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Parkinson’s disease (PD) is a multifactorial disorder involving various biological pathways. However, it is more accurate not to define PD as a unique entity, but rather as a mixture of several diseases with similar phenotypes. Attempts to classify subtypes of PD based on the clinical phenotype or biomarkers were tried. Nonetheless, for a subset of individuals, the classification based on the implied gene appears to be the most practical. Although the SNCA gene was the first identified in rare patients, pathogenic variants in GBA1 and LRRK2 are the most common genetic causes or risk factors of PD, and PRKN is the most frequent gene of autosomal recessive PD. Patients with pathogenic variants in SNCA, GBA1, LRRK2 or PRKN show various clinical, anatomopathological and biochemical aspects. Therefore, these four genes associated to PD are of particular interest for the development of targeted therapies. This fact is reinforced by the reality that current approaches are only symptomatic, and no curative treatment is available today. A number of clinical trials aiming to slow or stop disease progression are running, based on the gene involved. In this review, we will discuss the therapeutic approaches targeting SNCA, GBA1, LRRK2 and PRKN.

The purpose of this narrative review is to provide a deeper understanding of the benefits of traditional Chinese exercises, Baduanjin (BDJ), and provide strong evidence for the benefits of BDJ in the prevention and rehabilitation of disease. By alleviating symptoms and improving mental health, BDJ could be used to promote rehabilitation of Parkinson's disease, knee osteoarthritis, cancer, and COVID-19 sequelae. Further studies have demonstrated that BDJ not only promoted rehabilitation when used alone, but it was also more effective when combined with traditional Chinese medicine and other exercise techniques. There are more aging people and various diseases. This makes it necessary to develop effective measures that promote disease recovery. The function of the BDJ is to regulate the nervous system, the body, and the breathing, and as a form of enhanced physical exercise it is beneficial for the rehabilitation process. We hope more people can learn about traditional Chinese sports and benefit from long-term practice. Evidence suggests that BDJ can promote disease rehabilitation. In the present study, most clinical data is based on Chinese data, so there is a need for additional clinical data to support this conclusion. [ABSTRACT FROM AUTHOR]

Introduction: Parkinson's disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care. Materials and Methods: A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders. Results: In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified. Discussion: This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study's strength lies in evaluating an unselected primary care population, whereas limitations include small sample size. Conclusion: This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients. [ABSTRACT FROM AUTHOR]

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Il existe une grande variété de dysfonctions sexuelles (DS) chez les patients atteints de pathologies neurologiques. L'objectif de notre étude était de rapporter une mise au point sur les DS chez ces patients. Une revue de la littérature a été réalisée sur la base de données PubMed en novembre 2023 en utilisant les mots clés « sexuality », « male infertility » et « erectile dysfunction » associés aux mots clés « neurological », « spinal dysraphism », « spinal cord injury » « multiple sclerosis » et « Parkinson's disease ». Les DS sont classées en dysfonctions primaires (liées à l'atteinte du système nerveux altérant la réponse sexuelle), secondaires (liées à l'atteinte physique) ou tertiaires (liées aux troubles psychosociaux). La prise en charge doit être pluridisciplinaire et concerner l'ensemble de ces types de dysfonction. Pour les troubles du désir, des traitements hormonaux substitutifs ainsi que des psychothérapies pourront être proposés (hors AMM chez la femme). En cas de dysfonction érectile, le même panel de thérapeutique que chez l'homme non neurologique est possible. En cas de trouble de l'excitation chez la femme, des IPDE5, des lubrifiants pouvant être associés à des vibreurs ont montré leur efficacité. En cas de troubles de l'éjaculation, un traitement par midodrine et une prise en charge en centre de PMA peuvent être proposés. Les DS du patient neurologique sont à évaluer de façon pluridisciplinaire afin d'améliorer la qualité de vie des patients et de leur proposer une prise en charge adaptée à la pathologie neurologique. There are a wide variety of sexual dysfunctions (SD) in patients with neurological diseases. The aim of our study was to report an update on SD in these patients. A literature review was conducted on the PubMed database in November 2023 using keywords "sexuality", "male infertility" and "erectile dysfunction" associated with the keywords "neurological", "spinal dysraphism", "spinal cord injury", "multiple sclerosis", and "Parkinson's disease". SD are classified as primary dysfunctions (related to the involvement of the nervous system altering the sexual response), secondary (related to physical impairment) or tertiary (related to psycho-social disorders). Management must be multidisciplinary and concern all these types of dysfunction. For desire disorders, hormonal substitution treatments and psychotherapies may be offered. In case of erectile dysfunction, the same panel of therapeutics as in non-neurological patients is possible. In case of excitation disorder in women, IPDE5 and lubricants that can be associated with vibrators have shown their effectiveness. In case of ejaculation disorders, treatment with midodrine and treatment in a PMA center can be offered. The SD of the neurological patient are to be evaluated in a multidisciplinary way in order to improve the quality of life of the patients and to propose them a management adapted to the neurological pathology. [ABSTRACT FROM AUTHOR]

