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Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Parkinson's disease (PD) has traditionally been viewed as a movement disorder characterized by tremor, rigidity, akinesia, and impaired posture and gait, but more recent work documents a range of concomitant non-motor symptoms including changes in sensation, perception, and visuospatial cognition. PD subtypes are defined by characteristics of motor symptoms at disease onset, such as type of symptom (tremor, non-tremor) and body side of symptom onset, but the nature of the non-motor symptoms accompanying these subtypes is relatively unknown. The first two studies explored visual perceptual and spatial function in relation to PD subtypes. PD patients with non-tremor symptoms at onset were hypothesized to perform more poorly than those with tremor onset because of greater cortical and subcortical neuropathology. Patients with symptoms starting on the left side of the body were hypothesized to perform more poorly than right-onset patients on visuospatial functioning, reflecting hemispheric asymmetries in dopamine levels. The third study examined an intervention to counteract visual deficits relevant to activities of daily living (ADLs) in PD in general. Study 1 used a self-report measure to identify which visual domains are most affected in PD subtypes, as well as objective measures of visual functioning. Patients with non-tremor onset, but not those with tremor onset, had impairments in contrast sensitivity and specific visual ADLs. Study 2 used a standard neuropsychological measure to assess visuospatial functioning in PD subtypes. Patients with left-side motor symptoms at onset and non-tremor symptoms at onset performed significantly more poorly than the control group. Study 3 examined the effect of visually-based environmental enhancements on five instrumental ADLs in PD and control participants. These enhancements improved performance on specific ADLs in both groups. The present studies provided evidence for reduced contrast sensitivity, worse visuospatial functioning, and more self-reported problems with visual ADLs in the nontremor PD subtype than in those with tremor at onset, and worse visuospatial functioning in patients with left than right motor symptoms at onset. Characterizing perceptual and cognitive changes in PD subtypes provides a more complete picture of the disorder. Future studies should focus on the relation between these changes and ADLs in PD subtypes. / 2999-01-01

Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Introduction: Parkinson's disease (PO) is a neurodegenerative disorder. Medication is by far the most effective and important treatment for PO and levodopa is the most effective and commonly used medicine to control motor symptoms in PD. However, its long-term usage often induces several adverse events (AEs). Both combination therapy of monoamine oxidase type B inhibitor. (MAOBI) with levodopa and catechol-0-methyltransferase inhibitor (COMTI) with levodopa were demonstrated to provide benefits to PO patients, such as regulating motor fluctuations and reducing levodopa dose, but are accompanied by increased frequency of dopaminergic AEs. Available data is too limited to directly compare the safety of these combination therapies (MAOBI vs. COMTI). Thus the aim of this study is to investigate whether MAOBI and COMTI have different AE profiles. Methods: All the data used to analyze the AEs of different PO medications were retrieved from "The Boston University Medical Center's Parkinson's Disease and Movement Disorder Database". Ten categories of AEs, i.e. compulsive behavior, dyskinesia, dementia, depression, freezing, hallucinations, motor fluctuations, orthostatic hypotension, other autonomic dysfunction and psychosis, were compared between MAOBI and COMTI groups. Fisher's exact test and multivariable logistic regression models were applied to analyze data. Results: In total 87 subjects were included in the analysis. Out of 10 AEs, presence of dementia was significantly different between the MAOBI and COMTI groups with OR of 6.9 (COMTI vs. MAOBI, 95%CI: 1.3-37.0). Motor fluctuations were also found to be differently distributed in the two medication groups with OR of 3.1 (COMTI vs. MAOBI, 95%CI: 1.0-9.8). Conclusion: COMTI combined with levodopa therapy was more likely to be associated with dementia and motor fluctuations than MAOBI. The results need to be further tested in other independent studies. / 2999-01-01

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