Asunto(s)

RESUMEN

Research on the implications of anxiety in Parkinson's disease (PD) has been neglected despite its prevalence in nearly 50% of patients and its negative impact on quality of life. Previous reports have noted that neuropsychiatric symptoms impair cognitive performance in PD patients; however, to date, no study has directly compared PD patients with and without anxiety to examine the impact of anxiety on cognitive impairments in PD. This study compared cognitive performance across 50 PD participants with and without anxiety (17 PDA+; 33 PDA-), who underwent neurological and neuropsychological assessment. Group performance was compared across the following cognitive domains: simple attention/visuomotor processing speed, executive function (e.g., set-shifting), working memory, language, and memory/new verbal learning. Results showed that PDA+ performed significantly worse on the Digit Span forward and backward test and Part B of the Trail Making Task (TMT-B) compared to the PDA- group. There were no group differences in verbal fluency, logical memory, or TMT-A performance. In conclusion, anxiety in PD has a measurable impact on working memory and attentional set-shifting.

RESUMEN

Previous research has shown that anxiety in Parkinson's disease (PD) is associated with freezing of gait (FOG), and may even contribute to the underlying mechanism. However, limited research has investigated whether PD patients with FOG (PD+FOG) have higher anxiety levels when compared directly to non-freezing PD patients (PD-NF) and moreover, how anxiety might contribute to FOG. The current study evaluated whether: (i) PD+FOG have greater anxiety compared to PD-NF, and (ii) anxiety in PD is related to attentional set-shifting, in order to better understand how anxiety might be contributing to FOG. In addition, we explored whether anxiety levels differed between those PD patients with mild FOG (PD+MildFOG) compared to PD-NF. Four hundred and sixty-one patients with PD (231 PD-NF, 180 PD+FOG, 50 PD+MildFOG) were assessed using the Freezing of Gait Questionnaire item 3 (FOG-Q3), Hospital Anxiety and Depression Scale (HADS), Digit Span Test, Logical Memory Retention Test and Trail Making Tests. Compared to PD-NF, PD+FOG had significantly greater anxiety (p<0.001). PD+MildFOG, however, demonstrated similar levels of anxiety as the PD+FOG. In all patients, the severity of anxiety symptoms was significantly correlated to their degree of self-reported FOG on FOG-Q3 (p<0.001) and TMT B-A (p=0.039). Similar results were found for depression. In conclusion, these results confirm the key role played by anxiety in FOG and also suggest that anxiety might be a promising biomarker for FOG. Future research should consider whether treating anxiety with pharmacological and/or cognitive behavioural therapies at early stages of gait impairment in PD may alleviate troublesome FOG.

Asunto(s)

RESUMEN

Parkinson's disease patients who suffer from freezing of gait (PD-FOG) may have sensory and/or perceptual deficits, although they are difficult to disentangle. This study evaluated whether visuospatial perception or self-motion perception were more impaired in PD-FOG, and whether distance estimation errors might be related to misperception of physical walking (compared to imagined). Finally, cognitive status was evaluated in order to evaluate whether cognitive status predicts any of the perception deficits identified. Nine PD-FOG and 15 PD-nonFOG were tested. In experiment 1, participants were shown a target, then the target was removed, before participants demonstrated the original position of the target in two different feedback conditions (pointing with a laser, or walking to its original position). In experiment 2, participants walked to a target (3, 4.5, 6m) and then imagined walking to that same target. The time to complete both of these tasks was measured and compared. Experiment 1 found a significantly greater judgment error in PD-FOG across both conditions (p=0.013) (compared to PD-nonFOG). Constant error revealed that both groups significantly underestimated during the self-motion condition only (p=0.01). Interestingly, results from experiment 2 demonstrated a significant discrepancy between the time it took to imagine walking compared to their actual movement times, specifically in PD-FOG (p=0.03). This mismatch as well as cognitive status significantly predicted judgment errors during the self-motion condition from experiment 1. Therefore, this study found evidence that PD-FOG have significantly greater sensory-perception deficits compared to PD-nonFOG. These findings have important clinical implications for further understanding FOG and developing new rehabilitative strategies for FOG symptoms.

