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COPPADIS Study Group., Quality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p, Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB and Zambon and have received grants from the Spanish Ministry of Economy and Competitiveness [PI16/01575] co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación) and by Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía [CVI-02526, CTS-7685], the Consejería de Salud y Bienestar Social de la Junta de Andalucía [PI-0437-2012, PI-0471-2013], the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña.

Background and objective: Freezing of gait (FOG) is a disabling symptom more frequent in Parkinson’s disease (PD) patients with postural instability gait difficulty (PIGD) phenotype. The aim of this study was to determine the prevalence of self-reported FOG in a large group of PD patients as well as assess its relationship with functional dependency with regard to motor phenotype. Methods: The data correspond to the baseline evaluation of the COPPADIS-2015 study. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the freezing of gait questionnaire (FOG-Q). Functional dependency was defined as a Schwab and England (S&E) ADL scale score less than 80%. PIGD and non-PIGD (tremor dominant + indeterminate) groups were considered regarding to motor phenotype. Results: Among the 689 PD patients (62.6 ± 8.9 years old, 59.8% males), 240 reported FOG (34.8%), whereas 63 presented functional dependency (9.1%). A total of 22.1% of patients with FOG presented functional dependency vs. only 2.2% of those without FOG (p < 0.0001). FOG was related to functional dependency (OR = 3.470; 95%CI 1.411–8.530; p = 0.007) after adjustment to age, gender, disease duration, daily equivalent levodopa dose, comorbidity (number of non-antiparkinsonian drugs/day), motor status (UPDRS-III), PIGD phenotype, motor complications (UPDRS-IV), NMS burden (NMSS total score), cognition (PD-CRS), and mood (BDI-II). However, according to motor phenotype, FOG was related to functional dependency only in PIGD patients (OR = 7.163; 95%CI 1.206–42.564; p = 0.030). Conclusions: Self-reported FOG is associated with functional dependency in PIGD but not in non-PIGD motor phenotype patients., Santos-García D. has received honoraria for educational presentations and/or advice service by Abbvie, UCB Pharma, Lundbeck, KRKA, Zambon, Bial, and Teva. de Deus Fonticoba T. has received honoraria for educational presentations and advice service by Abbvie. Suárez Castro E: None. Ángel Aneiros Díaz: None. Feal Painceiras M: None. Paz González JM has received honoraria for educational presentations and/or advice service by UCB Pharma, Lundbeck, KRKA y Zambon. García Sancho C: None. Jesús S. has received honoraria from AbbVie, Bial, Merz, UCB, and Zambon. She also holds the competitive contract “Juan Rodés” supported by the Instituto de Salud Carlos III. She has received grants from the Spanish Ministry of Economy and Competitiveness (PI18/01898) and the Consejería de Salud de la Junta de Andalucía (PI-0459-2018). Mir P. has received honoraria from AbbVie, Abbott, Allergan, Bial, Merz, UCB, and Zambon. Also, he has received grants from the Spanish Ministry of Economy and Competitiveness (PI16/01575) co-founded by ISCIII (Subdirección General de Evaluación y Fomento de la Investigación), Fondo Europeo de Desarrollo Regional (FEDER), the Consejería de Economía, Innovación, Ciencia y Empleo de la Junta de Andalucía (CVI-02526, CTS-7685), the Consejería de Salud y Bienestar Social de la Junta de Andalucía (PI-0437-2012, PI-0471-2013), the Sociedad Andaluza de Neurología, the Jacques and Gloria Gossweiler Foundation, the Fundación Alicia Koplowitz, and the Fundación Mutua Madrileña. Planellas LL. has received travel bursaries grant from Abbvie. García Caldentey J. has received honoraria for educational presentations and advice service by Qualigen, Nutricia, Abbvie, Italfarmaco, UCB Pharma, Lundbeck, Zambon, Bial, and Teva. Caballol N. has received honoraria for educational presentations and advice service by Qualigen, Nutricia, Abbvie, Italfarmaco, UCB Pharma, Lundbeck, Zambon, Bial, and Teva. Legarda I. has received honoraria for educational presentations and advice service by Abbvie, UCB Pharma, Zambon, Bial, and Teva. Hernández Vara J. has received travel bursaries and educational grants from Abbvie and has received honoraria for educational presentations from Abbvie, Teva, Bial, Zambon, Italfarmaco, and Sanofi-Genzyme. González Aramburu I: None. Ávila Rivera MA. has received honoraria from Zambon, UCB Pharma, Qualigen, Bial, and Teva, and sponsorship from Zambon and Teva for attending conferences. Catalán MJ: None. Nogueira V: None. Álvarez Sauco M. has received honoraria for educational presentations and advice service by Abbvie, UCB Pharma, Zambon, Bial, and Teva. Vela L. has received honoraria for educational presentations and advice service by Abbvie, UCB Pharma, Lundbeck, KRKA, Zambon, Bial, and Teva. Escalante S. has received honoraria for educational presentations and advice service by Abbvie, Zambon, and Bial. Cubo E: travel grants: Abbvie, Allergan, Boston; lecturing honoraria: Abbvie, International Parkinson’s disease Movement Disorder Society. Sánchez Alonso P. has received honoraria for educational presentations and advice service by Abbvie, UCB Pharma, Lundbeck, KRKA, Zambon, Bial, and Teva. Alonso Losada MG. has received honoraria for educational presentations and advice service by Zambon and Bial. López Ariztegui N. has received honoraria for educational presentations and advice service by Abbvie, Italfarmaco, Zambon, and Bial. Martinez-Martin P: Honoraria: from Editorial Viguera and National School of Health for lecturing in courses; International Parkinson and Movement Disorder Society for management of the Program on Rating Scales; Abbvie and Zambon for advice in clinic-epidemiological studies www.curemoselparkinson.org.

