published_or_final_version / Medicine / Master / Master of Philosophy

Η νόσος του Πάρκινσον (ΝΠ) είναι η δεύτερη πιο συχνά εμφανιζόμενη νευροεκφυλιστική νόσος του ΚΝΣ και επηρεάζει το 1%-2% του γηράσκοντα πληθυσμού. Η κύρια ιστοπαθολογία της νόσου χαρακτηρίζεται από την προοδευτική εκφύλιση των ντοπαμινεργικών κυττάρων της μέλαινας ουσίας, γεγονός που οδηγεί στην εμφάνιση των πρωτογενών συμπτωμάτων της νόσου τα οποία σχετίζονται με κινητικές δυσλειτουργίες. Τα συμπτώματα της νόσου, στα οποία στηρίζεται η διάγνωσή της, εμφανίζονται αφού ένας σημαντικός αριθμός ντοπαμινεργικών νευρώνων έχει ήδη εκφυλιστεί. Επιπρόσθετα, τα συμπτώματα αυτά δεν είναι ειδικά για τη ΝΠ, θέτοντας τη διάγνωσή της ειδικά στα πρώτα στάδια εκδήλωσής της σχετικά επισφαλή. Η αιτιολογία της νόσου παραμένει άγνωστη έως σήμερα. Η ΝΠ θεωρείται ένα πολυπαραγοντικό σύνδρομο, οι μηχανισμοί παθογένειας της οποίας είναι ακόμα αδιευκρίνιστοι, καθώς τα πρώτα στάδια εξέλιξής της, στα οποία η όποια θεραπεία αναμένεται να είναι πιο αποτελεσματική, δε γίνονται αντιληπτά και κατά συνέπεια δεν μπορούν να μελετηθούν άμεσα στον άνθρωπο. Η παρούσα ερευνητική εργασία είχε 2 σκοπούς: 1) τη μελέτη της παθογένειας της εκφύλισης της μελαινοραβδωτής οδού και 2) την ανίχνευση του παθολογικού φαινοτύπου της ΝΠ σε περιφερειακό ιστό. 1) Στα πλαίσια της πρώτης κατεύθυνσης μελετήθηκε ο μεταλλαγμένος μυς weaver, που αντιπροσωπεύει ένα μοναδικό γενετικό μοντέλο προοδευτικής εκφύλισης της μελαινοραβδωτής οδού. Ο ιστοπαθολογικός του φαινότυπος στηρίζεται σε μια σημειακή μετάλλαξη στο γονίδιο girk2 που κωδικοποιεί μια υπομονάδα των GIRK καναλιών. Αν και η μετάλλαξη αυτή βρέθηκε να μη συσχετίζεται με την εμφάνιση της ΝΠ στον άνθρωπο, ανάλογοι υποπληθυσμοί ντοπαμινεργικών κυττάρων εκφυλίζονται και χαρακτηρίζουν την παθολογία του μοντέλου όσο και της νόσου. Σημαντικό πλεονέκτημα του μοντέλου weaver επίσης είναι ότι η έναρξη της νευροεκφυλιστικής διαδικασίας είναι γνωστή και άρα μπορεί να μελετηθεί. Έχοντας ως βάση τα προηγούμενα, κύριος στόχος της ερευνητικής αυτής προσέγγισης ήταν ο προσδιορισμός υποψήφιων γονιδίων που ενέχονται στην έναρξη της ντοπαμινεργικής εκφύλισης στο μοντέλο weaver. Για το σκοπό αυτό εξετάστηκε το μεταγραφικό προφίλ ολόκληρου του γονιδιώματος της ευρύτερης θιγόμενης περιοχής του μεσεγκεφάλου weaver και φυσιολογικών μυών χρησιμοποιώντας μικροσυστοιχίες DNA πλήρους γονιδιώματος μυός. Επιλέχτηκαν μύες 7 ημερών, ηλικίας που βρίσκεται ακριβώς πριν την έναρξη της εκφυλιστικής διαδικασίας. Τα αποτελέσματα που παρήχθησαν περιλαμβάνουν ένα σχετικά μικρό αριθμό γονιδίων που σημειώνουν περιορισμένη αλλά σημαντική αλλαγή των επιπέδων έκφρασης τους στους weaver μύες. Τα γονίδια αυτά διακρίνονται με βάση την λειτουργία τους σε 4 κατηγορίες που αφορούν στη φυσιολογία της σύναψης ή τη νευροδιαβίβαση, τη μεταγωγή σήματος, την ενεργοποίηση της μεταγραφής και τη μεταφορά. Αν και εξετάστηκε η ευρύτερη περιοχή του μεσεγκεφάλου που παράλληλα με τη μέλαινα ουσία περιλαμβάνει και μη θιγόμενες ντοπαμινεργικές ή μη περιοχές και επιφέρει σημαντική αραίωση στα αποτελέσματα των γονιδίων που εμπλέκονται στην εκφύλιση της μελαινοραβδωτής οδού, οι λειτουργίες αυτές έχουν βρεθεί ότι επηρεάζονται στη ΝΠ και στο νευροτοξικό μοντέλο MPTP σε μύες, ακόμα και σε πρώιμα στάδια νευροεκφύλισης. Μάλιστα, είναι η πρώτη φορά που μία τέτοια προσπάθεια προσδιορισμού των μοριακών μηχανισμών παθογένειας του ντοπαμινεργικού θανάτου πραγματοποιείται σε τόσο πρώιμο στάδιο, πριν ουσιαστικά η εκφύλιση αρχίσει να παρατηρείται. Μεταξύ των γονιδίων των οποίων το μεταγραφικό προφίλ βρέθηκε να χαρακτηρίζει ειδικά τη