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OBJECTIVE: To investigate the feasibility of radiomics analysis of brain MR images to differentiate Parkinson's disease motor subtypes. METHODS: 42 postural instability gait difficulty (PIGD) patients, 92 tremor-dominant (TD) patients and 96 healthy controls were included from the Parkinson's Progressive Marker Initiative public database. For each subject, 4850 radiomic features from 148 cortical and 14 subcortical brain regions were extracted. The variance threshold and the least absolute shrinkage and selection operator were used to select the optimal features. Classification models based on Support Vector Machine, Logistic Regrcession, and Multi-Layer Perceptron were constructed to assess the performance of optimal features in the discrimination of the two subtypes. Correlations between radiomic features and clinical scores of the two subtypes were estimated. RESULTS: The Support Vector Machine demonstrated the best performance in discriminating between the two subtypes, and the mean area under the curve was 0.833 (specificity = 83.3%, sensitivity = 75.0%, and accuracy = 80.7%). For the postural instability gait difficulty patients, these optimal features in the hippocampal showed closed correlations with the Montreal Cognitive Assessment scores (P < 0.05). CONCLUSION: The results of our study provide preliminary evidence that radiomics analysis of brain MR images could allow discrimination between patients with TD, PIGD and control subjects and has great potential value in the clinical practice.
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Trastornos Neurológicos de la Marcha/diagnóstico , Sustancia Gris/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador , Enfermedad de Parkinson/complicaciones , Sustancia Blanca/diagnóstico por imagen , Anciano , Estudios de Casos y Controles , Diagnóstico Diferencial , Estudios de Factibilidad , Femenino , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Sustancia Gris/fisiopatología , Voluntarios Sanos , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/fisiopatología , Equilibrio Postural/fisiología , Sustancia Blanca/fisiopatologíaRESUMEN
OBJECTIVE: Uric acid has been found to be potentially neuroprotective in Parkinson's disease (PD). We investigated the relationship between serum uric acid levels and both motor and non-motor features in a prospective early PD cohort study. METHODS: Fasting serum uric acid levels were measured from 125 early PD patients. Demographic, clinical characteristics, motor and non-motor assessments were performed. Patients were categorized into three motor subtypes: tremor-dominant (TD), postural instability/gait difficulty (PIGD), and mixed. Non-motor symptoms were classified as present or absent based on the appropriate cut-offs for each non-motor instrument. RESULTS: Most patients had TD (nâ¯=â¯51, 40.8%) and mixed (nâ¯=â¯63, 50.4%) motor subtypes, while a minority had PIGD (nâ¯=â¯11, 8.8%) motor subtype. The mean serum uric acid levels were significantly different between the three motor subtypes (pâ¯=â¯0.0106), with the mixed subtype having the lowest serum uric acid levels. Using the TD subtype as reference, patients with higher serum uric acid levels were less likely to have the mixed (ORâ¯=â¯0.684; pâ¯=â¯0.0312) subtype as opposed to the TD subtype. Uric acid levels were not significantly different between the TD and PIGD subtypes. For non-motor symptoms, higher serum uric acid levels were significantly associated with less fatigue (ORâ¯=â¯0.693; pâ¯=â¯0.0408). CONCLUSION: Higher serum uric acid levels were associated with TD motor subtype and less fatigue in early PD, which could be related to its anti-oxidative properties. Uric acid could be an important biomarker for specific motor features and symptoms of fatigue in PD.
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Enfermedad de Parkinson/sangre , Enfermedad de Parkinson/fisiopatología , Equilibrio Postural/fisiología , Trastornos de la Sensación/etiología , Temblor/etiología , Ácido Úrico/sangre , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: Tremor dominant (TD), postural instability/gait difficulty (PIGD), and akinetic-rigid (AR) subtypes are widely used in classifying patients with Parkinson's disease (PD). METHODS: We compared clinical characteristics between PD subtypes in a large retrospective cohort. Between 1998 and 2016, we included a total of 1003 patients with PD in this retrospective study. Six hundred ninety-four patients had more than one visit. Data were collected regarding motor/non-motor symptoms at the initial/final visits. Based on the prominent symptom at the initial visit, we classified patients into one of the four subtypes: TD, AR, gait difficulty, and mixed. Rapid progression was defined by emergence of falls, dementia, or dependency within 5years after onset. RESULTS: TD was the most prevalent subtype (44%), followed by AR (29%), mixed (18%), and gait difficulty (9%). Rapid progression was observed more frequently in gait difficulty compared to AR (OR: 3.59 P<0.001). Hallucinations at the final visit were more likely to occur in AR (OR: 2.36, P=0.005) and mixed (OR: 3.28, P<0.001) compared to TD. CONCLUSIONS: Our findings provide support for a distinction of four different PD subtypes: TD, AR, gait difficulty, and mixed. The gait difficulty subtype was distinguishable from the AR subtype.