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Parkinson's disease (PD) is associated with inflammation and lipid profile abnormalities. Considering the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on inflammation and lipid metabolism, the present study aimed to investigate the effects of ω-3 PUFAs supplementation on the pro- and anti-inflammatory cytokines and lipid profile in PD. In this study, 44 patients with PD were selected and divided into two groups. The intervention group received two capsules of ω-3 PUFAs daily, each capsule containing 120 mg eicosapentaenoic acid and 180 mg docosahexaenoic acid, and the placebo group received two soft capsules of soybean oil daily for eight weeks. Weight, height, lipid profile (TG, HDL-c, LDL-c, total cholesterol [TC]), and pro- and anti-inflammatory cytokines (IL-6, TNF-α, and IL-10) were assessed at the beginning and at the end of the study. Body mass index (P = 0.02), weight (P = 0.04), HDL-c (P = 0.01), LDL-c (P = 0.03), and IL-6 (P = 0.02) levels increased, while TG (P = 0.01), TNF-α (P = 0.01), and IL-10 (P = 0.01) decreased significantly in the ω-3 PUFAs group. Between-group comparisons revealed the changes not to be significant after adjustments for baseline values and confounders. Moreover, the changes in TC were not significant in either within- or between-group comparisons. Based on the results of the study, 600 mg ω-3 PUFAs supplementation for eight weeks has no significant effect on the assessed pro- and anti-inflammatory cytokines and lipid profiles in patients with PD. Further studies with higher doses are needed to better clarify the role of ω-3 PUFAs in the biochemical and clinical outcomes of PD patients. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD), whose cause is unknown, is a chronic and degenerative condition that affects the central nervous system, body movements, and posture. Focusing on the subject of long-term illness, we aimed to analyze the relationship between the experience of the disease and the identity processes of people diagnosed with PD. Understanding that experiences are constituted in an interrelation with social reality, we also seek to scrutinize the social representations around the illness process and the influence of the PD diagnosis on the development and identity of the affected subject. Thus, we conducted semi-structured interviews with 10 participants from the Parkinson's Association of Pernambuco, whose data were analyzed using content analysis. The reports led us to understand that PD does not represent a socially known object and that most respondents did not know what the disease was about until they received the diagnosis, which emerged as a non-normative event in development, mobilizing aspects of their identities. The participants emphasize the need to adapt to the new dynamics of life imposed with the progression of the disease, whose effects are felt beyond the organic body, but also in changes in social relationships and in the way of perceiving the possibilities and limitations linked to the course of life. The experiences built by the participants in their individual and collective processes through the identity dynamics were also relevant in the speeches that evoked coping strategies, construction of knowledge, and anchoring attempts after the diagnosis. [ABSTRACT FROM AUTHOR]