μεσεγκεφαλική περιοχή των μυών weaver, επιλεχτήκαν να πιστοποιηθούν περαιτέρω με QPCR σε μια νέα ομάδα ζώων της ίδιας ηλικίας συγκεκριμένα γονίδια με γνώμονα τη λειτουργία τους και το ποσοστό της αλλαγής των επιπέδων έκφρασής τους στα μεταλλαγμένα ζώα. Τα γονίδια που πιστοποιήθηκαν ότι αλλάζουν το προφίλ της έκφρασής τους στο μεσεγκέφαλο των weaver μυών περιλαμβάνουν το supt16h, το lasp1, το dlgh4 και ένα καινούργιο μετάγραφο του nurr1. Το supt16h κωδικοποιεί τη μεγάλη υπομονάδα του συμπλόκου FACT, το οποίο είναι σύμπλοκο αναδιαμόρφωσης της χρωματίνης και παίζει σημαντικό ρόλο στη διεκπεραίωση της μεταγραφικής διαδικασίας. Η μείωση της έκφρασης του supt16h στο μεσεγκέγαλο των μυών weaver είναι πιθανό να σηματοδοτεί ένα γενικότερο μηχανισμό μείωσης της μεταγραφικής δραστηριότητας στην περιοχή. Το nurr1 είναι ένα πρώιμο γονίδιο με καλά χαρακτηρισμένη λειτουργία στην ανάπτυξη και διατήρηση των ντοπαμινεργικών νευρώνων, ενώ μεταλλάξεις του έχουν εμπλακεί στην παθογένεια της ΝΠ. Αλλαγές στο προφίλ έκφρασης του ίσως σηματοδοτούν ένα αντισταθμιστικό μηχανισμό που ενεργοποιείται στη θιγόμενη περιοχή στα πρώιμα στάδια εκφύλισης ή εμπλέκονται στους μοριακούς μηχανισμούς παθογένειας της νευροεκφύλισης. Το lasp1 και το dlgh4 παρατηρήθηκαν να μειώνουν τα επίπεδα της έκφρασής τους στο μοντέλο weaver. Πρόκειται για 2 γονίδια που κωδικοποιούν 2 συναπτικές πρωτεΐνες με πολύ σημαντικό ρόλο στη νευροδιαβίβαση και την απόκριση του μετασυναπτικού νευρώνα. Η μείωση των επιπέδων των πρωτεϊνών αυτών στο μοντέλο weaver μπορεί να οδηγήσει σε δυσλειτουργία της σηματοδότησης στη σύναψη ή της απόκρισης του μετασυναπτικού κυττάρου σε μηχανισμούς που τροποποιούν τη συναπτική φυσιολογία. Επιπρόσθετα, η μείωση των επιπέδων των συναπτικών αυτών πρωτεϊνών θα μπορούσε να επιφέρει αλλαγές στην αρχιτεκτονική της σύναψης, οι οποίες είναι αναμενόμενο να έχουν αντίκτυπο και στο προσυναπτικό άκρο. Συνοψίζοντας, τόσο η μεταβολή της μεταγραφικής δραστηριότητας όσο και η απώλεια ή η διαταραχή της συναπτικής λειτουργίας όπως ανιχνεύονται από τον προσδιορισμό των γονιδίων που διαφοροποιούν το μεταφραφικό τους προφίλ ειδικά στο μεσεγκέφαλο των weaver μυών, υπαινίσσονται διαδικασίες που ενεργοποιούνται στην ευρύτερη περιοχή πριν η εκφύλιση των ντοπαμινεργικών νευρώνων αρχίσει να παρατηρείται. Η περαιτέρω ιστολογική ανάλυση της έκφρασης των γονιδίων αυτών στο μεσεγκέφαλο των weaver μυών, ίσως σηματοδοτεί μια νέα μοριακή κατεύθυνση στη διερεύνηση της έναρξης της εκφυλιστικής διαδικασίας στα ντοπαμινεργικά κύτταρα. 2) Ο δεύτερος σκοπός αυτής της διατριβής ήταν η προσπάθεια ανίχνευσης του μοριακού αποτυπώματος της ΝΠ σε περιφερειακό ιστό. Προς την κατεύθυνση αυτή χρησιμοποιήθηκαν περιφερειακά λεμφοκύτταρα αίματος επειδή είναι ένας εύκολα προσβάσιμος ιστός, στον οποίο η έκφραση υποδοχέων νευροδιαβιβαστών έχει προταθεί ότι μπορεί να αντικατοπτρίζει την κατάσταση των ομόλογων υποδοχέων του εγκεφάλου, ενώ ειδικά σε σχέση με τη ΝΠ, έχει δειχθεί ότι εκφράζουν φυσιολογικά υποδοχείς ντοπαμίνης οι οποίοι υπερεκφράζονται στη νόσο, ενώ το περιεχόμενο της ντοπαμίνης και η ανοσοαπόκριση της υδροξυλάσης της τυροσίνης μειώνονται στα πρώιμα στάδια της νόσου. Τα στοιχεία αυτά ενισχύουν το ρόλο των λεμφοκυττάρων ως περιφερικό δείκτη της δυσλειτουργίας του ΚΝΣ στη ΝΠ. Για τη μελέτη του μεταγραφικού προφίλ των λεμφοκυττάρων ασθενών της ΝΠ χρησιμοποιήθηκαν πρωτοδιαγνωσμένοι ασθενείς που δεν είχαν λάβει καμία θεραπεία. Πραγματοποιήθηκε υψηλής κλίμακας ανάλυση της γονιδιακής τους έκφρασης με μικροσυστοιχίες DNA πλήρους γονιδιώματος ανθρώπου. Από τη σύγκριση των παρκινσονικών ασθενών με φυσιολογικά