exudates and Parkinson-Disease

Intensive voice therapy is one of the best evidence-based treatments to improve speech and voice difficulties to individuals with Parkinson's disease (PD). However, accessibility to intensive voice therapy is highly challenging in Malaysia due to the lack of voice specialised speech-language therapists. This study examined the feasibility of using smartphone videoconference to deliver intensive voice therapy to individuals with PD in Malaysia.. Intensive voice therapy was delivered to 11 adults with PD using a smartphone videoconference method via WhatsApp Messenger freeware. The therapy consisted of 12 sessions over four weeks and focused on increasing vocal loudness. Outcomes were assessed using objective, perceptual and quality-of-life measures pre and post treatment. Participant satisfaction with the telerehabilitation method was obtained via the Smartphone-Based Therapy Satisfaction Questionnaire.. Significant gains were reported for sound pressure level in sustained vowels and monologue. Perceptual ratings showed significant improvements in overall mean severity and loudness after treatment. Mean scores of speech intelligibility and Voice Handicap Index-10 were significantly better post treatment. Overall, participants were highly satisfied with the smartphone videoconference method.. Present results suggest that the smartphone videoconference method is feasible to deliver intensive voice therapy to individuals with PD to gain better speech and voice functions. Future studies need to address the standardisation of the system protocol to optimise this novel service delivery method in Malaysia.

Topics: Adult; Humans; Malaysia; Parkinson Disease; Smartphone; Speech Therapy; Videoconferencing; Voice Disorders

Genome-wide association studies (GWAS) have shown that variants in the 3-methylcrotonyl-CoA carboxylase (MCCC1)/lysosome-associated membrane protein 3 (LAMP3) loci (rs10513789, rs12637471, rs12493050) reduce the risk of Parkinson's disease (PD) in Caucasians, Chinese and Ashkenazi-Jews while the rs11248060 variant in the diacylglycerol kinase theta (DGKQ) gene increases the risk of PD in Caucasian and Han Chinese cohorts. However, their roles in Malays are unknown. Therefore, this study aims to investigate the association of these variants with the risk of PD in individuals of Malay ancestry.. A total of 1114 subjects comprising of 536 PD patients and 578 healthy controls of Malay ancestry were recruited and genotyped using Taqman® allelic discrimination assays.. The G allele of rs10513789 (OR = 0.83, p = 0.001) and A allele of rs12637471 (OR = 0.79, p = 0.007) in the MCCC1/LAMP3 locus were associated with a protective effect against developing PD in the Malay population. A recessive model of penetrance showed a protective effect of the GG genotype for rs10513789 and the AA genotype for rs12637471. No association with PD was found with the other MCCC1/LAMP3 rs12493050 variant or with the DGKQ (rs11248060) variant. No significant associations were found between the four variants with the age at PD diagnosis.. MCCC1/LAMP3 variants rs10513789 and rs12637471 protect against PD in the Malay population.

Topics: Asian People; Carbon-Carbon Ligases; Case-Control Studies; Genetic Predisposition to Disease; Genome-Wide Association Study; Genotype; Humans; Lysosomal Membrane Proteins; Malaysia; Neoplasm Proteins; Parkinson Disease; Polymorphism, Single Nucleotide