• La prévalence de la goutte dans une population urbaine méditerranéenne de plus de 40 ans s'élevait à 2,5 %. • La goutte a été associée à un moindre risque de développer la maladie de Parkinson chez les sujets de plus de 75 ans. • La goutte a été associée à une réduction du risque de MP dans les deux sexes. Des taux sanguins élevés d'acide urique, considéré comme un puissant antioxydant, ont été associés à un effet neuroprotecteur dans la maladie de Parkinson (MP). Cependant, la relation entre la goutte et la MP reste contradictoire. L'objectif est d'étudier si l'effet neuroprotecteur de l'acide urique est maintenu chez les patients goutteux au sein d'une large population urbaine méditerranéenne. Étude cas-témoins s'appuyant sur la base de données des dossiers médicaux électroniques des soins primaires du système de santé publique de Barcelone. Cette base de données contient les données anonymes de 1 520 934 patients. Tous les sujets âgés de plus de 40 ans, avec un nouveau diagnostic de MP ou une nouvelle prescription de médicaments dopaminergiques, ont été inclus (cas incidents). Chaque cas a été apparié sur l'âge et le sexe à quatre témoins sélectionnés de manière aléatoire, selon la méthode d'appariement en pourcentages. Les données rétrospectives des facteurs de risque de MP ont également été collectées pour chaque individu. Un modèle de régression logistique multivariée a été utilisé pour évaluer l'association entre la goutte et la MP, ajustée pour la présence d'autres facteurs de risques. Un nouveau diagnostic de MP a été posé chez 17 629 individus (taux de diagnostic incidents de 2,2 pour 1000 individus). Le modèle de régression logistique multivariée a montré pour la goutte : un ORa = 0,83 (0,76–0,91). Après stratification des individus par âge, l'ORa était de 0,99 (0,85–1,16) pour les sujets de moins de 75 ans et de 0,77 (0,70–0,86) pour ceux de 75 ans ou plus. La dyslipidémie, l'hypertension et le diabète ont été associés à un risque accru de MP. Le tabagisme a montré un rôle préventif dans l'apparition de la maladie. Notre étude, la première réalisée au sein d'une population méditerranéenne, a révélé un effet protecteur de la goutte contre le risque de MP chez les hommes et les femmes de plus de 75 ans. [ABSTRACT FROM AUTHOR]

Despite its high prevalence among neurodegenerative diseases, Lewy body disease (LBD), or Lewy body dementia (LBD), because of its clinical proximity to Alzheimer's and Parkinson's diseases, is often undiagnosed or misdiagnosed. Better identification of this condition, in order to provide better care for sufferers and their carers, is a health objective on which progress is desirable., (Copyright © 2024. Publié par Elsevier Masson SAS.)

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The gut is a complex system that plays a fundamental role in the absorption and distribution of nutrients needed by the various organs of the body, such as, glucose for the brain. Finely regulated by the nervous system, the digestive system also houses a player that plays a crucial role: the intestinal flora -- the old term for the "microbiota" -- which weighs as much as the brain itself. As the gastrointestinal tract is also exposed to risks of being invaded by pathogens, a fourth player plays a key role: the immune system. The latter keeps a close watch on the gastrointestinal tract and plays an important role in the interactions between the gut and the brain, for better or for worse... Whether it is the gut or the brain, these two organs are relatively isolated from the rest of the body by barriers whose proper functioning is vital, protecting the body and its central control by the brain from potentially fatal infectious mechanisms. Yet... There are pathways connecting them, which contribute to the dialogue between -- but also to the vulnerability of -- these different protagonists in different ways. The human physiological landscape is thus a complex amalgam of human cells, but also of bacterial cells that work closely together to control human health. Not only is the microbiota capable of digesting certain nutrients that cannot be degraded by the gastrointestinal tract itself, but a growing number of scientific studies suggest a link between gastrointestinal and brain function--and thus an association with certain neurological and psychiatric diseases. For example, it is suspected that the gut-brain axis is involved in a number of psychiatric or neuroimmune diseases in children and adults. In addition, it has been suggested that bowel disorders are a "risk factor" for the development of neurological disorders. Last but not least, stress regulates the composition and activity of the intestinal microbiota, a property that could even affect psychiatric health across generations. The concept of the "gut-brain axis" proposes that there is a constant dialogue between the gut and the brain. The microbiota can today be proposed as a major player of an ecosystem in which the nature of exchanges could condition the neurological and psychiatric balance of the human being. [ABSTRACT FROM AUTHOR]

Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease. The pathophysiology of Parkinson's disease is complex and imperfectly known. Primum movens is abnormal intra-neuronal accumulation of the protein α-synuclein, leading to metabolic disturbances and neurodegeneration. This abnormal accumulation of α-synuclein is also found in dementia with Lewy bodies and multiple system atrophy, which together with Parkinson's disease form the group of α-synucleinopathies. Well known by its motor signs (bradykinesia, rest tremor, cogwheel rigidity and gait disturbance), Parkinson's disease is above all a systemic disease composed of a myriad of non-motor symptoms (constipation, sense of smell disorders, rapid eye movement sleep behaviour disorders, genitourinary disorders...). These non-motor symptoms caused by accumulation and migration of α-synuclein deposits from the gut and the olfactory bulb to the central nervous system may precede motor signs by ten years and therefore be of interest for early diagnosis. Furthermore, non-motor symptoms have a poorer impact on quality of life than motor signs themselves. Therefore, understanding, recognition and management of non-motor symptoms are crucial in management of parkinsonian patient. In this paper, we offer an update on the main non-motor symptoms of Parkinson's disease, from their pathophysiology to their screening, ending with their management. [ABSTRACT FROM AUTHOR]