άτομα ιδίου φύλου και κατά το δυνατόν αντίστοιχης ηλικίας, η κατηγοριοποίηση όλων των δειγμάτων της έρευνας με βάση το μεταγραφικό προφίλ όλων των γονιδίων τους έδειξε ότι τα παρκινσονικά άτομα διαχωρίζονται μεν, δε διαφέρουν όμως πάρα πολύ από τα φυσιολογικά. Επιπρόσθετα, από την ανάλυση των αποτελεσμάτων της γονιδιακής έκφρασης σε όλα τα δείγματα προέκυψε ότι η ηλικία, τουλάχιστον οι μεγάλες διακυμάνσεις της, παίζει πιο δραστικό ρόλο στον καθορισμό του μεταγραφικού προφίλ των λεμφοκυττάρων από ότι η νόσος ή το φύλο. Η ομαδοποίηση των δειγμάτων με βάση το πρότυπο της γονιδιακής τους έκφρασης έδειξε ότι τα φυσιολογικά άτομα κατηγοριοποιούνται μαζί σε μία ομάδα παρότι είναι διαφορετικού φύλου. Αντίθετα, το σύνολο των παρκινσονικών ασθενών που χρησιμοποιήθηκαν είναι πιο ετερογενές, γεγονός που υποδεικνύει ότι πέρα από τον κλινικό φαινότυπο των ασθενών και το στάδιο της νόσου, υπάρχουν άλλοι παράγοντες της νόσου που ρυθμίζουν το μεταγραφικό προφίλ των λεμφοκυττάρων . Λαμβάνοντας υπόψη αυτήν την ποικιλομορφία των παρκινσονικών ασθενών καθώς και το ρόλο της ηλικίας στην εξαγωγή των αποτελεσμάτων, παράλληλα με την κύρια σύγκριση μεταξύ όλων των φυσιολογικών και όλων των παρκινσονικών ατόμων, δοκιμάστηκε μία ακόμη σύγκριση μεταξύ μόνο των παρκινσονικών και υγιών εκείνων ατόμων που πέρα από το χαρακτηρισμό τους διαχωρίζονται μεταξύ τους και από το προφίλ της γονιδιακής τους έκφρασης με βάση τα αποτελέσματα της κατηγοριοποίησης. Τα γονίδια που προέκυψαν από τις συγκρίσεις αυτές να μεταβάλλουν τα επίπεδα έκφρασης τους στα λεμφοκύτταρα των παρκινσονικών ασθενών αφορούν σε λειτουργίες που αντιστοιχούν στη βιοσύνθεση των πρωτεϊνών και τη μεταγραφή, τη μεταφορά, τη μεταγωγή σήματος και το μεταβολισμό. Οι λειτουργίες αυτές είτε αφορούν σε μηχανισμούς που έχουν βρεθεί να διαταράσσονται στη μέλαινα ουσία της ΝΠ, ή αντιπροσωπεύουν μια περιφερική απόκριση στη νόσο, η παθολογία της οποίας επεκτείνεται έξω από τον εγκέφαλο. Ο προσδιορισμός συγκεκριμένων γονιδίων μεταξύ των αποτελεσμάτων που έχουν ήδη εμπλακεί στη ΝΠ ή παίζουν ρόλο στη φυσιολογία του εγκεφάλου, προσφέρει ένα βιολογικό υπόβαθρο στην προσπάθεια διερεύνησης του μοριακού αποτυπώματος της ΝΠ στα λεμφοκύτταρα. / Parkinson’s disease (PD) is the second most common neurodegenerative disease of the CNS, affecting 1%-2% of the aging population. The main histopathology of the disease is characterized by the progressive degeneration of the dopaminergic neurons of the substantia nigra leading to primary symptoms that are correlated to motor abnormalities. The diagnosis of PD is possible only after its primary symptoms appear, when a severe degree of neurodegeneration has already occurred. Moreover, the symptoms are not specific for the disease, weakening the accuracy of its diagnosis, especially in its early stages. The etiology of the disease remains unknown. PD is considered to be a rather multifactorial syndrome, the pathogenic mechanisms of which have not yet been clarified, as the onset of the disease cannot be identified presymptomatically. The present thesis had two primary targets: 1) The study of the pathogenesis of the degeneration of the nigrostriatal pathway and 2) the detection of the pathological phenotype of PD in blood. 