Inverse associations of outdoor activity and vitamin D intake with the risk of Parkinson’s disease Coenzyme Q10 deficiency in patients with Parkinson's disease Amelioration of osteoporosis by menatetrenone in elderly female Parkinson's disease patients with vitamin D deficiency. Randomized, double-blind, placebo-controlled trial of vitamin D supplementation in Parkinson disease. Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease. Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinson disease [RETRACTED] Dietary and lifestyle variables in relation to incidence of Parkinson’s disease in Greece The health-related, social, and economic consequences of parkinsonism: a controlled national study Pilot trial of high dosages of coenzyme Q10 in patients with Parkinson's disease Alendronate and vitamin D2 for prevention of hip fracture in Parkinson's disease: a randomized controlled trial. Degeneration of substantia nigra in chronic Parkinson's disease visualized by transcranial color-coded real-time sonography Minimal clinically important change on the unified Parkinson's disease rating scale. The Four Square Step Test in individuals with Parkinson's disease: association with executive function and comparison with older adults. Self-reported functioning and well-being in patients with Parkinson's disease: comparison of the short-form health survey (SF-36) and the Parkinson's Disease Questionnaire (PDQ-39) Hypertension, hypercholesterolemia, diabetes, and risk of Parkinson disease Deprenyl and tocopherol antioxidative therapy of parkinsonism (DATATOP) Once-weekly risedronate for prevention of hip fracture in women with Parkinson's disease: a randomised controlled trial Bilateral subthalamic nucleus stimulation does not improve prolonged P300 latencies in Parkinson's disease The Effects of Adapted Tango on Spatial Cognition and Disease Severity in Parkinson's Disease Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study. Physical therapy and Parkinson's disease Entacapone in elderly Parkinsonian patients experiencing levodopa-related wearing-off: a pilot study Moderate-intensity interval training increases serum brain-derived neurotrophic factor level and decreases inflammation in Parkinson's disease patients.
Early studies had suggested that vitamin D intake was inversely associated with neurodegenerative diseases , such as Alzheimer ’s disease and multiple sclerosis . However , the associations of vitamin D intake and outdoor activities with Parkinson ’s disease ( PD ) are still unclear , so this study is to evaluate these relationships from a case-control study in elderly Chinese . The study population involved 209 cases with new onsets of PD and 210 controls without neurodegenerative diseases . The data on  dietary vitamin D and outdoor activities  were collected using a food-frequency question naire and self-report question naire . Multivariable logistic regressions  were used to examine the associations between dietary outdoor activities , vitamin D intake and PD . Adjustment was made for sex , age , smoking , alcohol use , education , and body mass index ( BMI ) . Adjusted odds ratios ( ORs ) for PD in quartiles for outdoor physical activity were 1 ( reference ) , 0.739 ( 0.413 , 1.321 ) , 0.501 ( 0.282 , 0.891 ) , and 0.437 ( 0.241 , 0.795 ) , respectively ( P=0.002 for trend ) . Adjusted ORs for PD in quartiles for total vitamin D intake were 1 ( reference ) , 0.647 ( 0.357 , 1.170 ) , 0.571 ( 0.318 , 1.022 ) , and 0.538 ( 0.301 , 0.960 ) , respectively ( P=0.011 for trend ) . Our study suggested that outdoor activity and total vitamin D intake were inversely associated with PD , and outdoor activity seems to be more significantly associated with decreased risk for PD.概要研究目的评估户外活动 、 维生素D 的摄入与帕金森病(PD)风险关系。研究方法收集209 例新发PD 病例和210 名无神经退行性疾病对照人群 , 进行食物频率问卷调查 , 计算膳食维生素D 摄入量并记录自我报告的问卷调查户外活动情况 。 利用多变量Logistic 回归研究膳食维生素D 摄入及户外活动与PD 的相关性 , 并校正性别 、 年龄 、 吸烟 、 饮酒 、 教育程度和身体质量指数 ( BMI ) 变量 。 按户外活动时间从少到多四分位分组 , 校正后的比值比(OR)(95%可信区间(CI))值分别为1(参考 ) 、 0.739(0.413 , 1.321 ) 、 0.501(0.282 , 0.891)和0.437(0.241 , 0.795 ) , 趋势P=0.002 ; 按维生素D 摄入量从少到多四分位分组 , 校正后的OR 值分别为1(参考 ) 、 0.647(0.357 , 1.170 ) 、 0.571(0.318 , 1.022)和0.538(0.301 , 0.960 ) , 趋势P=0.011。