COPPADIS Study Group., [Background and purpose] The objective of this study was to analyze the relationship between motor complications and non‐motor symptom (NMS) burden in a population of patients with Parkinson’s disease (PD) and also in a subgroup of patients with early PD., [Methods] Patients with PD from the COPPADIS cohort were included in this cross‐sectional study. NMS burden was defined according to the Non‐Motor Symptoms Scale (NMSS) total score. Unified Parkinson’s Disease Rating Scale (UPDRS) part IV was used to establish motor complication types and their severity. Patients with ≤5 years of symptoms from onset were included as patients with early PD., [Results] Of 690 patients with PD (62.6 ± 8.9 years old, 60.1% males), 33.9% and 18.1% presented motor fluctuations and dyskinesia, respectively. The NMS total score was higher in patients with motor fluctuations (59.2 ± 43.1 vs. 38.3 ± 33.1; P < 0.0001) and dyskinesia (63.5 ± 40.7 vs. 41.4 ± 36.3; P < 0.0001). In a multiple linear regression model and after adjustment for age, sex, disease duration, Hoehn & Yahr stage, UPDRS‐III score and levodopa equivalent daily dose, UPDRS‐IV score was significantly related to a higher NMSS total score (β = 0.27; 95% confidence intervals, 2.81–5.61; P < 0.0001), as it was in a logistic regression model on dichotomous NMSS total score (≤40, mild or moderate vs. >40, severe or very severe) (odds ratio, 1.31; 95% confidence intervals, 1.17–1.47; P < 0.0001). In the subgroup of patients with early PD (n = 396; mean disease duration 2.7 ± 1.5 years), motor fluctuations were frequent (18.1%) and similar results were obtained., [Conclusions] Motor complications were frequent and were associated with a greater NMS burden in patients with PD even during the first 5 years of disease duration.

Background and Objective: The aim of this study is to identify risk factors for mortality in a community-based cohort of nondemented patients with Parkinson disease (PD) during prospective long-term follow-up, while also comparing the effect of motor complications to nonmotor symptoms (NMS) on risk of mortality. Methods: One hundred forty seven nondemented patients with PD (57.1% males; 70.9 ± 8.6 years old) were included in this 48 month follow-up, longitudinal, single, evaluation study. Motor and therapy-related complications were assessed using the Unified Parkinson’s Disease Rating Scale/part-IV (UPDRS-IV). Non-Motor Symptoms Scale (NMSS) total score was used to assess NMS burden. Cox proportional hazard models were applied to identify independent predictors of mortality during follow-up. Results: Twenty-two patients of 146 (15.1%) died (1 case without information). Both UPDRS-IV and NMSS total scores were higher at baseline in patients with PD who died (3.5 ± 3.1 vs 2.4 ± 2.4, P = .049 and 96.9 ± 58.6 vs 61.9 ± 51.0, P = .004, respectively). Unadjusted hazard ratios (HRs) associated with UPDRS-IV and NMSS total scores among those who died during follow-up were 1.171 (95% confidence interval [CI]: 1.012-1.357; P = .035) and 1.008 (95% CI: 1.002-1.013; P = .006), respectively. Independent predictors of mortality during follow-up after adjusting for other covariates were UPDRS-IV (HR: 1.224; 95% CI: 1.002-1.494; P = .047), age (HR: 1.231; 95% CI: 1104-1.374; P < .0001), and comorbidity (Charlson Index; HR: 1.429; 95% CI: 1.023-1.994; P = .036), but not NMSS total score (HR: 1.005; 95% CI: 0.996-1.014; P = .263). Conclusions: Both motor complications (UPDRS-IV) and NMS (NMSS) were associated with mortality at 4 years, being motor complications an independent predictor of it.