1) Towards the first direction, the mutant mouse weaver was studied, which represents a unique genetic model of progressive nigrostriatal neurodegeneration. Its pathophysiological phenotype lies on an autosomal missense mutation identified in the girk2 gene, which codes for a subunit of a G-protein-activated inwardly rectifying K+ channel. Although this mutation was not correlated to PD in humans, similar subpopulations of dopaminergic neurons are affected and characterize the pathology of both PD and the weaver mouse model. In addition, a crucial advantage in weaver mice is that the onset of the progressive dopaminergic degeneration is known and thus, can be studied. Based on these facts, the first aim of this thesis was the identification of candidate genes involved in the initiation of the dopaminergic degeneration in weaver mice. In this context, the complete transcriptional profile of the affected midbrain area of weaver mice was investigated using mouse full-genome DNA microarrays. Seven days-old mice were selected for this study, a time point that is currently the last reported at which no neurodegeneration has yet occured in the weaver midbrain. The results that were obtained include a relatively small number of genes that exhibit a limited but significant change in their expression levels. These genes are separated based on their function in four categories that concern the physiology of the synapse or neurotransmission, signal transduction, the regulation of transcription and transport. In the current experimental approach, the broader midbrain area of weaver mice was examined that besides the substantia nigra it includes other non affected dopaminergic or non dopaminergic areas, thus inducing quite a dilution to the genes identified to alter their expression significantly during the initiation of dopaminergic degeneration in weaver mice. However, the gene functions detected to be affected in this study have also been reported in PD and in the MPTP neurotoxical mouse model, even in the early stages of neurodegeneration. Notably, this is the first time such a study of the molecular pathogenic mechanisms of dopaminergic death is conducted so early in the neurodegenerative process, even before cell death begins to be observed. Among the genes whose transcriptional profile was found to specifically characterize the midbrain area of weaver mice, certain genes were selected to be validated by QPCR in a new group of weaver mice, based on their function and their ratio of differential gene expression in the mutant mice. The genes validated to alter their expression profile in the midbrain of weaver mice include supt16h, lasp1, dlgh4 and a predicted transcript variant of nurr1. Supt16h codes for the large subunit of the FACT complex, a chromatin remodeling complex playing an important role in transcription processing. The down regulation of Supt16h in the midbrain of weaver mice could imply a more generalized reduction of the transcriptional activity in the area. Nurr1 is an early gene playing an established role in the development and maintenance of dopaminergic neurons, whereas several mutations of the gene have been associated with PD. Changes in the expression level of Nurr1 might be observed either because of a compensative mechanism taking place in the early stages of dopaminergic degeneration, or alternatively due to the involvement of Nurr1 in the pathogenesis of the nigrostriatal neurodegeneration. Lasp1 and Dlgh4 were found to be downregulated in the midbrain of weaver mice. They code for two synaptic proteins that play a very important role in neurotransmission and post-synaptic response. The decrease of the expression levels of both genes in weaver mice could lead to signaling impairment in the synapse or to abnormalities in the post-synaptic response to stimuli affecting synaptic physiology. Furthermore, the down-regulation of those two synaptic proteins could