重要结论表明户外活动和总的维生素D 摄入量与PD 呈负相关 ; 户外活动可更显著下降PD 的风险相关 UNLABELLED Reactive oxygen species ( ROS ) are well known to contribute to the pathophysiology of Parkinson 's disease ( PD ) . Clinical trials of antioxidants are currently underway in PD patients , however , antioxidant research has been hindered by a lack of peripheral biomarkers . METHODS Twenty-two patients with PD elected to have a novel antioxidant assessment ( Functional Intracellular Assay ( FIA ) , SpectraCell Lab , Houston , TX ) performed between 2004 and 2008 . Each PD case was compared to four age- and gender-matched controls ( n=88 ) in four separate , r and om iterations using laboratory data su bmi tted during the same time period . Logistic regression was used to determine the odds of functional deficiency in antioxidant nutrients ( i.e. , glutathione , coenzyme Q10 , selenium , vitamin E and alpha-lipoic acid ) by case-control status . The proportion of cases with functional deficiency was also compared to that for controls by chi(2 ) test . RESULTS Compared to cases , PD patients had a significantly greater odds of deficiency in coenzyme Q10 status ( OR : 4.7 - 5.4 ; 95 % CI : 1.5 - 17.7 ; P=0.003 - 0.009 ) based on FIA results , but not of vitamin E , selenium , lipoic acid , or glutathione ( all P>0.05 ) . The proportion of cases with coenzyme Q10 deficiency was also significantly greater in cases than in controls ( 32 - 36 % vs. 8 - 9 % ; P=0.0012 - 0.006 ) . CONCLUSIONS Deficiency of coenzyme Q10 assessed via FIA should be explored as a potential peripheral biomarker of antioxidant status in PD Significant reduction in bone mineral density ( BMD ) occurs in patients with Parkinson 's disease ( PD ) , correlating with immobilization and with vitamin D deficiency , and increasing the risk of hip fracture , especially in elderly women . As a biological indicator of compromised vitamin K status , an increased serum concentration of undercarboxylated osteocalcin ( Oc ) has been associated with reduced BMD in the hip and an increased risk of fracture in otherwise healthy elderly women . We evaluated treatment with vitamin K(2 ) ( menatetrenone ; MK-4 ) in maintaining BMD and reducing the incidence of nonvertebral fractures in elderly female patients with PD . In a r and om and prospect i ve study of PD patients , 60 received 45 mg of MK-4 daily for 12 months , and the remaining 60 ( untreated group ) did not . At baseline , patients of both groups showed vitamin D and K(1 ) deficiencies , high serum levels of ionized calcium , and glutaminic residue ( Glu ) Oc , and low levels of parathyroid hormone ( PTH ) and 1,25-dihydroxyvitamin D [ 1,25-(OH)(2)D ] , indicating that immobilization-induced hypercalcemia inhibits renal synthesis of 1,25-(OH)(2)D and compensatory PTH secretion . BMD in the second metacarpals increased by 0.9 % in the treated group and decreased by 4.3 % in the untreated group ( p < 0.0001 ) .  Vitamin K(2 ) level increased by 259.8 % in the treated group . Correspondingly , significant decreases in Glu Oc and calcium were observed in the treated group , in association with an increase in both PTH and 1,25-(OH)(2)D. Ten patients sustained fractures ( eight at the hip and two at other sites ) in the untreated group , and one hip fracture occurred among treated patients ( p = 0.0082 ; odds ratio = 11.5 ) . The treatment with MK-4 can increase the BMD of vitamin D- and K-deficient bone by increasing vitamin K concentration , and it can also decrease calcium levels through inhibition of bone resorption , result ing in an increase in 1,25-(OH)(2)D concentration BACKGROUND In our previous study , higher serum 25-hydroxyvitamin D [ 25(OH)D ] concentrations and the vitamin D receptor ( VDR ) FokI CC genotype were associated with milder Parkinson disease ( PD ) . OBJECTIVE We evaluated whether vitamin D3 supplementation inhibits the progression of PD on the basis of patient VDR subgroups . DESIGN Patients with PD ( n = 114 ) were r and omly assigned to receive vitamin D3 supplements ( n = 56 ; 1200 IU/d ) or a placebo ( n = 58 ) for 12 mo in a double-blind setting . Outcomes were clinical changes from baseline and the percentage of patients who showed no worsening of the modified Hoehn and Yahr ( HY ) stage and Unified Parkinson 's Disease Rating Scale ( UPDRS ) . RESULTS Compared with the placebo , vitamin D3 significantly prevented the deterioration of the HY stage in patients [ difference between groups : P = 0.005 ; mean ± SD change within vitamin D3 group : + 0.02 ± 0.62 ( P = 0.79 ) ; change within placebo group : + 0.33 ± 0.70 ( P = 0.0006 ) ] . Interaction analyses showed that VDR FokI genotypes modified the effect of vitamin D3 on changes in the HY stage ( P-interaction = 