Thousands of individuals with Parkinson's disease (PD) in low-income countries have limited access to marketed levodopa preparations. Mucuna pruriens (MP), a levodopa-containing leguminous plant ...growing in tropical areas, may be a sustainable alternative therapy for indigent patients. Single-dose intake of MP proved noninferior to marketed levodopa preparations.
Fourteen PD patients with motor fluctuations and dyskinesias received MP powder (obtained from roasted seeds) and marketed levodopa/carbidopa (LD/CD) in a randomized order and crossover design over a 16-week period. Efficacy measures were changes in quality of life, motor and non-motor symptoms, and time with good mobility without troublesome dyskinesias. Safety measures included tolerability, frequency of adverse events, changes in laboratory indices and electrocardiogram.
Daily intake of MP was associated with a variable clinical response, especially in terms of tolerability. Seven patients (50%) discontinued MP prematurely due to either gastrointestinal side-effects (n = 4) or progressive worsening of motor performance (n = 3), while nobody discontinued during the LD/CD phase. In those who tolerated MP, clinical response to MP was similar to LD/CD on all efficacy outcome measures. Patients who dropped out entered a study extension using MP supernatant water (medianIQR, 16 7–20 weeks), which was well tolerated.
The overall benefit provided by MP on the clinical outcome was limited by tolerability issues, as one could expect by the relatively rapid switch from LD/CD to levodopa alone in advanced PD. Larger parallel-group studies are needed to identify appropriate MP formulation (e.g. supernatant water), titration scheme and maintenance dose to minimize side-effects in the long-term.
NCT02680977.
•MP is comparable to LD/CD in the symptomatic control of advanced PD.•MP powder is limited by nausea and/or drug tolerance: consider MP supernatant water.•Longer titration and follow-up are needed to improve tolerability in the long-term.•Future studies (parallel-group, not crossover) in larger PD population are needed.
Summary Background & aims Parkinson's disease (PD) patients can benefit considerably from appropriate nutritional care, particularly from diet. However, there is limited evidence on the eating habits ...of PD patients and their relationship with the features of the disease. Methods We conducted a large case–control study. Consecutive PD patients ( N = 600) receiving systematic nutritional care and healthy controls ( N = 600) matched (1:1) for age, gender, education, physical activity level and residence were studied using a 66-item food frequency questionnaire. The relationship between dietary habits and the following features of PD were investigated in patients: body weight, energy balance, constipation, and levodopa therapy (dose) and its related motor complications. Results PD patients had lower BMI and reported higher food intake than controls. BMI was found to be inversely associated with disease duration and severity, and levodopa-related motor complications, whereas energy intake was positively associated with these variables. An increase in protein intake by 10 g over physiological requirements (0.8 g/kg/day) corresponded to a mean increase in levodopa dose of 0.7 mg/kg/day. Constipation was also associated with higher levodopa requirements. Finally, protein intake and its distribution throughout the day influenced levodopa-related motor complications. Conclusion The management of protein intake and the treatment of constipation should be considered to be an integral part of the care of PD patients. Attention should always be focused on energy intake also. This would result in the maintenance of nutritional status, the optimization of levodopa-therapy and the minimization of its related motor complications.
Abstract Background Swallowing disturbances are an important issue in Parkinson's disease (PD) as several studies have shown that they are associated with increased risk of aspiration pneumonia and ...mortality. Information about factors related to swallowing disturbances, such as disease duration, age at assessment and concomitant dementia, is limited and would be useful for their management. Methods All consecutive PD out-patients evaluated at a movement disorders clinic over a 7-year period (2007–2014), were included in the present retrospective study. Presence of symptomatic swallowing disturbances was assessed using the specific item of the Non Motor Symptom Questionnaire. Results In the whole PD population ( N = 6462), prevalence of symptomatic swallowing disturbances was 11.7% (95%CI, 10.9–12.5). Multivariable logistic regression analysis (adjusted for education) disclosed a significant interaction between disease duration and gender ( P = 0.009). In both gender strata, swallowing disturbances were significantly associated with longer disease duration and dementia ( P < 0.001 for all). A significant effect for age at assessment was also found in male patients. In non-demented patients, swallowing disturbances were associated with male gender, age and disease duration ( P < 0.02 for all). In demented patients an association was found only with male gender ( P = 0.018) and disease duration ( P < 0.001). Conclusions Gender, age, disease duration and dementia all seem to contribute to the occurrence of swallowing disturbances independently. However, the role played by these factors in sub-groups of patients stratified by gender and concomitant dementia suggests that swallowing disturbances are likely related to different neuro-degenerative patterns within the brain. The underlying mechanisms deserve further investigation.