induce alterations in the architecture of the synapse that would be expected to affect the pre-synaptic neuron as well. In summary, both transcriptional activity change and synaptic function loss or impairment as they are detected through the identification of genes that specifically differentiate their transcriptional profile in the midbrain of weaver mice are potentially processes that are observed to take place in the midbrain before the initiation of the dopaminergic degeneration. Further histological analysis of the expression pattern of those genes in the midbrain of weaver mice could possibly indicate a new molecular direction towards understanding the triggering of dopaminergic cell death. 2) The second goal of the current thesis was the detection of the molecular fingerprint of PD in a peripheral tissue. In this direction, the peripheral blood lymphocytes (PBLs) were chosen to be used. PBLs are an easily accessible tissue, expressing several neurotransmitter receptors that are believed to reflect the function of their brain homologues. Especially in relation to PD, PBLs have been found to normally express dopamine receptors that are upregulated in the disease, while both their dopamine content and the immunoreactivity of tyrosine hydroxylase are reduced in the early stages of PD. Those findings enhance the consideration of PBLs as a putative peripheral marker of CNS impairment in PD. To investigate the transcriptional profile of the lymphocytes from PD patients, a high-throughput analysis of gene expression was carried out using whole–genome human DNA microarrays. The PD patients that were used for this survey were all recently diagnosed to suffer from the disease and had received no treatment. The comparison of the transcriptome in lymphocytes between PD patients and age- and sex-matched healthy subjects identified that PD patients, in terms of their transcriptional profile in PBLs , are categorized separately from the healthy subjects, without however differing dramatically. Moreover, the analysis of gene expression among all samples pointed that age, at least its large variations, affects the transcriptional profile of lymphocytes more actively than sex or the disease itself. The clustering of samples according to their gene expression grouped all healthy subjects of advanced age together, regardless of their sex. On the contrary, the group of PD patients is more heterogeneous, a fact indicating that there might be other disease factors that regulate the transcriptional profile of lymphocytes besides the general clinical phenotype of the disease. Taking into consideration the variability of PD patients, as well as the effect of age on the results obtained, besides the main general comparison between all PD patients and all healthy subjects, another comparison was tried between only those PD patients and healthy subjects that are grouped separately between them based on the clustering outcome. The genes identified to specifically change their expression levels in the lymphocytes of PD patients have functions regarding protein biosynthesis transcription, transport, signal transduction and metabolism. Those functions either reflect the mechanisms underlying the pathology of SN in PD, or represent a peripheral response to the disease, the pathology of which extends beyond the brain to the periphery. The correlation of some of the genes identified in this study to previous studies of PD or brain physiology offers a biological background towards understanding the putative molecular fingerprint of PD in lymphocytes.