Topics: Age of Onset; Exons; Humans; Malaysia; Mutation; Parkinson Disease

Pathogenic and risk variants in the LRRK2 gene are among the main genetic contributors to Parkinson's disease (PD) worldwide, and LRRK2-targeted therapies for patients with PARK-LRRK2are now entering clinical trials. However, in contrast to the LRRK2 G2019S mutation commonly found in Caucasians, North-African Arabs, and Ashkenazi Jews, relatively little is known about other causative LRRK2 mutations, and data on genotype-phenotype correlations are largely lacking. This report is from an ongoing multicentre study in which next-generation sequencing-based PD gene panel testing has so far been conducted on 499 PD patients of various ethnicities from Malaysia. We describe 2 sisters of Chinese ancestry with PD who carry the R1441C mutation in LRRK2 (which in Asians has been reported in only 2 Chinese patients previously), and highlight interesting clinical observations made over a decade of close follow-up. We further explored the feasibility of using a brief, expert-administered rating scale (the Clinical Impression of Severity Index; CISI-PD) to capture data on global disease severity in a large (n = 820) unselected cohort of PD patients, including severely disabled individuals typically excluded from research studies. All patients in this study were managed and evaluated by the same PD neurologist, and these data were used to make broad comparisons between the monogenic PD cases versus the overall "real world" PD cohort. This report contributes to the scarce literature on R1441C PARK-LRRK2, offering insights into natural history and epidemiological aspects, and provides support for the application of a simple and reliable clinical tool that can improve the inclusion of under-represented patient groups in PD research.

Topics: Adult; Aged; Asian People; Female; Genetic Predisposition to Disease; Humans; Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; Malaysia; Middle Aged; Mutation; Parkinson Disease; Phenotype

An improved understanding of the genetic determinants of Parkinson's disease (PD) in underrepresented populations, and better characterization of genotype-phenotype correlations in monogenic PD, are needed. Scarce literature exists regarding the genetic aetiology of PD in Malays, who comprise 200 million individuals in South-East Asia. Phenotypic data regarding PARK-PINK1 are also limited.. A multi-ethnic cohort of PD patients from Malaysia (n = 499, including 185 Malays) were tested using a next-generation sequencing-based PD gene panel. The prevalence and clinico-radiological features of patients with the PINK1 p. Leu347Pro mutation are described. This mutation has previously only been reported in people of Filipino or Chamorro (native Guamanian) ancestry.. Homozygous p. Leu347Pro mutations were found in five unrelated Malay patients, yielding a prevalence of 6.9% among Malays with PD onset ≤50 years (2.7% of the Malay group overall). This variant was not detected in the homozygous state in 300 Malay controls, but two were heterozygous carriers (0.67%) indicating a relatively high population frequency in keeping with the high frequency of PARK-PINK1 among Malay patients. Interesting clinical features were observed, e.g., differences in the age at PD onset and clinical progression, despite having the same point mutations. Previously unreported brain MRI abnormalities involving the corticospinal tract and hypothalamus, and "loss of the swallow tail" sign, were documented.. This report contributes to the very limited literature on PD genetics in the Malay population, and more broadly to the epidemiological, phenotypic and neuroimaging characterization of PARK-PINK1. It also further supports the pathogenicity of the p. Leu347Pro variant.

Topics: Adult; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Prevalence; Protein Kinases

The LRRK2 gene is associated with Parkinson's disease (PD) as a number of mutations within the gene have been shown to be susceptibility factors. Studies on various global populations have determined that mutations such as G2019S, G2385R, and R1628P in LRRK2 increase the risk of developing PD while the N551K-R1398H haplotype is associated with conferring protection against developing PD. Here we report a study looking at the N551K and R1398H variants for the first time in the Malaysian population.. Cases (523) which conformed to the United Kingdom PD Brain Bank Criteria for PD were recruited through trained neurologists and age- and ethnically matched controls (491) were individuals free of any neurological disorder. The N551K and R1398H mutations were genotyped using the Taqman SNP genotyping assay.. A significant protective association for N551K was found in those of Malay ancestry, with a protective trend seen for R1398H. A meta-analysis of Chinese individuals in this cohort with other published cohorts of Chinese ancestry indicated a significant protective role for N551K and R1398H.. This study reports that the N551K-R1398H haplotype is also relevant to the Malaysian population, with a significant protective effect found in those of Malay and Chinese ancestries.