Benjamin Ball ne doit sa notoriété posthume qu'au fait d'avoir été choisi en 1877 pour être le premier titulaire d'une nouvelle chaire, créée en 1875 à la Faculté de Médecine de Paris, la Chaire des Maladies mentales et de l'Encéphale. Sa formation, hors des asiles mais auprès de maîtres en médecine mentale, Jacques Moreau de Tours et Charles Lasègue, lui a permis d'exercer pleinement sa fonction d'enseignant, apprécié par ses nombreux élèves pour sa compétence et sa verve. Sa rencontre fortuite, en 1858, au cours de son internat, avec le tout jeune Jean-Martin Charcot, l'a conduit à rédiger une thèse novatrice consacrée à la thrombose veineuse des membres et à l'embolie pulmonaire qui aurait dû contribuer davantage à son renom. Nous présentons ici quelques-unes de ses publications les plus notables, parmi la centaine dont il est l'auteur. Benjamin Ball's posthumous fame is due solely to his being chosen in 1877 to become the first holder of a new chair created in 1875 at the Faculté de Médecine in Paris, the Chair of Mental and Brain Diseases. His training, outside of asylums but with two prominent professors of mental illness, Jacques Moreau de Tours and Charles Lasègue, enabled him to have a full career as a teacher, appreciated by his numerous students for his expertise and verve. His chance meeting in 1858, during his time as a resident, with the then young Jean-Martin Charcot led him to write an innovative thesis, on venous thrombosis in the limbs and pulmonary embolism, which should have contributed more to his fame. We present here a few of his most notable publications, among the 100 or so that he authored. [ABSTRACT FROM AUTHOR]

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Résumé: La principale proposition thérapeutique face à une insomnie chronique associée à la maladie de Parkinson (MP) est la prescription de benzodiazépines ou apparentés. Comme en population générale, ces molécules sont peu efficaces dans la MP. Elles y sont également associées à des effets indésirables comme la dépendance, la somnolence et les chutes. Le principal objectif de cette revue consiste à sensibiliser les professionnels qui évoluent auprès de patients atteints de MP à une alternative thérapeutique non-médicamenteuse dans le traitement de l'insomnie chronique associée à la MP. Il s'agit de la thérapie cognitive et comportementale. Notons que cette thérapie est définie par la Haute autorité de santé et les instances internationales comme le traitement de première intention pour la prise en charge de l'insomnie chronique associée ou non à une comorbidité. Très récemment, nous avons mis en évidence que l'insomnie chronique associée à la MP était entretenue par les mêmes facteurs psychologiques (émotionnels, comportementaux et cognitifs) identifiés en l'absence de comorbidité neurologique. Nous avons également montré que la thérapie cognitive et comportementale de l'insomnie était un traitement acceptable pour les patients atteints de la MP et efficace sur les symptômes nocturnes et diurnes de l'insomnie associée à cette affection. Insomnia disorder is four times more frequent in Parkinson's disease (PD) than in the general population. In PD, insomnia is associated with a very significant decrease in quality of life and deleterious consequences on both patients and caregivers' health. The main therapeutic option in response to insomnia comorbid to PD is the prescription of benzodiazepines or related drugs. As in the general population, these sedative-hypnotic molecules have very low efficacy in PD and are associated with adverse effects. They are highly addictive and are also associated with drowsiness, risk of falling and decreased life expectancy. These side effects may in themselves be symptoms associated with PD in the absence of insomnia. In this clinical context, we can easily conceive that sedative-hypnotics are likely to potentiate these clinical symptoms in PD. We have recently documented that insomnia disorder comorbid to PD is associated with the classical psychological factors perpetuating insomnia in neurological disease-free individuals with insomnia. These results have allowed us to emphasize that target-oriented interventions for instance cognitive-behavioral therapy for chronic insomnia (CBT-i) should be considered as a treatment approach for insomnia disorder comorbid to PD. As a reminder, for decades, CBT-i is considered the most effective first-line treatment for the management of chronic insomnia associated or not with comorbidity. In this context, we demonstrated the acceptability of CBT-i in the treatment of insomnia comorbid to PD and its effectiveness for the management of night and daytime symptoms of insomnia associated with this neurological condition. The objective of this synthesis is to raise awareness among health professionals of the relevance of psychological therapies (mostly CBT) for insomnia in PD. Unlike drug treatments, these therapies are safety for patients who are already weakened by the PD itself. [ABSTRACT FROM AUTHOR]