0.045 ) , UPDRS total ( P-interaction = 0.039 ) , and UPDRS part II ( P-interaction = 0.021 ) . Compared with the placebo , vitamin D3 significantly prevented deterioration of the HY stage in patients with FokI TT [ difference between groups : P = 0.009 ; change within vitamin D3 group : -0.38 ± 0.48 ( P = 0.91 ) ; change within placebo group , + 0.63 ± 0.77 ( P = 0.009 ) ] and FokI CT [ difference between groups : P = 0.020 ; change within vitamin D3 group : ±0.00 ± 0.60 ( P = 0.78 ) ; change within placebo group : + 0.37 ± 0.74 ( P = 0.014 ) ] but not FokI CC . Similar trends were observed in UPDRS total and part II . CONCLUSION Vitamin D3 supplementation may stabilize PD for a short period in patients with FokI TT or CT genotypes without triggering hypercalcemia , although this effect may be nonspecific for PD . This trial was registered at UMIN Clinical Trials Registry as UMIN000001841 BACKGROUND A role for vitamin D deficiency in Parkinson disease ( PD ) has recently been proposed . OBJECTIVE To compare the prevalence of vitamin D deficiency in a research data base cohort of patients with PD with the prevalence in age-matched healthy controls and patients with Alzheimer disease ( AD ) . DESIGN Survey study and blinded comparison of plasma 25-hydroxyvitamin D ( 25[OH]D ) concentrations of stored sample s in a clinical research data base at Emory University School of Medicine . SETTING Referral center ( PD and AD patients ) , primary care clinics , and community setting ( controls ) . PARTICIPANTS Participants were recruited into the study between May 1992 and March 2007 . Every fifth consecutively enrolled PD patient was selected from the clinical research data base . Unrelated AD ( n = 97 ) and control ( n = 99 ) participants were r and omly selected from the data base after matching for age , sex , race , APOE genotype , and geographic location . MAIN OUTCOME MEASURES Prevalence of suboptimal vitamin D and mean 25(OH)D concentrations . RESULTS Significantly more patients with PD ( 55 % ) had insufficient vitamin D than did controls ( 36 % ) or patients with AD ( 41 % ; P = .02 , chi(2)test ) . The mean ( SD ) 25(OH)D concentration in the PD cohort was significantly lower than in the AD and control cohorts ( 31.9 [ 13.6 ] ng/mL vs 34.8 [ 15.4 ] ng/mL and 37.0 [ 14.5 ] ng/mL , respectively ; P = .03 ) . CONCLUSIONS This report of 25(OH)D concentrations in a predominantly white PD cohort demonstrates a significantly higher prevalence of hypovitaminosis in PD vs both healthy controls and patients with AD . These data support a possible role of vitamin D insufficiency in PD . Further studies are needed to determine the factors contributing to these differences and eluci date the potential role of vitamin D in pathogenesis and clinical course of PD BACKGROUND There is a high incidence of hip fractures in patients with Parkinson disease ( PD ) .  Bone mineral density ( BMD ) is decreased in patients with PD , correlating with the immobilization-induced bone resorption and hypovitaminosis D with compensatory hyperparathyroidism . OBJECTIVE To evaluate the effectiveness of risedronate , an inhibitor of bone resorption , on osteoporosis and the risk of hip fractures in elderly men with PD . METHODS This was a 2-year , r and omized , double-blind , placebo-controlled trial . In a prospect i ve study of patients with PD , 121 patients received a daily dose of 2.5 mg risedronate and vitamin D2 1,000 IU for 2 years , and the remaining 121 received placebo and vitamin D2  1,000 IU . Incidence of hip fractures was compared between the two groups . RESULTS Nine patients sustained hip fractures in the placebo group , and three hip fractures occurred in the risedronate group . The relative risk of a hip fracture in the risedronate group vs the placebo group was 0.33 ( 95 % CI , 0.09 to 1.20 ) . BMD increased by 2.2 % in the risedronate group and decreased by 2.9 % in the placebo group ( p < 0.0001 ) . Urinary deoxypyridinoline , a bone resorption marker , decreased by 46.7 % in the risedronate group and by 33.0 % in the placebo group . CONCLUSION Treatment with risedronate and vitamin D2 increases bone mineral density in elderly men with Parkinson disease and reduces the risk of hip fractures Identification of dietary and lifestyle variables associated with the development of Parkinson ’s disease ( PD ) may offer pathogenetic clues and prevention opportunities . In a population -based prospect i ve cohort study , 26,173 participants in the EPIC – Greece cohort had sociodemographic , anthropometric  ,  medical , dietary  and  lifestyle variables  ascertained at enrolment and periodically reassessed with follow-up contacts . Based on these data , subjects were screened as possible PD cases if they ( 1 ) reported either a medical diagnosis of PD or use of anti-PD drugs and ( 2 ) did not report preceding causes of secondary parkinsonism . For diagnostic validation , possible incident PD cases were assessed by a focused 3-item telephone question naire . Cox proportional hazards regression was used to evaluate associations between potential predictors and incident PD . The main multivariate model included gender , age , marital status , schooling years , farming occupation , smoking status , caffeinated coffee , body mass index , physical activity and energy intake . Additional models included all above variables plus one dietary item at a time . Incidence rate adjusted to the European population was 16.9 per 100,000 person-years . In multivariate models , incident PD exhibited strong positive association with consumption of milk , but not cheese or yoghurt . This finding may help narrow down the search for potential dairy product components with a facilitatory role in PD . Concerning other dietary components , inverse association was found between polyunsaturated fat intake and incident PD . Also , inverse association was found with tobacco smoking , in line with previous studies , but not with caffeine Parkinson ’s disease ( PD ) and atypical parkinsonism ( AP ) cause a significant socioeconomic burden , but there is insufficient information about the total disease burden at a national level . Thus , the goal of this study was to estimate the excess direct and indirect costs of PD and AP in a national sample . Using records from the Danish National Patient Registry ( 1997–2007 ) , 13,400 PD and 647 AP patients were identified and compared with , respectively , 53,600 and 2,588 control cases r and omly selected with respect to age , gender , civil status , and geographic location .  Direct costs including frequencies of primary and sector contacts and procedures , and medication from primary and secondary sectors were obtained from the Danish Ministry of Health , the Danish Medicines Agency , and the National Health Security . Indirect costs , which included labor supply and social transfer payments , were based on income data derived from the Coherent Social Statistics . Patients with PD and AP had significantly higher rates of health-related contact and medication use and a higher socioeconomic cost . Furthermore , they had very low employment rates , and those in employment had a lower income level than employed control subjects . The annual mean excess health-related cost was € 6,500 ( $ 8,975/£5,543 ) and € 9,771 ( $ 13,491/£8,332 ) for each patient with PD and AP , respectively . In addition , the patients with PD and AP received an annual mean excess social transfer income of € 324 ( £ 276/$447 ) and € 844 ( £ 719/$1,165 ) , respectively . The employment- and health-related consequences could be identified up to 8 years before the first diagnosis and increased with disease advancement . PD and AP have major socioeconomic consequences for patients and society . The health effects are present for up to more than 8 years before a diagnosis of PD/AP The safety and tolerability of high dosages of coenzyme Q10 were studied in 17 patients with Parkinson 's disease ( PD ) in an open label study . The subjects received an escalating dosage of coenzyme Q10 - -1200 , 1800 , 2400 , and 3000 mg/day with a stable dosage of vitamin E ( alpha-tocopherol ) 1200 IU/day . The plasma level of coenzyme Q10  was measured at each dosage . Thirteen of the subjects achieved the maximal dosage , and adverse events were typically considered to be unrelated to coenzyme Q10 . The plasma level reached a plateau at the 2400 mg/day dosage and did not increase further at the 3000 mg/day dosage . Our data suggest that in future studies of coenzyme Q10 in PD , a dosage of 2400 mg/day ( with vitamin E/alpha-tocopherol 1200 IU/day ) is an appropriate highest dosage to be studied Incidence of a fracture , particularly in the hip joint , is high in elderly women with Parkinson 's disease ( PD ) , and this is due to the immobilization-induced bone resorption and vitamin D deficiency with reduced bone mineral density ( BMD ) . The objective of