Topics: Asian People; Case-Control Studies; Cohort Studies; Female; Follow-Up Studies; Genetic Predisposition to Disease; Genotype; Haplotypes; Humans; Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; Malaysia; Male; Middle Aged; Mutation; Parkinson Disease; Prognosis

The objective of this study was to establish the psychometric properties of the AD8 Dementia Screening Interview in patients with Parkinson disease (PD) with or without cognitive impairment using the Montreal Cognitive Assessment Tool (MoCA) for comparison.. The AD8 was translated into Malay for Malay-speaking participants. A correlation analysis and a receiver operator characteristic curve were generated to establish the psychometric properties of the AD8 in relation to the MoCA.. One hundred fifty patients and their caretakers completed the AD8 and MoCA. Using a cutoff score of 1/8, the AD8 had 81% sensitivity and 59% specificity for the detection of cognitive impairment in PD. With a cutoff score of 2/8, the AD8 had 83% specificity and 64% sensitivity. The area under the receiver operator characteristic curve was 80%, indicating good-to-excellent discriminative ability.. These findings suggest that the AD8 can reliably differentiate between cognitively impaired and cognitively normal patients with PD and is a useful caregiver screening tool for PD.

Topics: Aged; Area Under Curve; Caregivers; Cognitive Dysfunction; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Predictive Value of Tests; Psychometrics; Sensitivity and Specificity; Surveys and Questionnaires

PARK16 was identified as a risk factor for Parkinson's disease in a Japanese cohort; however, subsequent studies in the other populations including the Chinese, European, Caucasian, and Chilean have shown a protective role instead. To investigate this locus in our Malaysian cohort, 1,144 individuals were screened for five SNPs in the PARK16 locus and logistic regression analysis showed that the A allele of the rs947211 SNP reduced the risk of developing PD via a recessive model (Odds ratio 0.57, P-value 0.0003). Pooled analysis with other Asian studies showed that A allele of the rs947211 SNP decreased the risk of developing PD via a recessive model (Odds ratio 0.71, P-value 0.0001). In addition, when meta-analysis was performed with other Asian population, three SNPs (rs823128, rs823156, and rs11240572) reduced risk of developing PD via a dominant model. © 2016 Wiley Periodicals, Inc.

Topics: Adult; Aged; Aged, 80 and over; Alleles; Ethnicity; Female; Genetic Association Studies; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Polymorphism, Single Nucleotide; Risk Factors

Reproducing genomewide association studies findings in different populations is challenging, because the reproducibility fundamentally relies on the similar patterns of linkage disequilibrium between the unknown causal variants and the genotyped single-nucleotide polymorphisms (SNPs).. The PARK16 locus was reported to alter the risk of Parkinson's disease (PD) in genomewide association studies in Japanese and Caucasians. We evaluated the regional linkage disequilibrium pattern at PARK16 locus in Caucasians, Japanese, and Chinese from HapMap and Chinese, Malays, and Indians from the Singapore Genome Variation Project, using the traditional heatmaps and targeted analysis of PARK16 gene via Monte Carlo simulation through varLD scores of these ethnic groups.. One hundred SNPs in Caucasians, 95 SNPs in Chinese, 78 SNPs in Japanese from HapMap, 86 SNPs in Chinese, 99 SNPs in Indians, and 97 SNPs in Malays from the Singapore Genome Variation Project were included. Our targeted analysis showed that the linkage disequilibrium pattern of SNPs close to rs947211 was similar in Caucasians and Asians, including Chinese, Japanese, and Malay (all P > 0.0001), whereas different linkage disequilibrium patterns around rs823128, rs823156, and rs708730 were found between Caucasians and these Asian groups (all P < 0.0001).. Our study suggests a higher chance to detect the association between rs947211 and PD in Chinese, Malay, and other Caucasian groups because of the similar linkage disequilibrium pattern around rs947211. The associations between rs823128/rs823156/rs708730 and PD are more likely to be replicated in Chinese and Malay populations.