Résumé: Plus de trois-quarts des patients atteints de la maladie de Parkinson (MP) se plaignent d'insomnie et la rémission spontanée de cette plainte est généralement rare. Le diagnostic formel d'insomnie chronique est porté chez plus de la moitié des patients. L'insomnie est ainsi définie comme le trouble du sommeil le plus répandu dans la MP. À l'heure actuelle, les échelles recommandées pour l'évaluation du sommeil dans la MP n'apprécient pas spécifiquement l'insomnie. Devant cette limite, nous avons très récemment montré l'utilité clinique dans la MP du Sleep condition indicator pour le dépistage de l'insomnie selon les critères du DSM-5. Tout comme en population générale, le sexe féminin, les symptômes de dépression et d'anxiété, la fatigue, la somnolence diurne et la consommation d'hypnotiques-sédatifs ont été associés à la sévérité de la plainte d'insomnie dans la MP. L'insomnie réduit également la qualité de vie des patients ainsi que celle de leurs aidants. En revanche, de manière assez intéressante, la contribution des caractéristiques cliniques de la MP à l'insomnie reste très discutée. Ces caractéristiques sont : la durée de la maladie, la sévérité des troubles moteurs, les traitements dopaminergiques et les signes de dysautonomie. Cette observation implique de ne pas considérer systématiquement l'insomnie comme une manifestation symptomatique secondaire à la MP, mais comme une entité clinique à part entière nécessitant un traitement spécifique. L'objectif de cette synthèse est de sensibiliser les professionnels de santé quant à l'importance du dépistage précoce de l'insomnie dans la MP afin de limiter les conséquences associées et sa chronicité. Insomnia is a common complaint in Parkinson's disease (PD) affecting more than three-quarters of patients. Longitudinal studies show that insomnia complaint is a persistent condition in PD, especially in patients with more severe insomnia at baseline. When international and standardized criteria are used, it is estimated that more than half of the patients meet the criteria for insomnia disorder. These data define insomnia as the most prevalent sleep disorder in PD. Given that background, it is surprising that none of the scales recommended by the International Parkinson and movement disorder society to assess sleep disturbances in PD is specifically dedicated to the assessment of insomnia disorder. In this insufficient methodological context, we have recently established the discriminant validity of the Sleep condition indicator for insomnia disorder in PD, as diagnosed with a clinical interview according to the DSM-5 criteria. As in the general population, female sex, symptoms of depression, anxiety, fatigue and daytime sleepiness have been associated with insomnia complaint severity in PD. Insomnia also reduces the quality of life of patients affected by PD and that of their caregivers. In contrast, clinical features of the disease were very slightly related to insomnia with small effect sizes. These features include motor fluctuations, autonomic problems, cardiovascular and thermoregulatory dysfunctions and doses of dopaminergic medications. This observation implies not systematically considering insomnia as a symptomatic manifestation secondary to PD but as a clinical entity requiring specific treatment. The objective of this synthesis is to raise awareness among health professionals of the importance of early detection of insomnia in PD in order to limit the consequences associated with its chronicity. Identifying and assessing insomnia in PD is therefore a major health issue. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le traitement médical de la maladie de Parkinson a pour principaux objectifs de corriger les symptômes, en particulier moteurs, d'atténuer leurs conséquences sur la vie personnelle et sociale du patient, mais aussi d'augmenter son espérance de vie. De nombreux antiparkinsonniens sont disponibles sur le marché. The medical treatment of Parkinson's disease aims to reduce the symptoms, in particular motor symptoms, lessen the impact they have on the patient's personal and social life and increase life expectancy. There are many antiparkinsonians available on the market. [ABSTRACT FROM AUTHOR]

