Fatigue is one of the most common and disabling nonmotor symptom in Parkinson's disease (PD). The aim of the present study was to investigate the 1-year course of fatigue in a consecutive sample of ...de novo drug-naïve patients with PD, and at systematically searching for baseline motor and nonmotor predictors associated with fatigue severity over time.
Fifty-five consecutive de novo PD patients (age: 64.71 ± 7.74 years) underwent a comprehensive examination, including Parkinson Fatigue Scale, Epworth Sleepiness Scale, Parkinson's Disease Sleep Scale, Beck Depression Inventory, Parkinson's Anxiety Scale, Apathy Evaluation Scale, and an extensive neuropsychological evaluation. Bivariate and multiple regression analyses were performed to identify baseline predictors independently related to fatigue severity at 1-year follow-up.
Prevalence rate of fatigue (defined by PFS cut-off) increased from 22% at baseline to 38% at 1-year follow-up. A similar increase in prevalence was observed for excessive daytime sleepiness, and apathy. Among patients with fatigue at baseline, 91% had fatigue at follow-up too (i.e., persistent fatigue). Multivariate regression analysis identified fatigue (p < 0.01), daytime sleepiness (p < 0.01), and emotional apathy (p < 0.01) as the main baseline variables significantly predicting fatigue severity at 1-year follow-up.
In early PD, fatigue increases and persists over time, and its severity is related to higher baseline levels of fatigue, excessive daytime sleepiness, and emotional apathy. These results warrant to monitor fatigue since the early stage of disease, and suggest that treating excessive daytime sleepiness and emotional apathy might prevent its worsening.
•Presence of fatigue in Parkinson's disease (PD) increases over time.•Fatigue persists in more than half of the patients with PD.•Baseline fatigue, sleepiness, and emotional apathy predict fatigue severity.
Positive changes (posttraumatic growth PTG) and negative changes (posttraumatic depreciation PTD) were assessed using the PTGI-42 with persons reporting changes from a stressful event. PTG and PTD ...were uncorrelated, and PTG was much greater than PTD. PTG was positively related to disruption of core beliefs and recent deliberate rumination and negatively related to recent intrusive rumination. PTD was positively related to intrusive rumination. Quality of life and meaning in one's life were positively related to PTG, negatively related to PTD, and an interaction indicated that PTG moderated the impact of PTD on both, indicating that PTG and PTD may separately contribute to current well-being.
Objective
The aims of the present study were to examine psychometric properties of the Spielberger State‐Trait Anxiety Inventory (STAI‐Y‐1 and STAI‐Y‐2, respectively) in a Multiple Sclerosis (MS) ...population and to identify a cut‐off score to detect those MS patients with high level of state and/or trait anxiety who could be more vulnerable to development of depression and/or cognitive defects.
Material and methods
The STAI‐Y‐1 and STAI‐Y‐2 was completed by a group of patients (n = 175) affected by MS and a group of healthy subjects (n = 150) matched for age, educational level, and gender. In MS patients internal consistency, divergent and discriminant validities were evaluated. Construct validity was examined by exploratory factor analysis for each scale.
Results
There was no missing data, no floor or ceiling effects for both scales. The two scales showed high internal consistency, good divergent, and Known‐groups validities. To identify high levels of state and trait anxiety in a patient with MS, we proposed three gender specific screening cut‐off values (1, 1.5, 2 SD) for the STAI‐Y‐1 and the STAI‐Y‐2.
Conclusions
The findings showed that the STAI‐Y‐1 and the STAI‐Y‐2 are a valid tool for clinical use in MS patients and can be useful to measure the severity of anxiety and to identify those patients with high anxiety to introduce them in specific non‐pharmacological intervention.
Background and purpose
In multiple sclerosis (MS), depression is a common disorder whose pathophysiology is still debated. To gain insights into the pathophysiology of depression in MS, resting‐state ...(RS) functional connectivity (FC) changes of the default mode network (DMN), salience network (SN) and executive control network (ECN) were assessed in a group of depressed MS (D‐MS) patients and in appropriately matched control groups.