Se desarrolla un consenso multidisciplinar sobre el uso de hipolipemiantes, pues las cifras de consumo de hipolipemiantes han aumentado considerablemente en los ultimos años, Las últimas guías publicadas han levantado bastante polémica y se considera necesario la realización de este consenso e identificar los niveles de riesgo de los pacientes, para tratar las dislipemias y normalizar el uso de hipolipemientes. Se realiza una mención especial al tratamiento de la dislipemia en la enfermedad renal crónica.

Las enfermedades cardiovasculares (ECV) constituyen la principal causa de morbilidad y mortalidad mundial. Cada año fallecen más personas por ECV que por cualquier otra causa. Se calcula que en 2012 murieron por ECV 17,5 millones de personas, lo cual representa un 30% de todos los decesos registrados en el mundo.

Pain is one of the most common non motor symptoms in patients with Parkinson's disease (PD). However, it is underrecognized. We examine the prevalence of pain, characteristics, associated factors, and relation with quality of life and autonomy in a consecutive series of PD patients.Pain was identified according to International Association for the Study of Pain. Brief Pain Inventory and Medical Outcomes Study 36-Item Short Form were used.Of the 159 patients (72.31 ± 8.83 years; 51.3% female), 115 (72.3%) presented pain. Of these, 51.3% reported pain onset before PD-diagnosis, 27.8% two or more pain types, and 53% PD-related pain. Musculoskeletal (74.8%) and radicular-neuropathic (24.3%) were the types of pain most frequent. The 37.4% of the patients with pain did not received analgesic treatment. Depression was an independent predictor of pain (OR = 7.82; 95% CI = 1.151-53.183; p = 0.035). Pain was an independent predictor of worst quality of life (PDQ-39; regression coefficient: 25.53; standard error: 11.852; 95% CI = 1.48-49.57; p = 0.03) and lower autonomy (Schwab and England; regression coefficient: -13.85; standard error: 6.327; 95% CI = -26.58 to -1.2; p = 0.034).Pain is very frequent in PD patients. It is associated with depression, and predicts a worst quality of life and lower autonomy for the patient.

Introduccion. El dolor es un sintoma no motor muy frecuente en la enfermedad de Parkinson (EP), aunque infravalorado. Analizamos la prevalencia del dolor, caracteristicas, factores asociados y su repercusion sobre la calidad de vida y autonomia del paciente en una serie consecutiva de pacientes con EP. Pacientes y metodos. El diagnostico de dolor se realizo de acuerdo con la International Association for the Study of Pain. Efectuamos una entrevista estructurada y utilizamos el Brief Pain Inventory y el Medical Outcome Study 36-Item Short Form. Resultados. De un total de 159 pacientes incluidos (edad media: 72,31 ± 8,83 anos; 51,3% mujeres), 115 (72,3%) presentaban dolor. De estos, el 51,3% presentaba dolor antes del diagnostico de EP y un 27,8% mas de un tipo de dolor, siendo los mas frecuentes el musculoesqueletico (74,8%) y el radicular-neuropatico (24,3%). En el 53%, el dolor se clasifico como relacionado con la EP. Un 37,4% no recibia ningun tratamiento para el dolor. La presencia de sintomatologia depresiva se mostro como un predictor independiente de dolor (odds ratio = 7,82; intervalo de confianza al 95%, IC 95% = 1,151-53,183; p = 0,035). El dolor se mostro como un predictor independiente de peor calidad de vida (Parkinson´s Disease Questionnaire-39; coeficiente de regresion: 25,53; error estandar: 11,852; IC 95% = 1,48-49,57; p = 0,03) y menor autonomia (escala de actividades de la vida diaria de Schwab y England; coeficiente de regresion: -13,85; error estandar: 6,327; IC 95% = -26,58 a -1,2; p = 0,034). Conclusiones. El dolor es un sintoma no motor muy frecuente en la EP, que se asocia a la presencia de depresion, y que predice una peor calidad de vida y autonomia por parte del paciente.

Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower limbs.We review the epidemiological, pathophysiological, clinical and therapeutic characteristics of this disease, with special emphasis on the diagnostic criteria.Diagnosis of RLS is mainly clinical and is based on the criteria established by the National Institutes of Health consensus development conference in 2002. There are specific criteria for special groups (the elderly with cognitive impairment and children) in which it is not possible to determine whether RLS exists or not using the usual diagnostic criteria.