Si l'alimentation est peu impliquée dans le déclenchement de la maladie de Parkinson, elle semble avoir un rôle important dans son évolution. Le modèle méditerranéen convient particulièrement aux patients parkinsoniens. En revanche, une attention particulière doit être portée aux apports protéiques, notamment aux stades avancés. Certains compléments peuvent être proposés, à l'instar des acides gras oméga 3, de la vitamine D et de quelques probiotiques. Although diet is not a major contributor to the onset of Parkinson's disease, it seems to play an important role in its progression. The Mediterranean model is particularly suitable for Parkinson's patients. On the other hand, particular attention must be paid to protein intake, especially in the advanced stages. Certain supplements can be proposed, such as omega 3 fatty acids, vitamin D and some probiotics. [ABSTRACT FROM AUTHOR]

La prise en charge du patient parkinsonien est pluridisciplinaire. Le traitement, indiqué dès l'apparition d'une gêne fonctionnelle, repose sur sept classes médicamenteuses et une stratégie chirurgicale. Un accompagnement et une gestion de la pharmacie clinique de qualité conditionnent la maîtrise des symptômes de la maladie et des effets iatrogènes. Le pharmacien est un acteur important pour la conduite et le suivi de la thérapeutique. The management of the Parkinsonian patient is multidisciplinary. The treatment, indicated as soon as functional discomfort appears, is based on seven classes of drugs and a surgical approach. The control of the symptoms of the disease and iatrogenic effects is determined by quality support and clinical pharmacy management. The pharmacist is an important player in the management and monitoring of therapy. [ABSTRACT FROM AUTHOR]

Deuxième affection neurodégénérative du sujet âgé la plus fréquente en France, la maladie de Parkinson est caractérisée par une évolution lente et progressive. Le tremblement est le motif de consultation le plus courant et l'akinésie le signe cardinal. Si certains troubles sont partiellement corrigés par le traitement médical, ce dernier en fait apparaître d'autres. L'attitude thérapeutique doit être adaptée aux différentes phases de l'évolution de la maladie. Parkinson's disease is the second most common neurodegenerative disease of the elderly in France, characterized by a slow and progressive evolution. Tremor is the most common reason for consultation and akinesia the key sign. If certain conditions are partially corrected by medical treatment, the latter causes others to appear. The therapeutic attitude must be adapted to the different phases of the disease evolution. [ABSTRACT FROM AUTHOR]

INTRODUCTION : actuellement nous n'avons pas de données précises sur les syndromes parkinsoniens à Madagascar. Nous voulions rassembler des données sur ces maladies. Alors l'objectif de notre étude était de décrire la fréquence et le profil clinique des syndromes parkinsoniens dans notre Service de NeurologieMéthodes: il s'agit d'une étude rétrospective descriptive allant de janvier 2014 à juin 2018 dans le Service de Neurologie, Befelatanana. Les données démographiques et cliniques des patients diagnostiqués comme ayant un syndrome parkinsonien étaient collectées. Nous en avons évalué les fréquences et les caractéristiques puis comparé les patients avec la maladie Parkinson idiopathique et les autres syndromes parkinsoniens. Les données étaient traitées par le logiciel R.Résultats: nous avons retenus 104 patients sur 3528, vus dans notre service. Parmi les patients avec un syndrome parkinsonien, 67 (64,42%) avaient une maladie de Parkinson idiopathique (MP) et 37 (35,47%) un syndrome parkinsonien autre. L'intervalle moyen entre le début de la maladie et la consultation ou l'hospitalisation dans le service était de 2,5 ans. Pour les MP, l'âge moyen de début était à 58,5 [23; 80] ans, l'âge du diagnostic à 62 [28; 83] ans et la sex-ratio était de 1,97. La médiane de score de Hoehn et Yahr était de 2.0. Les formes de MP étaient tremblantes dans 24 (35,42%), mixte 28 (41,71%) et akineto-rigide 15 (22,38%) des cas. Pour les autres syndromes parkinsoniens, 27(72,97%) étaient des hommes, l'âge moyen de début était à 57,5 [26; 83] ans, l'âge du diagnostic à 59,3 [26; 83] ans, l'atrophie multi-systématisée avec 17/37 (46,64%). Les patients atteints d'autres syndromes parkinsoniens avaient plus de troubles cognitifs (p=0,0306) et les MP étaient plus sensible au DOPAMINE (p=0,006).Conclusion: les patients parkinsoniens idiopathiques avaient des caractéristiques différentes de ceux avec autres parkinsonismes. Il y a avait eu un retard diagnostique comme dans les autres pays en voie de développement.

