Search

Competing Interests: Declaration of competing interest Dr. Schneider: Dr. Schneider has received research funding from the NIH/NINDS, the Michael J. Fox Foundation for Parkinson's Research, Biohaven Phamaceuticals, Acadia Pharmaceuticals, and Bial and has received funding from Clintrex for her role on a DSMB. Dr. Phillips: Dr. Phillips has no conflicts of interest to declare. Dr. Kalia: Dr. Kalia has received research support from Canadian Institutes of Health Research (CIHR), Cure Parkinson's, Krembil Foundation, Michael J. Fox Foundation for Parkinson's Research (MJFF), Natural Sciences and Engineering Research Council of Canada (NSERC), Parkinson Canada; consultancy fees from Cure Ventures, Ipsen, Knight Therapeutics, Right Brain Bio, UCB; and, honoraria from Canadian Movement Disorders Society (CMDS), Critical Path for Parkinson's (CPP), International Parkinson and Movement Disorder Society (MDS), IOS Press.

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gregory Pontone reports a relationship with ACADIA Pharmaceuticals Inc that includes: consulting or advisory. Gregory Pontone reports a relationship with GE Healthcare that includes: consulting or advisory. Kelly Mills reports a relationship with Tilosia that includes: consulting or advisory. Ruth Schneider reports a relationship with ACADIA Pharmaceuticals Inc that includes: funding grants. Ruth Schneider reports a relationship with Pfizer Inc that includes: funding grants. Ruth Schneider reports a relationship with Biohaven Ltd that includes: funding grants. Ruth Schneider reports a relationship with ESCAPE Bio that includes: consulting or advisory. none.