Introduccion. El estudio del sistema motor y de sus trastornos ha sido un tema importante para la neurofisiologia, siendo uno de sus objetivos intentar comprender los mecanismos fisiopatologicos que subyacen a las disfunciones del mismo. Desarrollo: Se revisa lo mas relevante acerca de: (1) Tecnicas neurofisiologicas utilizadas en el diagnostico de la EP y otros parkinsonismos; (2) Utilidad de la estimulacion magnetica transcraneal (EMT); (3) Estudios neurofisiologicos de los trastornos del sueno en la EP; (4) Aspectos neurofisiologicos de la estimulacion cerebral profunda (ECP). Conclusiones: Las pruebas neurofisiologicas puede ayudar en el diagnostico diferencial del parkinsonismo ademas de profundizar en la fisiopatologia de los sintomas y signos parkinsonianos. Diferentes tecnicas pueden emplearse en el estudio de los trastornos del sueno en la EP. La EMT resulta util tanto desde el punto de vista diagnostico como probablemente tambien terapeutico en la EP. Actualmente, los registros con microelectrodos constituyen la forma mas precisa de poder identificar la diana seleccionada en la cirugia de la EP.

El tratamiento con infusion continua de levodopa/carbidopa intraduodenal (Duodopa®) constituye una opcion de tratamiento para pacientes con enfermedad de Parkinson (EP) avanzada que no responden de forma satisfactoria al tratamiento convencional. Publicaciones previas han reportado que Duodopa mejora las complicaciones motoras, sintomas no motores, calidad de vida y autonomia de los pacientes asi como el grado de estres y sobrecarga del cuidador. Asegura la mayoria de las veces la monoterapia evitando otros farmacos con efectos secundarios. Las complicaciones graves son excepcionales, mientras que las menores relacionadas con el estoma y el dispositivo son frecuentes. El presente trabajo revisa la evidencia cientifica existente sobre Duodopa y aspectos practicos para el manejo de los pacientes con EP tratados con dicha terapia.

Introduccion. Los trastornos no motores de la enfermedad de Parkinson (EP) comprenden todos aquellos trastornos que no son sintomas motores: trastornos neuropsiquiatricos y de la conducta (demencia, depresion, ansiedad, psicosis), autonomicos (hipotension postural, trastornos gastrointestinales, genitourinarios, diaforesis), trastornos del sueno (insomnio, somnolencia, trastorno de conducta en fase REM, apnea), sensitivomotores (fatiga, diplopia, sindrome de piernas inquietas) y sensoriales. Desarrollo. Se revisa lo mas relevante acerca de los sintomas no motores sensoriales en la EP: alteraciones visuales, disfuncion olfatoria, alteraciones del gusto, hipoacusia y otros trastornos auditivos, y dolor y sintomas sensitivos asociados. Conclusiones. El dolor es un sintoma muy prevalente e infradiagnosticado en la EP, siendo muy importante su identificacion y tipificacion para un correcto tratamiento. La hiposmia es un sintoma muy frecuente que podria utilizarse como marcador precoz de la EP. Diversas alteraciones visuales y auditivas deben tenerse en cuenta igualmente en los pacientes con EP.

Introduccion. El sindrome de piernas inquietas (SPI) es un trastorno del movimiento de origen neurologico, que se manifiesta por clinica sensitivomotora localizada principalmente en las extremidades inferiores. Desarrollo. Se revisan las caracteristicas epidemiologicas, fisiopatologicas clinicas y terapeuticas de esta enfermedad, y se hace un especial enfasis en los criterios diagnosticos. Conclusiones. El diagnostico del SPI es eminentemente clinico y se basa en los criterios de la conferencia de consenso de los National Institutes of Health de 2002. Existen criterios especificos para grupos especiales (ancianos con deterioro cognitivo y ninos) en los cuales no es posible determinar si existe SPI mediante los criterios diagnosticos habituales.

In addition to the motor disturbances experienced by the patients suffering from Parkinson's disease (PD), several non-motor symptoms also affect the PD patients: neurobehavior symptoms (dementia, depression, anxiety, psychosis), autonomic (postural hypotension, urinary symptoms, gastro intestinal symptoms, diaphoresis), sleep disorders (insomnia, somnolence, REM sleep behavior disorder, apnea), sensitive-motor (fatigue, diplopia, restless legs syndrome), and sensory symptoms.We review the most relevant about sensory symptoms in PD: visual dysfunction, olfactory dysfunction, taste, hearing loss, and pain and other sensitive associate symptoms.Pain is frequently observed in patients with PD, being its prevalence high and probably infra diagnosed. Its identification and classification is very important for a correct treatment. Hyposmia is a common symptom in PD and could be a predictor of future PD. Visual dysfunction and hearing dysfunction among others must be considered in patients with PD.