Methods
Sixteen D‐MS patients, 17 non‐depressed MS (ND‐MS) patients, 17 non‐depressed healthy controls and 15 depressed subjects (D‐S), age, sex and education matched, cognitively preserved and non‐fatigued, were enrolled. All participants underwent a neuropsychological evaluation and RS functional magnetic resonance imaging study.
Results
Comparing D‐MS patients with D‐S, within the DMN, a significant RS‐FC suppression was found in the posterior cingulate cortex (PCC); comparing D‐MS with ND‐MS, FC was significantly increased in the anterior cingulate cortex and significantly reduced in the PCC. Within the SN increased FC in the right supramarginal gyrus and right middle frontal gyrus was found in D‐MS patients compared to D‐S and to ND‐MS; within the ECN increased FC in the right inferior parietal cortex was found in D‐MS patients compared to ND‐MS patients.
Conclusions
In cognitively preserved D‐MS patients, FC derangement occurs in the SN, ECN and DMN. In the latter, changes occurring both in the anterior cingulate cortex and PCC suggest that depression in MS may be linked to MS itself and, in particular, to a peculiar pattern of network abnormalities favored by MS pathology through disconnection mechanisms. Reduced FC in the PCC, similar to MS patients with cognitive impairment, suggests a functional link between depression and cognitive impairment in MS.
Background
Teriflunomide (TRF) and Dimethyl fumarate (DMF) are licensed drugs for relapsing-remitting Multiple Sclerosis (RRMS).
Objectives
We aimed to compare the rate and the time to ...discontinuation among persons with RRMS (pwRRMS), newly treated with TRF and DMF.
Materials and methods
A retrospective study on prospectively collected data was performed in nine tertiary MS centers, in Italy. The 24-month discontinuation rate in the two cohorts was the primary study outcome. We also assessed the time to discontinuation and reasons of therapy withdrawn. Discontinuation of TRF and DMF was defined as a gap of treatment ≥ 60 days.
Results
A cohort of 903 pwRRMS (316 on TRF and 587 on DMF) was analyzed. During 24 months of follow-up, pwRRMS on TRF and DMF showed similar discontinuation rates. The analysis of predictors with Cox regression model showed differences between the two groups (
p
for log-rank test = 0.007); male gender HR 2.21 (1.00–4.90);
p
= 0.01 and the number of previous switches HR 1.47 (1.16–1.86);
p
= 0.01 were associated with higher hazard of discontinuation in the DMF group.
Conclusions
In a real-world setting, pwRRMS on TRF and DMF had similar discontinuation rates over 24 months. Male pwRRMS on DMF with a previous history of therapeutic failure are at more risk of discontinuation therapy.
AIM: To analyze impacts of habitat loss on evolutionary diversity and to test widely used biodiversity metrics as surrogates for phylogenetic diversity, we study spatial and taxonomic patterns of ...phylogenetic diversity in a wide‐ranging endemic Neotropical snake lineage. LOCATION: South America and the Antilles. METHODS: We updated distribution maps for 41 taxa, using species distribution models and a revised presence‐records database. We estimated evolutionary distinctiveness (ED) for each taxon using recent molecular and morphological phylogenies and weighted these values with two measures of extinction risk: percentages of habitat loss and IUCN threat status. We mapped phylogenetic diversity and richness levels and compared phylogenetic distances in pitviper subsets selected via endemism, richness, threat, habitat loss, biome type and the presence in biodiversity hotspots to values obtained in randomized assemblages. RESULTS: Evolutionary distinctiveness differed according to the phylogeny used, and conservation assessment ranks varied according to the chosen proxy of extinction risk. Two of the three main areas of high phylogenetic diversity were coincident with areas of high species richness. A third area was identified only by one phylogeny and was not a richness hotspot. Faunal assemblages identified by level of endemism, habitat loss, biome type or the presence in biodiversity hotspots captured phylogenetic diversity levels no better than random assemblages. Pitvipers found in the richest areas or included in the IUCN Red List showed significant phylogenetic clustering. MAIN CONCLUSIONS: Usual biodiversity metrics were unable to adequately represent spatial patterns of evolutionary diversity in pitvipers. Current Red List status fails to properly represent evolutionary distinctiveness in the group. Phylogenetic diversity is unevenly distributed even within biodiversity hotspots, and species‐poor areas may harbour high phylogenetic diversity. This reinforces the need for targeted and spatially accurate approaches for adequately representing evolutionary processes in conservation planning.