this study was to address the possibility that treatment with alendronate and vitamin D2 may reduce the incidence of hip fractures in elderly women with PD . PD patients were r and omly assigned to daily treatment with 5 mg alendronate ( n = 144 ) or a placebo combined with 1,000 IU of vitamin D2 ( n = 144 ) and followed for 2 years . Incidence of hip fractures in the two patient groups during the 2-year follow-up period was studied . At baseline , both groups of patients had low BMD with high levels of serum-ionized calcium and urinary deoxypyridinoline ( D-Pyr ) . Hip fractures occurred in 14 patients in the placebo group and 4 in the alendronate group . The relative risk for hip fractures in the alendronate group as compared with the placebo group was 0.29 ( 95 % CI , 0.10 - 0.85 ) . The number of hip fracture per 1,000 patient-years was 14 and 49 for the alendronate and placebo groups , respectively . In the alendronate group , serum calcium and urinary D-Pyr levels decreased significantly during the follow-up period , while the levels in the placebo group were increased . BMD increased by 3.1 % in the alendronate group and decreased by 2.8 % in the placebo group ( P < 0.01 ) . Treatment with alendronate and vitamin D2 increases BMD in elderly women with PD and leads to the prevention of hip fractures Article abstract -To detect morphologic abnormalities in Parkinson 's disease ( PD ) , we examined 30 patients with PD and 30 age- and sex-matched nonparkisonian controls by transcranial color-coded real-time sonography ( TCCS ) . In 12 severely affected PD patients , the echogenicity of the substantia nigra was distinctly increased . In the remaining 18 PD patients and in all controls , the substantia nigra was poorly visualized or nondetectable by TCCS . The degree of hyperechogenicity of the substania nigra closely correlated with the severity and duration of PD ( p < 0.001 ) . The increased echogenicity of the substania nigra notably results from nigral gliosis and reflects the stage of degeneration . NEUROLOGY 1995;45 : 182 - The Unified Parkinson 's Disease Rating Scale ( UPDRS ) is the main outcome measure in clinical trials of Parkinson 's disease ( PD ) . The minimal change that represents a clinical ly meaningful improvement is unknown . The objective of this study was to determine the minimal change on the UPDRS that represents a clinical ly meaningful improvement in early PD after 6 months of treatment . Data from two independent r and omized treatment trials over 6 months involving 603 patients with de novo PD were analyzed to determine the minimal clinical ly important change ( MCIC ) , referred to the status before treatment , for the UPDRS motor , activities of daily living ( ADL ) , and total scores . An anchor-based method using ratings on a seven-point global clinical improvement was used . A change of five points on the UPDRS motor part was found to be the most appropriate cutoff score for all Hoehn and Yahr stages I to III , and a change of eight points for the UDPRS total score . For the UDPRS ADL score , an MCIC of two points for Hoehn and Yahr stages I/I.5 and II and of three points for Hoehn and Yahr stage II.5/III was the most appropriate cutoff score . These data give the first estimate for cutoffs defining clinical ly important changes in UPDRS ADL and motor scores . Further studies using larger data bases from more diverse study population s are encouraged to better define and solidify the MCIC for the UPDRS BACKGROUND In Parkinson 's disease ( PD ) , motor and cognitive impairments interact to affect functional performance adversely . A valid mobility test , the Four Square Step Test ( FSST ) involves multidirectional stepping over obstacles . FSST performance may also be associated with cognitive performance . OBJECTIVES This study determined the feasibility and reliability of an obstacle-based FSST in older individuals with versus without PD , and evaluated the association of PD performance of FSST with tests of cognition . METHODS Thirty-one individuals with mild-moderate PD , evaluated while ON medications , completed the obstacle-based FSST , other mobility and cognitive measures . FSST  performance was compared between a PD participant sub-set ( n = 24 ) and 24 age-matched older adults . Data were analyzed with independent t-tests , correlations , and linear regression . RESULTS Obstacle-based FSST was feasible and reliable within sessions in those with PD . Median best FSST time among individuals with PD was 11.72 s ( 9.99 , 13.98 ) and FSST had concurrent validity with tests of mobility , and cognitive dual-tasking . Among cognitive tests , Trails Making Test B , which evaluates executive function , emerged as a sole contributor ( 49 % ) of variance .  