Topics: Asian People; China; Genetic Association Studies; Humans; India; Japan; Linkage Disequilibrium; Malaysia; Parkinson Disease; Polymorphism, Single Nucleotide; Singapore; White People

Impulse control disorder (ICD) and behaviours (ICB) represent a group of behavioural disorders that have become increasingly recognised in Parkinson's disease (PD) patients who previously used dopaminergic medications, particularly dopamine agonists and levodopa. It has been suggested that these medications can lead to the development of ICB through the abnormal modulation of dopaminergic transmission and signalling in the mesocorticolimbic dopaminergic system. Several studies have reported an association between polymorphisms in the dopamine receptor (DRD) and N-methyl-D-aspartate 2B (GRIN2B) genes with the development of ICB in PD (PD-ICB) patients. Thus, this study aimed to investigate the association of selected polymorphisms within the DRD and GRIN2B genes with the development of ICB among PD patients using high resolution melt (HRM) analysis.. We used high resolution melt (HRM) analysis to genotype 11 polymorphisms in 5 DRD genes [DRD1 (rs4532, rs4867798 and rs265981), DRD2 (ANKK1 rs1800497, rs104894220 and rs144999500), DRD3 (rs3732783 and rs6280), DRD4 (rs1800443), and DRD5 (rs144132215)] and 1 polymorphism in GRIN2B (rs7301328) in PD patients with (cases, n = 52) and without (controls, n = 39) ICB. Cases were obtained from two tertiary movement disorder centres [UKMMC (n = 9) and UMMC (n = 43)]. At both centres, the diagnosis of ICB was made using the QUIP questionnaire. Controls were recruited from PD patients who attended UKMMC and were found to be negative for ICB using the QUIP questionnaire.. The HRM analysis showed that 7 of 11 polymorphisms [DRD1 (rs4532, rs4867798, and rs265981), DRD2 (ANKK1 rs1800497), DRD3 (rs3732783 and rs6280), and GRIN2B (rs7301328)] exhibited a clear distinction between wild-type and variant alleles. Variants of DRD2/ANKK1 rs1800497 (OR = 3.77; 95% CI, 1.38-10.30; p = 0.0044), DRD1 rs4867798 (OR = 24.53; 95% CI, 1.68-357.28; p = 0.0054), DRD1 rs4532 (OR = 21.33; 95% CI, 1.97-230.64; p = 0.0024), and GRIN2B rs7301328 (OR = 25.07; 95% CI, 1.30-483.41; p = 0.0097) were found to be associated with an increased risk of developing ICB among PD patients.. Our findings suggest that polymorphisms in dopamine [DRD1 (rs4532 and rs4867798) and DRD2/ANKK1 rs1800497] and glutamate (GRIN2B rs7301328) receptor genes confer increased risk of ICB development among PD patients.

Topics: Adult; Aged; Disruptive, Impulse Control, and Conduct Disorders; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Polymorphism, Genetic; Protein Serine-Threonine Kinases; Receptors, Dopamine D1; Receptors, Dopamine D2; Receptors, N-Methyl-D-Aspartate

Public knowledge regarding Parkinson's disease (PD) is important to facilitate good health-seeking behavior, but the literature on this topic is scarce.. We aimed to explore the level of public knowledge regarding PD in a large multiethnic urban Asian cohort, and (as a secondary aim) in a smaller cohort of PD patients and caregivers.. A Knowledge of PD Questionnaire (KPDQ) was developed and administered to members of the Malaysian general public, and to PD patients and caregivers. The KPDQ tests recognition of PD symptoms and general knowledge regarding PD.. 1,258 members of the general public completed the KPDQ. Tremor was the most widely recognized symptom (recognized by 79.0% of respondents); however, 83.7% incorrectly believed that all PD patients experience tremor. Memory problem was the most widely recognized NMS. Overall, motor symptoms were better recognized than NMS. Common misperceptions were that there is a cure for PD (49.8%) and that PD is usually familial (41.4%). Female gender, Chinese ethnicity, tertiary education, healthcare-related work, and knowing someone with PD were independently associated with higher KPDQ scores. PD patients (n = 116) and caregivers (n = 135) demonstrated superior knowledge compared with the general public group, but one-third of them believed that PD is currently curable.. This is the only study on public knowledge regarding PD in Asia. Important gaps in knowledge were evident, which could present a barrier to early diagnosis and appropriate treatment of PD. This highlights the need for targeted education campaigns and further research in this area.