The symptoms of Parkinson's disease occur due to degeneration of dopamine neurons in substantia nigra. It has been demonstrated that glial cell line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor when it comes to protect and enhance survival of dopamine neurons in animal models of Parkinson's disease. The aim of this study was to evaluate short- and long-term effects of GDNF on survival and nerve fiber outgrowth of dopamine cells and astrocytic migration in mouse fetal ventral mesencephalic (VM) tissue. Primary tissue cultures were made of mouse fetal VM tissue and evaluated at 7 and 21 days in vitro (DIV) in terms of dopaminergic nerve fiber outgrowth and astrocytic migration when developed with GDNF present, partially, or completely absent. The results revealed that VM tissue cultured in the absence of GDNF did not exhibit any significant differences in migration of astrocytes or dopaminergic nerve fiber outgrowth neither after 7 DIV nor after 21 DIV, when compared with tissue cultured with GDNF present. Migration of astrocytes and dopaminergic nerve fiber outgrowth reached longer distances when tissue was left to develop for 21 DIV in comparison with 7 DIV. In order to study the long-term effects of GDNF, mouse fetal dopaminergic tissue was transplanted into the ventricles of adult mice and evaluated after 6 months. No surviving dopamine neurons were present in the absence of GDNF. In contrast dopamine neurons developed with GDNF did survive, indicating that GDNF is an essential neurotrophic factor when it comes to long-term dopamine cell survival. More cases have to be assessed in the future in order to strengthen the findings. Thus, transplanted dopamine neurons will be assessed after 3 and 12 months in order to map out when dopamine neurons deprived of GDNF undergo degeneration.

Abstract Objective Patients with Parkinson’s disease often have symptoms of dysphagia. These swallowingproblems have consequences for quality of life as well for the physical wellbeing of thepatients. AimThe aim of this study was to describe and correlate Swallowing Quality of Life (SWAL-QOL)scores, self-assessment of swallowing function using a visual analogue scale and the resultsfrom a fiber endoscopic evaluation of swallowing function in patients who had been selectedfor Deep Brain Stimulation in caudal zona incerta. A secondary aim was to correlate diseaseduration with results from SWAL-QOL and the fiber endoscopic evaluation of swallowingfunction. Method Ten male Parkinson’s patients (age 45-69 yrs, median 61.5 yrs) who were selected for DeepBrain Stimulation completing the Swallowing Quality of life form, as well as rating theirswallowing function using a visual analogue scale and undergoing a fiber endoscopicevaluation of their swallowing function.     Results The median total SWAL-QOL score was 94% while the mean was 91%. The median scorefrom the self-assessment was 85% while the mean was 93%. The total SWAL-QOL scorecorrelated with disease duration measured as years since diagnosis (r=-.72, p<.05). Diseaseduration measured as years with symptoms correlated with pre-swallow spillage (r>.63,p<.05).    Conclusions The results showed high levels of swallowing related quality of life for the studied group. Theself-assessment on the visual analogue scale and the fiber endoscopic evaluations alsorevealed that swallowing function was good in this sample. There were significantcorrelations between disease duration and some SWAL-QOL parameters as well as some ofthe outcomes from the fiber endoscopic evaluation.

