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There are limited data on vascular, inflammatory, metabolic risk factors of dementia in Parkinson's disease (PD) with type 2 diabetes mellitus (DM) (PD-DM). In a study of 928 subjects comprising of 215 PD with DM (including 31 PD-DM with dementia, PD-DMD), 341 PD without DM (including 31 PD with dementia, PDD) and 372 DM without PD (including 35 DM with dementia, DMD) patients, we investigated if vascular, inflammatory, metabolic, and magnetic resonance imaging (MRI) markers were associated with dementia in PD-DM. Lower fasting blood glucose (FBG15μmol/L, OR=3.131; 95%CI: 1.243-7.888; p=0.015) and hyperlipidemia (OR=3.075; 95%CI: 1.142-8.277; p=0.026), increased age (OR=1.043; 95%CI: 1.003-1.084; p=0.034) were the most significant risk factors in PDD patients. Lower low-density lipoprotein cholesterol (LDL-C4g/L, OR=4.066; 95%CI: 1.467-11.274; p=0.007) were the most significant risk factors in PD-DMD patients. The area under the curve (AUC) for fibrinogen and LDL-C was 0.717 (P=0.001), with a sensitivity of 80.0% for the prediction of PD-DMD.In summary, we identified several factors including LDL-C and fibrinogen as significant risk factors for PD-DMD and these may have prognostic and treatment implications.

BackgroundIn 2015, the International Parkinson and Movement Disorder Society published clinical diagnostic criteria for Parkinson's disease (PD). Although recent validation studies suggest high accuracy, one unmet need is for highly specific criteria for clinical trials in early/de novo PD.ObjectivesThe objective of this study was to generate and test a PD diagnostic criteria termed "clinically established early PD."MethodsWe modified the Movement Disorder Society criteria to increase specificity for early PD by removing all disease duration components and changing red flags to absolute exclusions. We then estimated the sensitivity/specificity of clinically established early PD criteria in patients with disease duration

This document presents the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (PD). The Movement Disorder Society PD Criteria are intended for use in clinical research but also may be used to guide clinical diagnosis. The benchmark for these criteria is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise in PD diagnosis. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies on three categories of diagnostic features: absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of the PD diagnosis). Two levels of certainty are delineated: clinically established PD (maximizing specificity at the expense of reduced sensitivity) and probable PD (which balances sensitivity and specificity). The Movement Disorder Society criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, the Movement Disorder Society criteria will need continuous revision to accommodate these advances.

This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease-modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available.

With advances in knowledge disease, boundaries may change. Occasionally, these changes are of such a magnitude that they require redefinition of the disease. In recognition of the profound changes in our understanding of Parkinson's disease (PD), the International Parkinson and Movement Disorders Society (MDS) commissioned a task force to consider a redefinition of PD. This review is a discussion article, intended as the introductory statement of the task force. Several critical issues were identified that challenge current PD definitions. First, new findings challenge the central role of the classical pathologic criteria as the arbiter of diagnosis, notably genetic cases without synuclein deposition, the high prevalence of incidental Lewy body (LB) deposition, and the nonmotor prodrome of PD. It remains unclear, however, whether these challenges merit a change in the pathologic gold standard, especially considering the limitations of alternate gold standards. Second, the increasing recognition of dementia in PD challenges the distinction between diffuse LB disease and PD. Consideration might be given to removing dementia as an exclusion criterion for PD diagnosis. Third, there is increasing recognition of disease heterogeneity, suggesting that PD subtypes should be formally identified; however, current subtype classifications may not be sufficiently robust to warrant formal delineation. Fourth, the recognition of a nonmotor prodrome of PD requires that new diagnostic criteria for early-stage and prodromal PD should be created; here, essential features of these criteria are proposed. Finally, there is a need to create new MDS diagnostic criteria that take these changes in disease definition into consideration.

• The China's National Medical Products Administration (NMPA) approved new olfactory test is reported for the first time. • The current study sought to investigate the efficacy of a new olfactory test designed for Chinese PD patients and compare it with the most commonly used olfactory test, B-SIT. • In clinical practice, neurologists routinely ask subjects if they feel smell loss and make the diagnosis base on the reply of subjects in China. • However, our findings suggest that self-reported hyposmia might be unreliable in the diagnosis of PD. Hyposmia is a common non-motor symptom in Parkinson's disease (PD) and has been used to assist PD diagnosis and early screening of prodromal patients. Although the Brief Smell Identification Test (B-SIT) is the most commonly used olfactory test, its utility was limited by the culture difference in recognition of the smells included in the test. We have developed a new modified B-SIT test for Chinese (B-SITC), and validated and compare it with B-SIT in Chinese PD patients. From 2015 to 2018, PD patients were recruited from the Movement Disorder Clinic of Xuanwu Hospital and healthy controls were recruited from the Beijing Longitudinal Study on Aging Cohort II. The two olfactory tests were used in healthy volunteers and PD patients. A total of 428 subjects participated in the study: 211 healthy controls and 217 PD patients. The average B-SIT and B-SITC scores were significantly different between control and PD groups (B-SIT, 9.18 ± 1.94 vs. 6.90 ± 2.44, P = 0.0001; B-SITC, 8.60 ± 1.93 vs. 5.91 ± 2.21, P = 0.0001). The B-SITC had good sensitivity (73.1%), specificity (76.8%), positive predictive value (76.8%), and negative predictive value (73.1%) for the diagnosis of Chinese PD, and the area under the curve (AUC) value was greater for the B-SITC than for the B-SIT (0.838 vs. 0.761). The B-SITC is useful for the clinical assessment of olfactory function in Chinese PD patients. [ABSTRACT FROM AUTHOR]