FSST performance did not differ between those with PD and older adults . CONCLUSION The obstacle-based FSST is feasible and reliable in those with PD . The relationship between cognitive status and performance on the FSST did not appear to be strongly disease-stage dependent . Using FSST in the clinic may help assess the health status of a motor-cognitive interaction in individuals with PD The purpose of this paper was to document the impact of Parkinson 's disease ( PD ) upon patients using both a generic health status measure  ( the Short-form 36 health survey question naire , SF-36 ) and a disease-specific measure  ( the 39-item Parkinson 's Disease Question naire , PDQ-39 ) . Comparing the results of the SF-36 in this population with a similar aged group selected r and omly from two general practice s it was evident that the disease has considerable impact on general levels of functioning and well-being . Furthermore , other areas not contained on the SF-36 were found to be relevant to PD patients . It is suggested that the disease-specific measure will be of value , ideally alongside a generic measure , in studies aim ed at determining the impact of a treatment régimen upon PD patients , or to monitor the long-term progress of cohorts of patients with PD . The paper highlights the need for careful consideration of measures for evaluation Objective : To determine whether history of hypertension , hypercholesterolemia , or diabetes is associated with risk of Parkinson disease ( PD ) . Methods : Prospect i ve study among participants in two large cohorts : the Nurses ’ Health Study ( 121,046 women ) and the Health Professionals Follow-up Study ( 50,833 men ) . Mean duration of follow-up was 22.9 years in women , aged 30 to 55 years at baseline , and 12.6 years in men , aged 40 to 75 years at baseline . Relative risks ( RRs ) of PD were estimated from a Cox proportional hazards model adjusting for potential confounders . Results : We identified a total of 530 incident cases of PD during the follow-up .  Risk of PD was not associated with self-reported history of hypertension ( RR = 0.96 , 95 % CI = 0.80 to 1.15 ) , high cholesterol ( RR = 0.98 , 95 % CI = 0.82 to 1.19 ) , or diabetes ( RR = 1.04 , 95 % CI = 0.74 to 1.46 ) , after adjusting for age and smoking in pack-years . Risk of PD decreased modestly with increasing levels of self-reported total cholesterol  ( RR for a 50-mg/dL increase in total cholesterol = 0.86 , 95 % CI = 0.78 to 0.95 , p for trend = 0.02 ) , but use of cholesterol-lowering drugs was not associated with PD risk ( RR comparing users with nonusers = 0.85 , 95 % CI = 0.59 to 1.23 ) . Among individuals with PD , systolic blood pressure was similar to noncases up to the time of diagnosis but declined afterward . Conclusions : Results of this large prospect i ve study suggest that Parkinson disease risk is not significantly related to history of hypertension , hypercholesterolemia , or diabetes but may modestly decline with increasing blood cholesterol levels . GLOSSARY : ACE = angiotensin-converting enzyme ; BMI = body mass index ; DBP = diastolic blood pressure ; HPFS = Health Professionals Follow-up Study ; METS = metabolic equivalent tasks ; NHS = Nurses ’ Health Study ; NSAID = nonsteroidal anti-inflammatory drug ; PD = Parkinson disease ; RR = relative risk ; SBP = systolic blood pressure Abstract – DATA TOP is a double‐blind , multi‐center , placebo‐controlled clinical trial aim ed at slowing the decline of patients who are in the early stages of Parkinson 's disease ( PD ) . The specific aim is to determine whether or not chronic administration of deprenyl 10 mg per day and /or tocopherol 2000 IU per day to early , otherwise untreated PD patients will prolong the time until levodopa therapy is required to treat emerging disability .  Deprenyl and tocopherol exert antioxidative effects through separate but complementary mechanisms of action . A 2 X 2 factorial design allocates eligible subjects to one of four treatment groups : 1 ) deprenyl alone , 2 ) tocopherol alone , 3 ) deprenyl plus tocopherol , or 4 ) placebo .  