Psychological peculiarities of the patiens with Parkinson‘s disease Objektives: the aim of this research was to assess and to compare characteristics of quality of life, depression and social support of the patients with Parkinson‘s disease and healthy ones. Methods: using Ferrans and Powers (1985) Quality of Life Index (QLI), wich measures general quality of life (QOL) and four domains – health and funktioning, social and economic, psychological/spiritual and family), Centre for Epidemiologic Studies Depression scale (CES – D), ( Radloff, 1977) and O‘Brien, Wortman, Kessler, Joseph (1993) social support scale was used to interview 60 patients with Parkinson‘s disease (mean age 67,2 years) and 73 healthy people (mean age 67,0 years). The Cronbach alpha coefficient for the QOL Lithuanian version was 0,94, for CES – D scale – 0,87. Results:the research showed that people with Parkinson‘s disease had lower QOL than healthy people (respektively 16,42 and 19,96, t = - 6,393, p = 0,001).Analysis between patients with Parkinson‘s disease and healthy respondents showed that patients with Parkinson‘s disease had in all domains lower QOL than healthy respondents and there were statistically significant differences in all domains (p < 0,05). The most difference in QOL average was found in scale of physical health (14,33 and 19,03 respectively, p < 0,05) proving that people with Parkinson‘s disease experience more serious problems.Research showed that the... [to full text]

Background: Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease. The diagnosis is based on a combination of the motor signs: tremor, bradykinesia, rigidity and postural abnormalities. Mild Cognitive Impairment (MCI) is common early in the disease and a large proportion of patients with PD develop dementia (PDD). Associations between motor symptoms and cognitive decline have been suggested but the results are inconclusive due to differences in the selection of participants and variables tested. Large population based studies with comprehensive neuropsychological investigation in newly diagnosed cases with PD followed prospectively are rare. The aim of this thesis was to improve characterization and understanding of cognition in PD, and to explore the relationship to motor impairment in the early phase of PD. Methods: All new patients with suspected idiopathic parkinsonism in the catchment area (142 ooo inhabitants) were examined during a period of five years and four months. Among other investigations, a comprehensive neuropsychological evaluation was carried out in 119 of 148 patients with PD together with 30 age matched healthy controls. Assessments were repeated after one three and five years. Results: Patients performed worse than healthy controls in a majority of neuropsychological tests. MCI at the time of diagnosis were found in 36% according to recently published MCI criteria. Thirty % were cognitively impaired using another definition. One fourth of the patients developed PDD within five years after diagnosis and 25 % of those with MCI at baseline reversed back to normal cognition. Age and MCI were significant predictors of dementia. Education was an independent predictor for severe cognitive dysfunction at diagnosis but did not predict PDD. Patients with MCI converting to PDD had worse performance on visuospatial function, semantic fluency, episodic memory, mental flexibility and conceptual thinking. There were no differences in cognitive performance between patients with predominant Postural and Gait Disturbances (PIGD) and the tremor dominant subtype at the baseline investigation and belonging to the PIGD subgroup at baseline did not predict PDD. Dementia converters declined more rapidly than non-converters in posture/gait function. Associations between bradykinesia and measures of executive functions and working memory were found, and between posture and gait disturbances and visuospatial function. Some of these associations were persistent after one year. Patients receiving the dopamine agonist pramipexole performed significantly worse on a measure of verbal fluency at the one year follow up. Conclusions: The differences in proportions of cognitively impaired in the different studies emphasize the value of joint criteria for PD-MCI. Even when using such criteria, a substantial proportion of patients revert back to normal function. The increase in motor disability in patients with PDD could have several different causes that need to be further investigated. Associated motor and cognitive dysfunctions could reflect common pathophysiological processes in partly shared networks. Both dopaminergic and non-dopaminergic motor and cognitive functions seems to be involved in PDD which suggests that pharmacological treatment in PD needs to go beyond the scope of dopaminergic deficiency in search for new therapies that would also be effective for non-motor symptoms. / NYPUM