Highlights • The olfactory function evaluations in Chinese PD patients with B-SIT CV2. • The sensitivity and specificity for the B-SIT reached 64.1% and 83.9% respectively. • Most of the odors in the B-SIT were familiar to people in the Chinese population. Abstract Introduction Hyposmia is a common non-motor symptom occurring in Parkinson's disease (PD), and has been included in the diagnostic criteria. Although a version of the Brief Smell Identification Test (B-SIT) has been developed specifically for Chinese populations, there have been no reports of the utility of this test in the diagnosis of PD in China. Objective Considering the influence of cultural factors on olfactory test findings, we sought to investigate the utility and efficiency of the B-SIT in Chinese PD patients. Methods PD patients were recruited from the Movement Disorder Clinic of Xuanwu Hospital, and healthy controls were recruited from the Beijing Longitudinal Study on Aging Cohort II, between 2015 and 2016. The B-SIT was used for olfactory function testing in all subjects, and the familiarity of 59 odors questionnaire was performed for the investigation of familiarity of odors. Results A sample of 275 subjects participated in the study, including 112 healthy controls and 163 PD patients. The sensitivity (64.1%), specificity (83.9%), positive predictive value (83.5%) and negative predictive value (64.8%) for identifying PD were measured with the B-SIT. The consistency values between the results of self-reported smell loss and hyposmia identified by B-SIT in control and PD groups were 74.8% and 64.2%, respectively. Most of the odors in the B-SIT were familiar to people in the Chinese population, based on a survey of 3356 subjects using a familiarity questionnaire. Conclusions It is recommended to use the B-SIT olfactory test instead of self-reported smell loss for PD diagnosis for Chinese. [ABSTRACT FROM AUTHOR]

Objectives: We investigated postural sway in patients with early Parkinson’s disease (PD) to test the hypothesis that the postural control system was affected already at an early stage of PD. Moreover, we identified cases of dysfunction of stereopsis in PD patients. Methods: We examined 23 patients with early PD and 23 healthy, sex- and age-matched control subjects. Postural sway was measured with an accelerometer at the center of mass at the lower spine. Subjects were asked to stand quietly for 30 s under two usual conditions (eyes open and eyes closed) and two dual tasks conditions (eyes open with dual task, eyes closed with dual task). Stereopsis was assessed using the Titmus fly test. Results: In the usual conditions, no differences were found between the control group and PD group. With increasing task difficulty, PD patients showed an increase of RMS values of sway acceleration, compared to control subjects. These differences reached significance during cognitive task performance. PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance. Relative to controls, PD patients showed decreased stereopsis function. But, there were no statistically significant correlations between log seconds of arc of the Titmus test and JERK, even during cognitive task performance. Conclusion: Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients. St Abbreviations: ACC: Accelerometers; ANOVA: Analysis of variance; AP: Antero-posterior; COP: Center of pressure; EC: Eyes closed; ECDT: eyes closed with dual task; EO: Eyes open; EODT: Eyes open with dual task; GDS: Geriatric depression scale; JERK: Jerkiness of sway; ML: Medio-lateral; MMSE: Mini mental state examination; MoCA: Montreal cognitive assessment; PD: Parkinson’s disease; PDAbS: PD Patients with abnormal stereopsis; PDNrS: PD Patients with normal stereopsis; PIGD: Postural instability and gait disorder; RMS: Root mean square; UPDRS: Unified Parkinson’s disease rating scale. [ABSTRACT FROM AUTHOR]

Non-motor symptoms (NMS) are important preclinical features of Parkinson's disease (PD) and have become the leading cause of poor quality of life with disease progression. There are little data on how antiparkinsonian medications influence the NMS in PD at early stage. In this study, we explored the distribution of NMS in treated and untreated PD and investigated the association between NMS and antiparkinsonian medications in Chinese patients with early PD. Subjects were enrolled from a Chinese PD patient cohort based on 2 clinical trials. Face-to-face interviews and evaluations were performed for clinical information. NMS were compared in patients with or without antiparkinsonian treatment, and between subgroups of dopaminergic medications. Eight hundred and sixteen PD patients were enrolled in this study, of whom 428 were newly diagnosed PD. Only 5 in 646 patients who completed all these NMS measurements (0.6%) were free of NMS. PD patients with antiparkinsonian medications had a significantly higher frequency of poor sleep (p = 0.001), depression (p = 0.0001) and constipation (p = 0.0001) after adjusted gender, onset age, duration, and Hoehn & Yahr stage. Moreover, patients treated by levodopa plus dopamine agonist had a higher percentage of bad sleepers (adjusted p = 0.040), and correlation analysis revealed that Levodopa Equivalent Dose (LED) was associated with constipation (coefficient 0.146, p = 0.005). These findings suggest that although NMS exist in the prodromal stage of PD, antiparkinsonian treatment is associated with increased frequency of some NMS, which may challenge the management for PD. [ABSTRACT FROM AUTHOR]

The article offers information on a study that investigated whether octacosanol would attenuate neurotoxicity in 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine-treated C57BL/6N mice. The study examined the effects of octacosanol in a mouse model of Parkinson's disease. It reveals the possibility of mediating the protective effects afforded by octacosanol by blocking the phosphorylation of p38MAPK and JNK on the signal transduction in vivo.