Disturbances of movement are common and varied. Frequent causes are systemic diseases such as Parkinson's syndromes and the essential tremor. Treatment options in practice and hospital include conservative, predominantly drug strategies such as oral administration of dopamine precursors or agonists, and pharmacological or non-pharmacological escalation strategies such as intramuscular botulinum toxin A injections, the subcutaneous or enteral drug pumps for apomorphine or levodopa and carbidopa, the effective deep brain stimulation and the novel focused ultrasound therapy, which are bound to highly specialized centers and should be considered as treatment option quite earlier and more frequently. [ABSTRACT FROM AUTHOR]

La réadaptation est d'une importance capitale dans le cadre de la maladie de Parkinson puisqu'elle permet de compenser les déficiences des structures et des fonctions du corps et de préserver le plus longtemps possible une autonomie relative. Or, les personnes atteintes de cette maladie font état d'une faible adhérence à l'activité physique. Le but de cette recherche est d'examiner les bénéfices psychologiques potentiels de l'usage d'un « exergame », jeu vidéo « sérieux » basé sur l'exercice physique dans le cadre de la réadaptation fonctionnelle de la maladie de Parkinson, notamment sur le stress et le sentiment d'auto-efficacité. Un protocole à cas unique de type ABAB (n = 1) sur 4 semaines, 1 semaine par phase, trois points d'observations par phase, a été développé. Nos variables ont été mesurées par des questionnaires et nous nous sommes basés sur une analyse visuelle et statistique pour interpréter les changements aux scores entre les phases A et les phases B. L'intervention « exergame » semble améliorer les symptômes de stress et le sentiment d'auto-efficacité. Les résultats sont accompagnés d'un entretien exploratoire, faisant état de changements qualitatifs. L'usage « d'exergame » dans le cadre de la maladie de Parkinson semble prometteur, et ne porte pas préjudice à la personne. Mais la méthodologie utilisée n'est pas suffisante pour conclure sur sa réelle efficacité. Des études plus poussées sont nécessaires. Rehabilitation is of paramount importance in Parkinson's disease because it compensates for deficiencies in the body's structures and functions and preserves relative autonomy for as long as possible. Nevertheless, people with this disease report low adherence to physical activity. The purpose of this research is to examine the potential psychological benefits of using an "exergame", a "serious game" based on physical exercise in the functional rehabilitation of Parkinson's disease, including stress and self-efficacy. A single case ABAB protocol (n = 1) over 4 weeks, 1 week per phase, 3 observation points per phase, was developed. Our variables were measured by questionnaires and we used visual and statistical analysis to interpret changes in scores between Phases A and B. The "exergame" intervention appears to improve perceived stress and self-efficacy. The results are accompanied by an exploratory interview, reporting qualitative changes. The use of "exergame" in Parkinson's disease seems promising, and does not harm the person. But the methodology used is not sufficient to conclude on its real effectiveness. Further studies are needed. [ABSTRACT FROM AUTHOR]

The Parkinson's disease (PD) has a world prevalence around 100 to 150 cases per 100,000 inhabitants. Besides the motor symptoms, PD is also accompanied by cognitive decline that may indicate Mild Cognitive Impairment (MCI) and consequently, predict dementia. Although there are specific manuals to classify MCI due PD, they do not establish its expected neuropsychological profile. To identify the neuropsychological patterns of patients with PD through the analysis of empirical studies in order to answer the question about the neuropsychological profile of MCI/PD patients. The inclusion criteria were: (1) samples of human, (2) samples > 18 years old, (3) group with MCI/PD, (4) empirical studies and (6) languages in portuguese, spanish or english. The exclusion criteria were as follows: (1) Diagnosis of MCI by manuals other than DSM 5 or Movement Disorder Society Task Force Guidelines, (2) neuropsychological assessment without quantitative testing, 3) evaluating less than three distinct cognitive domains, 4) not having MCI/PD comparison group, 5) patients with surgical interventions such as Deep Brain Stimulation or neurological and / or psychiatrics comorbidities and (6) letters, editorials, systematic and bibliographic reviews. The quality assessment was conducted according to PEDro scale. The research was conducted in the MedLine and PsycINFO databases with publication period ranging from 2012 to 2019. Among the 39 potentially eligible articles, four were included in the final analysis. All studies were cross-sectional observational among which two were control cases and the other two were cohorts studies. The most compromised domains were executive functions, verbal memory and visuoperception/visuospatiality. Despite the heterogeneity of the data, it was possible to identify a tendency of neuropsychological profile that frequently affects the executive functions and less frequent learning and verbal memory and visuoperception / visuoespaciality. [ABSTRACT FROM AUTHOR]