Diseases of the central and peripheral nervous systems affect one in five people in North America. Parkinson’s disease (PD) is the second most common neurodegenerative disease, after Alzheimer’s disease, and occurs in approximately 1% of the general North American population. PD is a progressive movement disorder that is characterized by resting tremor, rigidity, bradykinesia (slowness of movement) or akinesia (absence of spontaneous movement), as well as postural instability. Current treatment of PD is symptom-based, and no pharmacological treatment currently exists to slow the progression of bradykinesia and akinesia. In fact, pharmacological therapies produce motor side effects in advanced stages of the disease. Given the difficulty in initiating and controlling movement as PD advances, and the ineffectiveness of medical therapies after prolonged treatment, physical and music therapies can be used to supplement classical therapies. Listening to, and performing, music affects a number of neural regions, including those that mediate motor behaviour, arousal or activation, and emotion. Despite anatomical connections between the auditory and motor systems at the level of the spinal cord, brain stem, midbrain, and cortex, the neural and behavioural mechanisms for sound-induced activation remains unclear. It is known, however, that PD patients recruit external sensory stimuli to improve movement. The aim of the current research was to create an animal model of sound-induced activation and to test the effect of previous motoric experience on the potency of auditory stimuli. To investigate behavioural activation in the normal and haloperidol-treated rat, two tasks were used: 1) orienting responses were analyzed for movement components in saline and haloperidol treated rats v to find out if rats responded in the same to a variety of naturally produced and generated activating sounds, and 2) a grid climbing task allowed for the righting components of naïve and familiar cataleptic rats to be compared. Our findings revealed that familiar auditory cues could release parkinsonian rats from catalepsy. The current research supports the theory that auditory stimulation retains “special access” to motor regions otherwise impaired in PD and likely bypasses basal ganglia circuitry to normalize movement through alternative pathways. / xiv, 142 leaves : ill. (some col.) ; 29 cm

Changes in postural stability following sensory manipulation were investigated among Parkinson's disease patients and healthy older adults. Sixteen Parkinson's disease patients (PD; mean age 68.2 + 2.7 years) and sixteen older adults (control; mean age 67.6 + 2.6 years) performed quiet standing trials that progressed through baseline, sensory manipulation, and reintegration. Postural control following visual deprivation was assessed following alternate removal and reinsertion of visual information. Postural recovery following sensory incongruence was assessed following the termination of visual, somatosensory, and visuosomatosensory incongruence. PD patients' balance was disrupted following visual deprivation, and was initially disrupted when visual information was returned. PD patients' pstural recovery was comparable to control subjects when sensory incongruence ended. These findings indicate that situations of visual deprivation in particular are initially disruptive for PD patients, and imply initial difficulty for sensory reorganization in these patients. Our results provide insight into environmental situations imposing greater fall risk among the parkinsonian population. / xii, 81 leaves ; 29 cm.

Conventional cylinder test measures have limited sensitivity in determining hemiparkinson rat forelimb use asymmetry and approximating substantia nigra (SN) dopaminergic neuron loss. This thesis investigates which cylinder test measures of hemiparkinson rat forelimb use asymmetry best predict methamphetamine-induced rotation and extent of dopaminergic neuron loss. Long-Evans rats were cylinder-tested after unilateral 1-methyl-4-phenylpyridinium (MPP+)-induced SN dopamine depletion. Time and count of numerous forepaw wall contact patterns were documented for MPP+ hemiparkinson rats and sham-operated controls using frame-by-frame video analysis, then regressed against methamphetamine-induced rotation and tyrosine hydroxylase-positive neuron depletion. Severely dopamine-asymmetric rats initiated movements slower and less often with the contralateral-to-lesion forepaw, indicating that the cylinder test may be used to assess Parkinson Disease motor impairments of bradykinesia and akinesia. Several new time and count asymmetry measures may improve cylinder test sensitivity to hemiparkinson-specific forelimb use asymmetries. / xi, 103 leaves : ill. ; 29 cm.

The effects of postural threat on gait initiation and steady state gait among Parkinson’s disease (PD) patients and age-matched adults were examined. Ten healthy adults (CTRL; mean age= 68.8 ± 8.4, range 56-80 years) and ten PD patients (PDOFF / ON ; mean age= 69.7 ± 10.3, range 54-81 years) initiated gait and continued with steady state walking along a walkway of two different height conditions. PD patients were first tested in a non-medicated state followed by testing in a medicated state. The results showed that gait initiation and steady state gait deficits inherent to PD are exacerbated in a postural threatening environment. As well, medication efficacy for overcoming parkinsonian deficits may be context dependent. These findings confirm the dynamic nature of movement deficits characteristic of parkinsonian patients and provide empirical evidence for specific environments that can create movement difficulties for people with PD. / x, 59 leaves : ill. ; 29 cm. --