To estimate prevalence of sarcopenia and dynapenia in outpatients with Parkinson disease (PD) and to investigate their association with the features of the disease.
Cross-sectional study.
A ...specialized tertiary care center.
Consecutive patients (n = 364) aged 65 years or older, affected by parkinsonian syndromes.
Skeletal muscle mass (SMM), as well as strength and gait speed (GS) were assessed by bioimpedence analysis, handgrip dynamometry, and the 4-meter walking test, respectively. Based on these assessments, sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People criteria. Dynapenia was defined as handgrip strength less than 30 kg in men and less than 20 kg in women.
In total, 235 patients (64.6%) had a diagnosis of idiopathic PD. Low SMM index was recorded in 27 patients. Due to gait disturbances and postural instability, GS could not be measured in 98 patients and was found to be reduced in 61.3% of those assessed. Prevalence of sarcopenia and dynapenia was 6.6% (95% confidence interval CI 4.3-9.7) and 75.5% (95% CI 70.8-79.9), respectively. Sarcopenia tended to be higher in patients unable to perform GS assessment and was unrelated to the type of parkinsonian syndrome. It was associated with older age, longer disease duration, more severe disease, and higher disability in activities of daily living, as assessed by disease-specific clinical rating scale. Dynapenia was directly associated with parkinsonism other than PD, older age, and disability, whereas regular physical therapy appeared to be a preventive factor. However, it was unrelated to disease duration and severity. Finally, the disability score of activities of daily living was inversely correlated with handgrip strength and GS, whereas no association was found with SMM index.
Being primarily motor disorders, parkinsonian syndromes are characterized by progressive disability in performing activities of daily living. Impaired functional status is a prominent feature of this patient population, independently of disease duration and severity. Sarcopenia is mainly related to advancing disease and, due to a significant sparing of SMM, is an infrequent condition, likely to play a minor role in disability. Several factors could be responsible for this favorable body composition (eg, motor symptoms, levodopa therapy) and deserve further investigation. The prognostic impact of sarcopenia also needs to be addressed.
Summary Background & aims To investigate if the reduced cardiometabolic risk in Parkinson's disease (PD) is independent of nutritional status, body composition and fat distribution. Methods We ...designed a case–control study comparing 80 non underweight PD patients with 80 controls matched for sex, age and body mass index (BMI). Nutritional assessment included: anthropometry (BMI and waist circumference WC), body composition estimated by impedance and biochemistry (fasting glucose, serum lipids and transaminases). The presence of arterial hypertension, diabetes mellitus and metabolic syndrome (MetS) were noted. Results Compared to controls and independently of gender, PD patients showed lower percentage of body fat ( P < 0.001) and biochemical parameters (glucose, P < 0.001; total cholesterol, P < 0.001; LDL, P < 0.001; triglycerides, P = 0.002; alanine aminotransferase, P < 0.001 and aspartate aminotransferase, P = 0.015) but similar WC ( P = 0.324). The prevalence of hypertension and MetS was similar in the two groups, as well as the frequency and the number of MetS criteria. The relationship between PD and low cardiometabolic profile was independent of age, gender, current smoking and BMI. After adjusting for WC and body fat, most of the associations remained significant. Conclusions PD patients seem to have a more favorable cardiometabolic risk profile, independently of nutritional status, body composition and fat distribution.
Abstract Objective Previous studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship ...between cardiometabolic risk factors and the duration of disease. Methods One hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases. Results In sex- and age-adjusted correlation models, duration of PD was inversely related to BMI ( r = −0.20; P < 0.05) and BF% ( r = −0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration ( P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD ( P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed. Conclusions HDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.
OBJECTIVES:Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation.
METHODS:We conducted a tertiary setting, randomized, ...double-blind, placebo-controlled trial in patients with PD with Rome III–confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4.
RESULTS:For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval CI 0.8–1.6) than placebo (0.1, 95% CI −0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4–1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics–prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1–5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8–8.1) during weeks 3 and 4.
CONCLUSIONS:The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD.
CLINICALTRIALS.GOV IDENTIFIER:NCT02459717.
CLASSIFICATION OF EVIDENCE:This study provides Class I evidence that for patients with PD who have constipation, fermented milk containing probiotics and prebiotics increases the frequency of CBMs.
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