Search

Mild cognitive impairment, especially executive dysfunction might occur early in the course of Parkinson's disease. Cognitive training is thought to improve cognitive performance. However, transfer of improvements achieved in paper and pencil tests into daily life has been difficult. The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor training. 240 PD-patients were included in the study and randomly allocated to three treatment arms, group A cognitive training, group B cognitive training and transfer training and group C cognitive training, transfer training and psychomotor and endurance training. The primary outcome measure was the ADAS-Cog. The secondary outcome measure was the SCOPA-Cog. Training was conducted for 4 weeks on a rehabilitation unit, followed by 6 months training at home. Caregivers received an education programme. The combination of cognitive training using paper and pencil and the computer, transfer training and physical training seems to have the greatest effect on cognitive function. Thus, patients of group C showed the greatest improvement on the ADAS-Cog and SCOPA-COG and were more likely to continue with the training programme after the study. [ABSTRACT FROM AUTHOR]

Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70 min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study. [ABSTRACT FROM AUTHOR]

TWO patients with moderate Huntington's disease (HD) received bilateral fetal striatal allografts. One patient demonstrated, for the first time, increased striatal D2 receptor binding, evident with C-raclopride positron emission tomography, and prolonged clinical improvement over 5 years, suggesting long term survival and efficacy of the graft. The other patient did not improve clinically or radiologically. Our results indicate that striatal transplantation in HD may be beneficial but further studies are needed to confirm this. [ABSTRACT FROM AUTHOR]

Background In the course of idiopathic Parkinson’s disease (IPD) 30% of patients develop dementia yielding to new challenges in diagnosis and therapy. Several studies in multiple sclerosis or HIV patients indicated a correlation of ventricular diameter as a marker of brain atrophy and a decline of cognitive function. Objective The aim of this study was to evaluate if ventricular diameter measured by TCS and MR-imaging is a marker of brain atrophy and if it is correlated with severity of disease and cognitive dysfunction. Methods In this study 108 PD patients (64% male, 36% female; mean age: 63,64 ± 8,24 years (yrs)) and 39 controls (36% male, 64% female; mean age: 51,7 ± 15,6 yrs) underwent a T1/T2-weighted MR Imaging and TCS. The transverse diameter of the third ventricle (3v) and the frontal horns of right (rv) and left (lv) lateral ventricles were measured. Furthermore, neurological examinations, standardized motor functional (UPDRS, Webster) and cognitive (MMST, PANDA, ZVT) tests were performed. 31 individuals underwent a follow up examination after 5 yrs. Results The TCS measurement of ventricular diameter significantly correlated with the MRI measurement (Spearman rank correlation, 3v: r = 0.8, lv: r = 0.4; p < 0.01, rv: r = 0.2; p < 0.05) with a high interobserver reliability. In the PD-group the diameter of the third ventricle was 0.54 ± 0.02 cm and of the lateral ventricles 1.49 ± 0.36 cm. Group membership did not influence ventricular diameter in TCS or MRI. Age had a significant impact on ventricular diameter (3v: r = 0.49; p < 0.01; rv: r = 0.389; p < 0.01; lv: r = 0.421; p < 0.01). Above all, MRI and TCS data were correlated significantly with cognitive tests: MMST ( 3v : r = −0.3; p = n. s.; lv : r = −0.5; p < 0.01; rv: r = −0.5; p < 0.05), PANDA-Test (Spearman rank correlation, 3v : r = −0.457; p < 0.05; lv : r = −0.417; p < 0.05; rv: r = −0.261; p = n.s.). No correlation between motor function and ventricular diameter was found. In 5-year follow-up all individuals showed a significant increase of lateral ventricular diameter (rv+lv: p < 0.0005) particularly in IPD. In summary, our data in IPD-patients demonstrated a correlation of cognitive function and ventricular diameter in TCS and MRI comparable to the studies in MS and HIV-patients. Conclusions Our results suggest that TCS measurement of ventricular diameter represents a quick, low priced and simple method as a surrogate marker of brain atrophy associated in IPD with age and cognitive function. Future investigations may define the value of TCS ventricular diameter measurement for evaluation of cognitive dysfunction in IPD in routine clinical practice. [ABSTRACT FROM AUTHOR]

Spasticity is one of the major causes of functional impairment in adults with lesions of the central nervous system. For instance, approximately 30% of post-stroke patients suffer from different degrees of spasticity with possible consecutive impairments. Numerous studies or meta-analyses showed that local injections of botulinum toxin in spastic muscles lead to dose-dependent reduction in muscle tone and improvement of passive movements (e. g. facilitated care), especially following repeated injections. However, country-specific regulations and patient-remote administration in German health care often do not allow adequate provision of this therapy. Thus, the present consensus statement based on the EBM analyses of the published international literature tries to highlight recent advances and the standard in the field of local spasticity treatment, aiming to facilitate communication between the decision makers and German reimbursement institutions in health care. Prior to initiation of BoNT-A injections, patient-oriented goals should be identified in a multiprofessional context to assure realistic goals for this specific treatment and patient expectations. In Germany for the treatment of focal spasticity following stroke three products have been approved: Botox® (Pharm Allergan, Ettlingen), Dysport® (Ipsen Pharma, Ettlingen) and Xeomin® (Merz Pharma, Frankfurt/Main). For all preparations safety has been repeatedly shown. Functional improvements have also been illustrated for selected patients concerning hand/arm function and gait. The dose per muscle and the selection of muscles to be injected have to be individualized according to the patient's symptoms and should be accompanied by modern neurorehabilitative therapies such as redression or repetitive activation of the injected and antagonistic muscles. [ABSTRACT FROM AUTHOR]