Topics: Adult; Aged; Caregivers; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Urban Population

Chronic pulsatile levodopa therapy for Parkinson's disease (PD) leads to the development of motor fluctuations and dyskinesia. We studied the prevalence and predictors of levodopa-induced dyskinesia among multiethnic Malaysian patients with PD.. This is a cross-sectional study involving 95 patients with PD on uninterrupted levodopa therapy for at least 6 months. The instrument used was the UPDRS questionnaires. The predictors of dyskinesia were determined using multivariate logistic regression analysis.. The mean age was 65.6 ± 8.5 years. The mean onset age was 58.5 ± 9.8 years. The median disease duration was 6 (7) years. Dyskinesia was present in 44% (n = 42) with median levodopa therapy of 3 years. There were 64.3% Chinese, 31% Malays, and 3.7% Indians and other ethnic groups. Eighty-one percent of patients with dyskinesia had clinical fluctuations. Patients with dyskinesia had lower onset age ( p < 0.001), longer duration of levodopa therapy ( p < 0.001), longer disease duration ( p < 0.001), higher total daily levodopa dose ( p < 0.001), and higher total UPDRS scores ( p = 0.005) than patients without dyskinesia. The three significant predictors of dyskinesia were duration of levodopa therapy, onset age, and total daily levodopa dose.. The prevalence of levodopa-induced dyskinesia in our patients was 44%. The most significant predictors were duration of levodopa therapy, total daily levodopa dose, and onset age.

Topics: Aged; Antiparkinson Agents; Cross-Sectional Studies; Dyskinesia, Drug-Induced; Female; Humans; Levodopa; Malaysia; Male; Middle Aged; Parkinson Disease; Predictive Value of Tests; Risk Factors; Severity of Illness Index

The LRRK2 gene has been associated with both familial and sporadic forms of Parkinson's disease (PD). The G2019S variant is commonly found in North African Arab and Caucasian PD patients, but this locus is monomorphic in Asians. The G2385R and R1628P variants are associated with a higher risk of developing PD in certain Asian populations but have not been studied in the Malaysian population. Therefore, we screened the G2385R and R1628P variants in 1,202 Malaysian subjects consisting of 695 cases and 507 controls. The G2385R and R1628P variants were associated with a 2.2-fold (P = 0.019) and 1.2-fold (P = 0.054) increased risk of PD, respectively. Our data concur with other reported findings in Chinese, Taiwanese, Singaporean, and Korean studies.

Topics: Aged; Asian People; Case-Control Studies; Female; Genetic Predisposition to Disease; Humans; Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; Malaysia; Male; Middle Aged; Parkinson Disease; Polymorphism, Single Nucleotide; Protein Serine-Threonine Kinases

The G2385R and R1628P LRRK2 gene variants have been associated with an increased risk of Parkinson's disease (PD) in the Asian population. Recently, a new LRRK2 gene variant, A419V, was reported to be a third risk variant for PD in Asian patients. Our objective was to investigate this finding in our cohort of Asian subjects.. Eight hundred and twenty-eight subjects (404 PD patients, and 424 age and gender-matched control subjects without neurological disorders) were recruited. Genotyping was done by Taqman® allelic discrimination assay on an Applied Biosystems 7500 Fast Real-Time PCR machine.. The heterozygous A419V genotype was found in only 1 patient with PD, compared to 3 in the control group (0.4% vs 1.3%), giving an odds ratio of 0.35 (95% confidence interval (CI), 0.01 to 3.79; P = 0.624).. A419V is not an important LRRK2 risk variant in our Asian cohort of patients with PD. Our data are further supported by a literature review which showed that 4 out of 6 published studies reported a negative association of this variant in PD.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alanine; Case-Control Studies; China; Cohort Studies; Cytosine; Female; Gene Frequency; Genetic Variation; Genotype; Heterozygote; Humans; India; Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; Malaysia; Male; Middle Aged; Parkinson Disease; Polymorphism, Genetic; Protein Serine-Threonine Kinases; Risk Factors; Singapore; Thymine; Valine; Young Adult