Introduction: In Parkinson's disease (PD), anxiety is common, associated with lower health-related quality of life, and undertreated. The primary objective of this study was to determine the tolerability of buspirone for the treatment of anxiety in PD., Methods: Individuals with PD and clinically significant anxiety were randomized 4:1 to flexible dosage buspirone or placebo for 12 weeks. Treatment was initiated at 7.5 mg twice daily and titrated based on response and tolerability to an optimal dosage (maximum 30 mg twice daily). The primary outcome was the proportion of participants who failed to complete the study on study drug. Secondary outcomes included adverse events, dosage reductions, motor function, dyskinesias, and anxiety., Results: A total of 21 participants enrolled, 4 were randomized to placebo and 17 to buspirone (mean (SD) age 65.5 (9.8), 76.5% male, 88% on concomitant antidepressant or anxiolytic). In the buspirone group, 7 (41%) failed to complete the study on drug, 5 due to intolerability. The median buspirone dosage was 7.5 mg twice daily. No serious adverse events occurred. A total of 9 (53%) buspirone participants experienced adverse events consistent with worsened motor function. In the buspirone group, mean (SD) improvement from baseline to week 12 in Hamilton Anxiety Rating Scale was -3.9 (3.8) and Parkinson Anxiety Scale -7.1 (6.4)., Conclusion: Tolerability concerns do not support moving immediately forward with a large-scale efficacy trial. However, concomitant anxiolytics may have affected tolerability and a signal of efficacy was seen suggesting that future studies of buspirone monotherapy be considered., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Cognitive decline creates substantial morbidity and cost in Parkinson's disease (PD) and clinicians have limited tools for counseling patients on prognosis. We aimed to use data from a randomized, controlled trial of isradipine in Parkinson's disease (STEADY-PD III) to determine which objective cognitive domain deficits drive patient complaints of cognitive symptoms., Methods: Neuro-Quality of Life (Neuro-QoL) Cognition: General Concerns (GC), and Cognition: Executive Function (EF) (subjective measures), were administered at baseline, 1, 2, and 3 years in 324 people with PD. Baseline Montreal Cognitive Assessment (MoCA) was divided into 4 domains: visuospatial/executive, memory, attention, and language (objective measures). Spearman rank correlations and multiple regression models adjusted for other clinical variables evaluated associations between baseline Neuro-QoL domains and individual MoCA domains. Multiple regression models evaluated the association between baseline MoCA domain performance and Neuro-QoL change over three years. Cox proportional hazards predicted development of PD-MCI based on baseline and time-varying Neuro-QoL reporting., Results: Higher MoCA memory performance was associated with better Neuro-QoL-GC (β = 0.75, SE = 0.391, p = 0.05) and Neuro-QoL-EF (β = 0.81, SE = 0.36, p = 0.02) at baseline. There was a trend for baseline MoCA memory to predict the degree of subjective cognitive decline on the Neuro-QoL-EF (β = 0.70, SE = 0.42, p = 0.09). Baseline depression and anticholinergic use were associated with worsened Neuro-QoL-EF and Neuro-QoL-GC. Increasing subjective cognitive complaints in Neuro-QoL-EF were associated with development of PD-MCI over 3 years of follow-up (HR = 0.95, CI = 0.90-1.0, p = 0.039)., Conclusions: Objective memory impairment may be a stronger predictor than executive or visuospatial dysfunction for the presence of subjective cognitive complaints in early PD., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Deep brain stimulation (DBS) surgery is an efficacious, underutilized treatment for Parkinson's disease (PD). Studies of DBS post-operative outcomes are often restricted to data from a single center and consider DBS in isolation. National estimates of DBS readmission and post-operative outcomes are needed, as are comparisons to commonly performed surgeries., Methods: This study used datasets from the 2013 and 2014 Nationwide Readmissions Database (NRD). Our sample was restricted to PD patients discharged alive after hospitalization for DBS surgery. Descriptive analyses examined patient, clinical, hospital and index hospitalization characteristics. The all-cause, non-elective 30-day readmission rate after DBS was calculated, and logistic regression models were built to examine factors associated with readmission. Readmission rates for the most common surgical procedures were calculated and compared to DBS., Results: There were 6058 DBS surgeries for PD in our sample, most often involving a male aged 65 and older, who lived in a high socioeconomic status zip code. DBS patients had an average of four comorbidities. With respect to outcomes, the majority of patients were discharged home (95.3%). Non-elective readmission was rare (4.9%), and was associated with socioeconomic status, comorbidity burden, and teaching hospital status. Much higher acute, non-elective readmission rates were observed for common procedures such as upper gastrointestinal endoscopy (16.2%), colonoscopy (14.0%), and cardiac defibrillator and pacemaker procedures (11.1%)., Conclusion: Short-term hospitalization outcomes after DBS are generally favorable. Socioeconomic disparities in DBS use persist. Additional efforts may be needed to improve provider referrals for and patient access to DBS., Competing Interests: Declaration of competing interest RBS: Has no conflicts of interest relevant to this work but reports grant support from the National Institute of Neurological Disorders and Stroke, Biohaven Pharmaceuticals, CHDI Foundation, Teva Pharmaceuticals, Pfizer, Nuredis Inc., The Michael J. Fox Foundation, and the Canadian Institute of Health Research as well as financial support from the Parkinson's Foundation. JJ-S: Reports research support from Medtronic and St. Jude Medical/Abbott as well as consulting agreements with Medtronic, St. Jude Medical/Abbott, and Boston Scientific relevant to this work. Also reports research support from Teva and Lilly; consulting agreements with Bracket and Nuvelution; and grant support from the National Institute of Neurological Disorders and Stroke, the Michael J. Fox Foundation, and the Simons Foundation. DSA: Has no conflicts of interest relevant to this work but reports research support from the National Institutes of Health and financial support from the Parkinson's Foundation. DPT: None. SM: None. MF: Has no conflicts of interest relevant to this work but reports active research funding from the American Academy of Neurology, American Brain Foundation, and the Parkinson's Foundation. MAB: Has no conflicts of interest relevant to this work but reports active research funding from the Parkinson's Foundation. KLC: Has no conflicts of interest relevant to this work but reports active research funds from the National Institutes of Health and the Parkinson Study Group, consulting agreements with Sunovion Pharmaceuticals, and royalties from UpToDate and Springer. MS: Has no conflicts of interest relevant to this work but reports active research funding from Abbvie, USWorldMeds, Sanofi, Lundbeck, and Abbott. WJJ: None. P-FD: Has no conflicts of interest relevant to this work but reports service as an Officer of Neurotargeting LLC. MKY: Has no conflicts of interest relevant to this work but reports personal compensation for consultant, Steering Committee, and Data Safety Monitoring Board service from the Michael J. Fox Foundation and Boston Scientific. JCK: None. JMS: Has no conflicts of interest relevant to this work but reports research grants from Medtronic, service as a consultant for Guidant, LLC, and salary support from Blue Cross Blue Shield of Michigan. AJE: Has no conflicts of interest relevant to this work but reports grant support from the National Institutes of Health, Great Lakes Neurotechnologies, and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, TEVA, Impax, Acadia, Acorda, Cynapsus/Sunovion, Lundbeck, Osmotica Pharmaceutical, and USWorldMeds; publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer; and honoraria from Abbvie, UCB, USWorldMeds, Lundbeck, Acadia, the American Academy of Neurology, and the Movement Disorders Society. LCS: Has no conflicts of interest relevant to this work but reports employment with Biogen, Inc. DKS: Has no conflicts of interest relevant to this work but reports research funding from BioElectron Technology, Lysosomal Therapeutics, Mission Therapeutics, Voyager Therapeutics, the Weston Brain Institute, and the National Institutes of Health as well as honorarium for Steering Committee service from the Michael J. Fox Foundation and Biogen. CH: None. JAGC: Has no conflicts of interest relevant to this work but reports research support from the Northern Ontario Academic Medicine Association. AWW: Has no conflicts of interest relevant to this work but reports research funding from the National Institutes of Health and the Parkinson's Foundation., (Copyright © 2019. Published by Elsevier Ltd.)