the Spanish language Severe Mini Mental Exam were administered to 103 patients with a diagnosis of severe dementia. Psychometric analyses were performed to determine acceptability, reliability, validity, and responsiveness. As a whole, the MAC-SD sections showed no floor effects, satisfactory internal consistency, reproducibility, construct validity, precision, and sensitivity to change. The MAC-SD performed as a useful, valid, and potentially responsive tool to measure cognition and functioning in the most advanced stages of dementia. © 2015, Springer-Verlag Berlin Heidelberg. Source

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