Parkinson disease (PD) is the second most prevalent neurodegenerative disorder after Alzheimer disease. Besides motor presentations, cognitive impairment is among the other likely complications as the illness progresses. This study aimed to determine the prevalence of cognitive impairment in PD and the factors associated with the cognitive impairment.. A cross-sectional, descriptive study was conducted on all PD patients at different stages of their illness, in two major tertiary hospitals in Malaysia with their caregivers, over a three month period in 2002. Patients' cognitive functions were tested using the Mini Mental State Examination (MMSE). Important sociodemographic data and relevant clinical information of the patients as well as caregivers' information on income, duration of care-giving, relationship with the patient, and other relevant variables were gathered. Patients' level of functioning was assessed using the Activities of Daily Living (ADL) index. Staging of illness was done based on the Hoehn and Yahr Scale.. Out of 115 eligible patients, 35% were in the 60-69 age group with 57% in stage 2 of illness, A total of 29% of patients experienced various degrees of cognitive impairment , with almost half (47%) in the stage 3 and 4 exhibiting MMSE scores <24. Factors which were significantly associated with impaired cognitions were race, educational level and stage of illness.. Cognitive impairment was fairly common in PD and the severity of impairment in cognition and physical functioning increased with the advancement of the illness.

Topics: Activities of Daily Living; Adult; Age of Onset; Aged; Aged, 80 and over; Antiparkinson Agents; Caregivers; Cognition Disorders; Cross-Sectional Studies; Educational Status; Ethnicity; Female; Follow-Up Studies; Humans; Levodopa; Malaysia; Male; Middle Aged; Neuropsychological Tests; Parkinson Disease; Risk Factors; Severity of Illness Index; Surveys and Questionnaires; Urban Population

Parkinson disease (PD) affects the lives of both the individuals and their family members. This study aims at investigating for clinical as well as socio-demographic factors associated with the perception of burden among the caregivers of individuals with PD in Malaysia.. This is a descriptive, cross-sectional study on PD patients and their caregivers who attended the neurology clinics of 2 tertiary hospitals in Kuala Lumpur. Socio-demographic and clinical data of the patients were obtained, including caregivers' perception of burden using the Caregiver's Burden Scale (CBS).. The patients' mean age was 62.12±9.69 years, almost half of them were in stage 2 of their illness, had developed PD at the age of 50-69 and had duration of illness of less than 5 years. The caregivers were mostly females and a third of them were wives. Factors which were significantly associated with increased caregiver burden were patients' advancing age, later stage of illness and those having longer duration of caring. Caregivers' perceived burden was related to their race gender, social status, kinship with patient or duration of care-giving.. Burden of care is significantly more in PD patients of advanced age and stage of illness.

Topics: Age of Onset; Aged; Aged, 80 and over; Caregivers; Cost of Illness; Cross-Sectional Studies; Data Interpretation, Statistical; Educational Status; Family; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Socioeconomic Factors; Surveys and Questionnaires