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Parkinson's disease (PD) is a degenerative neurological disorder that impacts all aspects of life, including leisure. Although there are numerous investigations of the constraints to leisure participation experienced by adults living with acquired disabilities and illnesses, to date there are limited studies on the experiences of living with PD. This qualitative study, involving in-person or telephone interviews with five persons recently diagnosed with PD, sought to explore: (a) relationships among PD, leisure participation, and physical, mental, and social health; and (b) the ways that leisure is a component of coping with and self-managing PD. Three overarching themes were constructed using thematic analysis: (a) leisure participation prior to diagnosis; (b) the impact of emerging PD symptoms on leisure participation; and (c) the role of leisure in living well with PD. Results are discussed in relation to the role of various forms of leisure in reducing social isolation and self-managing PD. La maladie de Parkinson (MP) est une maladie neurologique dégénérative qui touche tous les aspects de la vie, y compris les loisirs. Bien que de nombreuses études aient été menées sur les obstacles à la pratique de loisirs des adultes vivant avec une invalidité et une maladie acquises, il existe à ce jour peu d'études sur les expériences vécues avec la MP. Cette étude qualitative, qui s'est faite par l'entremise d'entrevues en personne ou par téléphone avec cinq personnes chez lesquelles on avait récemment diagnostiqué une MP, visait à explorer (a) les relations entre la MP, la pratique de loisirs et la santé physique, mentale et sociale; et (b) la manière dont le loisir est un élément de gestion et de l'autogestion de la MP. L'analyse thématique a permis de définir trois thèmes principaux : (a) la participation à des loisirs avant le diagnostic; (b) l'impact des symptômes émergents de la MP sur la participation à des loisirs; et (c) le rôle des loisirs dans le bien-vivre avec la MP. Les résultats sont discutés en relation avec le rôle des diverses formes de loisirs dans la réduction de l'isolement social et l'autogestion de la MP. [ABSTRACT FROM AUTHOR]

Occupational therapy works with Parkinson's sufferers and their caregivers to help them maintain or resume their activities of daily living and their independence, by recommending environmental adaptations, technical aids, compensation strategies and functional training., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Psychologists specializing in neuropsychology, more commonly known as neuropsychologists, play an important role in the care of cognitive, behavioral and emotional aspects of patients with Parkinson's disease. They are also involved in research and public education on the disease., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The rapid increase in the number of Parkinson's patients in the population is raising questions about the organization of expert resources. The creation of advanced practice nurses is likely to have an impact on this public health issue, as is the implementation of multi-level care gradation and the prospects for paramedical development., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The creation of Parkinson's expert centers (PEC) led to the emergence of new nurses, known as coordination nurses. And in 2018, the emergence of advanced practice nursing led to the creation of a new category of professionals, advanced practice nurses (APN). Nurses coordinators and APN play a major role in meeting the public health challenges posed by Parkinson's disease. They are the guarantors of the implementation of a personalized care pathway, the aim of which is to offer patients an optimized quality of life. They forge an indispensable link between the city's healthcare services and the PEC, collaborating with the many healthcare professionals who work with people suffering from Parkinson's disease., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The number of people suffering from Parkinson's disease is constantly increasing. Diagnosis is based on the motor and non-motor symptoms present throughout the course of the disease. To preserve patient autonomy, the main therapeutic challenge is to propose a treatment adapted to each profile, in conjunction with the implementation of non-medication strategies, reflection on improved accessibility to existing medication and research into innovative therapies., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

La stimulation cérébrale profonde constitue l'une des options thérapeutiques disponibles en cas de fluctuations motrices chez les patients atteints d'une maladie de Parkinson idiopathique. Ce traitement n'est envisagé qu'en cas de symptômes invalidants malgré un traitement optimal chez des sujets âgés de moins de 70 ans. Les principales cibles sont le noyau sous-thalamique, le noyau intermédiaire du thalamus et le pallidum interne. Deep brain stimulation is one of the treatment options available for motor fluctuations in patients with idiopathic Parkinson's disease. This treatment is only considered in cases of disabling symptoms despite optimal treatment in subjects under 70 years of age. The main targets are the subthalamic nucleus, the intermediate nucleus of the thalamus and the internal pallidum. [ABSTRACT FROM AUTHOR]