Asunto(s)

RESUMEN

Adult male mice were stereotaxically implanted with permanent indwelling guide cannulae for bilateral injections into the nucleus accumbens (ACB). The effects on spontaneous locomotor activity of selective agonists for adenosine receptor subtypes were examined following bilateral injections into the ACB. Intra-ACB injections of CGS 21680, a potent and selective agonist at striatal adenosine A2a receptors, elicited pronounced, dose-related reductions in locomotor activity whereas similar bilateral dosages of CPA, a selective agonist at adenosine A1 receptors, did not significantly affect locomotor activity. The pronounced locomotor depression elicited by intra-ACB injections of CGS 21680 were completely blocked by I.P. pretreatment with DMPX, an adenosine receptor antagonist exhibiting selectivity for striatal A2 receptors, at a dosage which alone had no significant effect on locomotor activity. Adenosine A2a receptors in the nucleus accumbens may selectively modulate dopamine-mediated mesolimbic behavioral circuits involved in spontaneous locomotion.

Asunto(s)

RESUMEN

Sexually transmitted diseases comprise one of the most common medical complications of pregnancy. Prompt treatment is essential to minimize the risk of fetal and neonatal adverse consequences. At this time, however, no pharmacologic therapy is routinely employed for the viral STDs during pregnancy, including HIV, HSV, and hepatitis B virus. Appropriate antibiotic treatment, considered in the context of fetal drug effects, provides high cure rates for many of the other sexually transmitted agents. The approach of the emergency physician to STDs centers on recognition and treatment; however, all physicians encountering this patient population have a responsibility to facilitate access to primary prophylaxis for STD. This means ensuring that issues related to education regarding transmission of STDs, safer sex, and sexual contact counseling are addressed initially or via a primary care referral. In the appropriate setting, complications of pregnancy due to STDs should also be addressed.

Asunto(s)

RESUMEN

The effects on locomotor activity (LA) of selective agonists for adenosine receptor subtypes were examined in mice following bilateral injections into the nucleus accumbens (ACB). The ACB is not only richly innervated by dopaminergic (DA) terminals but also exhibits the highest densities of adenosine A2a receptors in the brain. CGS 21680 (2-[p-(2-carboxyethyl)phenethylamino]-5'-N-ethylcarboxamidoadenosi ne), a potent and highly selective adenosine A2a receptor agonist, elicited pronounced, dose-related reductions in LA (ID50 dosage = 0.0031 nmol/mouse). NECA (5'-N-ethylcarboxamidoadenosine), a mixed adenosine receptor agonist which exhibits high selectivity and potency at striatal A2a receptors, similarly elicited dose-related reductions in LA (ID50 dosage = 0.0023 nmol/mouse). In contrast, intra-ACB injections of CPA (N6-cyclopentyladenosine), a highly selective agonist for adenosine A1 receptors, did not exert any significant effects on LA, even at 2.0 nmol/mouse, a dosage at which both CGS 21680 and NECA depressed LA by almost 90% compared to vehicle controls. Further, the pronounced locomotor depression elicited by intra-ACB injections of both CGS 21680 and NECA, at approximately the ID65 dosage, was significantly antagonized by IP pretreatment with DMPX, (3,7-dimethyl-1-propargylxanthine), an adenosine receptor antagonist with selectivity for A2 receptors in the striatum, at a dosage (0.15 micromol/mouse) [corrected] which alone had no significant effect on LA. These observations provide support for the notion that adenosine may selectively modulate DA-mediated mesolimbic behavioral circuits via agonist actions at a population of A2a receptors densely concentrated in the ventral striatum.

Asunto(s)