There are limited data on the prevalence of impulsive-compulsive behaviors and subsyndromal impulsive-compulsive behaviors in Asian patients with Parkinson's disease, who are treated with lower dosages of dopaminergic medications.. The recently-validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease was administered to 200 consecutive patients attending a Malaysian university-based neurology clinic. Informant report was also systematically obtained.. A high rate of Questionnaire positivity was found (35.0% by combined patient and informant report; 24.6% by patient report alone; 27.4% by informant report alone), despite usage of relatively low dosages of dopaminergic medications (mean/median total l-dopa equivalent units of 528/450 mg/day; mean/median agonist-only l-dopa equivalent units of 74/37 mg/day). Eating, sexual and punding or hobbyism behaviors were relatively common, while gambling and compulsive medication use occurred less frequently. Agreement between patient- and informant-reporting of impulsive-compulsive behaviors was moderate-to-fair (Kappa values ranging from 0.203 to 0.494). Factors associated with Questionnaire positivity on univariate analysis were male gender, younger age at Parkinson's disease onset, longer disease duration, use of dopamine agonist or amantadine therapy, higher total l-dopa equivalent units and higher dopamine agonist-only l-dopa equivalent units. On multivariate analysis, male gender and longer disease duration independently predicted Questionnaire positivity. No association was found with cognitive or apathy scores.. Our findings suggest that Asian patients with Parkinson's disease may be susceptible to dopaminergic medication-related side effects. The data here also contribute to the understanding of the psychometric properties of the Questionnaire for Impulsive-Compulsive Disorders.

Topics: Age of Onset; Asian People; Compulsive Behavior; Dopamine Agonists; Female; Humans; Impulsive Behavior; Levodopa; Malaysia; Male; Parkinson Disease; Prevalence; Surveys and Questionnaires

There are limited studies reporting the frequency of sleep-disordered breathing (SDB) in Parkinson's disease (PD), and the figures quoted are variable, ranging from 2.5 to 66 percent. This study aimed to determine the prevalence and types of SBD in PD patients attending the Universiti Kebangsaan Malaysia Medical Centre neurology clinic, and the correlation between the subjective sleep symptoms using the Parkinson's disease sleep scale (PDSS) and the objective measurements using polysomnography (PSG).. This was a cross-sectional study involving 46 PD patients over a period of six months. The patients' demographic data, Hoehn and Yahr staging and PDSS scores were collected. The patients were then subjected to overnight PSG using the Somnomedic system.. There were 27 male and 19 female patients with a mean age of 64.0+/-9.7 years. 29 were Chinese, 15 Malay and 2 Indian. The mean duration of illness was 5.8+/-4.3 years. The mean PDSS score was 120.3+/-13.5. SDB was found in 54.6 percent of the patients (apnoeahypopnoea index [AHI] 5 and above), with 27.3 percent having moderate and severe SDB (AHI 15 and above). The median AHI was 6.7 (range 0-40.4). The prevalence of SDB in PD patients based on the AHI cutoffs were 27.3 percent for mild, 18.2 percent for moderate and 9.1 percent for severe. There were statistically significant positive correlations between the AHI and the neck circumference and between the AHI and the waist-hip ratio. There was no significant correlation between the AHI and PDSS, or the AHI and disease severity.. There was a high prevalence of SBD in our PD patients, which was comparable to other studies. Obstructive sleep apnoea was the dominant type of SBD. There was no correlation between the subjective sleep symptoms using the PDSS and the objective measurements using PSG.

Topics: Academic Medical Centers; Aged; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Polysomnography; Prevalence; Sleep Apnea, Central; Sleep Apnea, Obstructive

The aim of our study was to assess the longitudinal validity of the 8-item Parkinson's Disease Questionnaire (PDQ-8) in terms of responsiveness and test-retest reliability and to determine the minimally important difference (MID) for PDQ-8 using the anchor-based approach in Asians with Parkinson's disease (PD). A consecutive sample of PD patients attending a tertiary neuroscience clinic in Singapore completed the English or Chinese version of PDQ-8 twice during two different clinic visits. During the second visit, patients were also asked to rate their changes in health in general, PD severity, and overall impact of PD since at the time of their first visit 1 year ago using a 5-point response scale. A total of 96 patients participated in the study. For patients who reported changed conditions in the second visit, responsiveness measured by Cohen's effect size, standardized response mean, and Guyatt's responsiveness index ranged from 0.21 to 0.68. The intraclass correlation coefficient values calculated using patients reporting no change in health or PD status ranged from 0.64 to 0.76. The mean changed PDQ-8 summary index score in patients who reported that their health or PD status worsened only "a little bit" ranged from 5.8 to 7.4 points. Our current results show that PDQ-8 is a longitudinally reliable and responsive measure for assessing the health-related quality of life in patients with PD. The MID of the PDQ-8 estimated in the study will further support the use of this instrument in both clinical research and practice.