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Trastornos Neurológicos de la Marcha/fisiopatología , Enfermedad de Parkinson/clasificación , Enfermedad de Parkinson/fisiopatología , Trastornos de la Sensación/fisiopatología , Temblor/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Trastornos Neurológicos de la Marcha/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/epidemiología , Equilibrio Postural/fisiología , Prevalencia , Estudios Retrospectivos , Trastornos de la Sensación/diagnóstico , Estadísticas no Paramétricas , Temblor/diagnóstico , Adulto JovenRESUMEN
OBJECTIVE: Parkinson's disease (PD) is a progressive neurodegenerative disease. As the severity of disease worsens, patients have lower tolerance for treatments and occasionally need to be hospitalized. This study focuses on characteristics of patients with PD who were emergently admitted to our hospital and evaluates their prognosis during hospitalization. METHODS: Hospital-based study on emergency admission was conducted in a consecutive series of patients with PD between April 2009 and March 2015. RESULTS: A total of 164 admissions involving 136 patients with PD with available medical records were identified. Among these, 40 admissions involving 38 patients were emergency admissions. The most common cause of hospitalization was aspiration pneumonia (n = 17) followed by parkinsonism hyperpyrexia syndrome (n = 6), cerebrovascular disease (n = 2), dehydration (n = 2), and others (n = 13). The mean Hoehn and Yahr stage at admission and discharge were 3.5 and 4.2, respectively, with significant differences between time points (p < 0.001). All patients except one presented with either postural instability gait difficulty phenotype (PIGD) or mixed phenotype with PIGD and tremor. All 17 patients with aspiration pneumonia had various combinations of three components: abnormalities seen on videofluoroscopy swallowing study, cognitive impairment, and history of psychiatric symptoms. CONCLUSION: Aspiration pneumonia was the most common reason for emergency admission in patients afflicted with PD for more than five years. Abnormalities seen in videofluoroscopy, PIGD and mixed phenotypes, cognitive impairment, and history of psychiatric symptoms could potentially be predictors for aspiration pneumonia in patients with PD.
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AIMS: Postural instability/gait difficulty (PIGD) and tremor-dominant (TD) subtypes of Parkinson's disease (PD) show different clinical manifestations; however, their underlying neural substrates remain incompletely understood. This study aimed at investigating the subtype-specific patterns of spontaneous brain activity in PD. METHODS: Thirty-one patients with PD (12 TD/19 PIGD) and 22 healthy gender- and age-matched controls were recruited. Resting-state functional magnetic resonance imaging data were collected, and amplitude of low-frequency fluctuations (ALFF) was measured. Voxelwise one-way analysis of covariance and post hoc analyses of ALFF were performed among the three groups, with age and gender as covariates (levodopa daily dosage and gray matter volume as additional covariates for validation analysis). Correlations of clinical variables (e.g., disease duration and PIGD/tremor subscale score) with ALFF values were examined. RESULTS: Compared with controls, patients with TD exhibited higher ALFF in the right cerebellar posterior lobe and patients with PIGD exhibited lower ALFF in the bilateral putamen and cerebellar posterior lobe, and higher values primarily in several cortical areas including the inferior and superior temporal gyrus, superior frontal, and parietal gyrus. Compared with patients with PIGD, patients with TD had higher ALFF in the bilateral putamen and the cerebellar posterior lobe, as well as lower ALFF in the bilateral temporal gyrus and the left superior parietal lobule. In all patients, ALFF in the bilateral cerebellar posterior lobe positively correlated with tremor score and ALFF in the bilateral putamen negatively correlated with PIGD score. CONCLUSION: Different patterns of spontaneous neural activity in the cerebellum and putamen may underlie the neural substrate of PD motor subtypes.