El Niño–Southern Oscillation (ENSO) phenomena occur in the equatorial Pacific and differentially affect the global climate. Recently, studies have begun to analyse the influence of ENSO intensity on ...the global climate, but how this intensity affects South American precipitation remains unclear. This work defined the ENSO intensities each season (versus annually, as is more commonly done) because understanding this seasonal intensity is essential for seasonal forecasting. The atmospheric patterns identified in this study showed that the stronger the sea surface temperature (SST) anomalies (SSTA) in the equatorial eastern Pacific were, the stronger the atmospheric responses. The known South American precipitation pattern occurred at all ENSO intensity categories but had different intensities. However, the most important patterns in this study differed from the main pattern. Central‐eastern South America did not have a notable precipitation pattern during all El Niño (EN) years, but there was a negative pattern of strong ENs. In addition, the intensity of the precipitation anomaly during weak EN and La Niña (LN), mainly in northeastern South America, was stronger in austral autumn than in austral summer because the intensity in a previous season can influence the current season's precipitation pattern and the total SST in autumn is stronger than that in summer. Asymmetries between EN and LN events are important to consider; EN tends to be more intense than LN, and deep convection anomalies during EN are displaced eastward relative to those during LN. In this study, categories were defined based on ENSO intensities, but asymmetries appeared in atmospheric patterns, mainly in omega patterns during strong events. The intensities of SSTAs over the equatorial eastern Pacific affected the intensities of the Walker circulation and Rossby waves and, consequently, the intensity of precipitation patterns in different South American regions.
The influence of ENSO on South American precipitation has been extensively studied, and it is known that during El Niño, there is an increase (decrease) in precipitation in southeastern (northern/northeastern) South America. The opposite occurs during La Niña. This study analyses how different intensities of ENSO affect South American precipitation. The figure below shows that the intensities of South American precipitation anomalies depend on the intensity of ENSO episodes.
Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children ...(PTGI‐C‐R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI‐C‐R demonstrated good reliability. Analyses focused on trauma‐related variables in predicting PTG. Child‐reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow‐up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI‐C‐R may assist efforts to understand children's responses posttrauma.
ABSTRACT
The teleconnections of different types of El Niño Southern Oscillation (ENSO) to the Indian summer monsoon are investigated in observations and models. We find that, not all regions in India ...are strongly affected by ENSO, so we focus on two regional teleconnections: (1) a negative rainfall signal around central north east (CNE) India and ‘hilly’ region during El Niño (and vice versa for La Niña) and (2) similar signal for parts of southern peninsular region. Using correlations, it is found that >50% of the fifth phase of the Coupled Model Inter‐comparison Project models capture these two regional teleconnections, with first captured by >80% of models. Furthermore, using a compositing technique that may better capture asymmetries in response to warm and cold events, the authors find that most models again agree on the sign of regional teleconnection around the CNE and hilly region, suggesting the robustness of ENSO signal in that region. The peninsular teleconnection is less well simulated in models. We find a clear connection between the Walker circulation and Indian summer monsoon rainfall around central India in models.
From the authors who pioneered the concept of posttraumatic growth comes Posttraumatic Growth in Clinical Practice, a book that brings the study of growth after trauma into the twenty-first century. ...Clinicians will find a framework that's easy to use and flexible enough to be tailored to the needs of particular clients and specific therapeutic approaches. And, because it utilizes a model of relating described as "expert companionship," clinicians learn how to become most empathically effective in helping a variety of trauma survivors. Clinicians will come away from this book having learned how to assess posttraumatic growth, how to address it in treatment, and they'll also have a basic grasp of the ways the changes they're promoting will be received in various cultural contexts. Case examples show how utilizing a process developed from an empirically-based model of posttraumatic growth can promote important personal changes in the aftermath of traumatic events.
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