Topics: China; Female; Humans; India; Language; Malaysia; Male; Middle Aged; Parkinson Disease; Quality of Life; Reproducibility of Results; Severity of Illness Index; Singapore; Surveys and Questionnaires

Sleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson's disease (PD). However, studies in the Asian population are limited.. This was a cross-sectional study involving 46 Malaysians with PD using polysomnography (PSG) and standardized translated Parkinson's disease sleep scale (PDSS). Overnight PSG recordings, UPDRS and PDSS scores, and baseline demographic data were obtained.. Data from 44 patients were analysed. Thirty-six patients (81.8%) had PSG-quantified sleep disorders. Twenty-three (52.3%) had sleep fragmentation, 24 (54.6%) had SDB and 14 (32%) had PLM. EDS was present in 9.1%. Insomnia was reported by 31.8%. Patients with sleep fragmentation had significantly higher UPDRS scores and lower PDSS insomnia sub-scores. The UPDRS scores correlated negatively with the TST and sleep efficiency. All patients with EDS had SDB (p=0.056). The PDSS insomnia sub-items correlated with sleep fragmentation on PSG.. : The prevalence of sleep disorders based on PSG and PDSS in our PD patients was high, the commonest being sleep fragmentation and SDB, while EDS was the least prevalent. Problem specific sub-items of the PDSS were more accurate in predicting the relevant PSG-related changes compared to the PDSS as a whole.

Topics: Aged; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Parkinson Disease; Polysomnography; Prevalence; Severity of Illness Index; Sleep Wake Disorders

To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.. A two-phase, cross-sectional study of randomly selected population from central Singapore with disproportionate race stratification.. Community-based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers.. Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate).. The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders-Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively.. The overall age- and race-standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10-1.45). Prevalence (in 5-year age bands) was 0.08% (50-54), 0.08% (55-59), 0.44% (60-64), 1.16% (65-69), 1.84% (70-74), 3.26% (75-79), 8.35% (80-84), and 16.42% (>/=85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese.. Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.

Topics: Aged; Aged, 80 and over; Asian People; China; Cross-Sectional Studies; Dementia; Epilepsy; Female; Humans; India; Malaysia; Male; Middle Aged; Parkinson Disease; Prevalence; Risk Factors; Singapore; Stroke

To investigate the prevalence of Parkinson disease (PD) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians.. A three-phase community-based survey among a disproportionate random sample of 15,000 individuals (9,000 Chinese, 3,000 Malays, 3,000 Indians) aged 50 years and above who live in central Singapore was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a validated 10-question questionnaire. In phase 2, medical specialists examined participants who screened positive to any of the questions. Participants suspected to have PD had their diagnosis confirmed in phase 3 by a movement disorders specialist.. The participation rate was 67% among 22,279 eligible individuals. Forty-six participants with PD were identified of which 16 were newly diagnosed cases. The prevalence rate of PD for those aged 50 and above in Singapore was 0.30% (95% CI: 0.22 to 0.41), age-adjusted to US 1970 census. The prevalence rates increased significantly with age. The age-adjusted prevalence rates among Chinese (0.33%, 95% CI: 0.22 to 0.48), Malays (0.29%, 95% CI: 0.13 to 0.67), and Indians (0.28%, 95% CI: 0.12 to 0.67) were the same (p = 1.0).. The prevalence of PD in Singapore was comparable to that of Western countries. Race-specific rates were also similar to previously reported rates and similar among the three races. Environmental factors may be more important than racially determined genetic factors in the development of PD.

Topics: Aged; Aged, 80 and over; China; Ethnicity; Female; Health Surveys; Humans; India; Malaysia; Male; Middle Aged; Parkinson Disease; Prevalence; Research Design; Sampling Studies; Singapore; Surveys and Questionnaires