Eligible subjects include early PD patients ( illness duration less than 5 years and in stages I and II ) , aged 30 to 79 , who are not taking or requiring any anti‐PD medications . The major response variable is the time period from r and omization until the blinded investigator judges levodopa necessary to treat emerging parkinsonian disability . R and omization is stratified to ensure that treatment assignments are balanced for each blinded investigator . Cerebrospinal fluid is sample d just prior to r and omization and one month after washout of experimental medications in order to help distinguish between symptomatic and protective effects of interventions . Based on pilot studies it is estimated that approximately 85 % of untreated PD patients will require levodopa within two years and a total sample size of 800 subjects will provide a 95 % likelihood for detecting a 10 % “ survival'’difference between experimental medications and placebo . Between September 1987 and November 1988 , 800 eligible subjects were enrolled in DATA TOP by 34 investigators of the Parkinson Study Group , representing research centers in the United States and Canada . Primary analyses of DATA TOP should be completed in 1991 Background Incidence of a fracture , particularly in the hip joint , is high in Parkinson 's disease ( PD ) , owing to the immobilisation-induced bone resorption and vitamin D deficiency with reduced bone mineral density ( BMD ) . The authors previously demonstrated the lowered incidence of hip fractures in PD by daily administration of risedronate and vitamin D. Methods This r and omised , double-blind , placebo-controlled study was conducted to determine the efficacy of 17.5 mg once-weekly risedronate in the prevention of hip fracture in women with PD . Patients were r and omly assigned to 17.5 mg risedronate once a week ( n=136 ) or a placebo ( n=136 ) combined with daily 1000 IU of ergocalciferol .  Incidence of hip fractures was compared between the two groups during the 2-year follow-up . Results Hip fractures occurred in 15 patients in the placebo group and 3 patients in the risedronate group . The RR for hip fractures in the risedronate group as compared with the placebo group was 0.20 ( 95 % CI 0.06 to 0.66 ) . In the risedronate group , serum calcium levels decreased during the follow-up , while the levels in the placebo group increased . BMD increased by 3.4 % in the risedronate group and decreased by 3.2 % in the placebo group ( p<0.01 ) . Conclusions Treatment with once-weekly risedronate and ergocalciferol prevents hip fractures in older women with PD Abstract Bilateral deep brain stimulation is an effective treatment for most motor signs of Parkinson 's disease ( PD ) , but the effects on cognitive functions are less clear . We therefore examined the effects of bilateral deep brain stimulation on central information processing , using the event-related auditory P300 potential as an electrophysiological index of mental chronometry . Eight PD patients with bilateral stimulators within the subthalamic nuclei ( STN ) and eight age-matched controls participated . Patients were examined after overnight withdrawal of antiparkinson medication  , both “ on ” and “ off ” stimulation ( in r and om sequence ) . The P300 and reaction times were recorded using an auditory oddball paradigm  . P300 latencies were prolonged in PD patients off stimulation ( 440 ± 45 ms ) compared to controls ( 397 ± 16 ms ; P < 0.05 ) . STN stimulation significantly reduced clinical disease severity ( as indexed by the Unified Parkinson 's Disease Rating Scale ) and markedly improved reaction times , but did not improve the prolonged P300 latencies in PD patients ( 429 ± 36 ms ) . These results confirm that P300 latencies are prolonged in PD . Significantly , bilateral STN stimulation did not improve this electrophysiological measure of cognitive impairment , even though motor disability was markedly reduced . This suggests that some dopa-responsive features are resistant to STN stimulation , possibly due to involvement of dopaminergic deficits outside the nigrostriatal pathway , which are not influenced by outflow from the STN ABSTRACT The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinson 's disease ( PD ) while controlling for the effects of social interaction . Thirty-three individuals with mild-to-moderate PD ( stage I – III ) were assigned to twenty 90-min tango ( n = 24 ) or education ( n = 9 ) lessons over 12 weeks . Disease severity , spatial cognition , balance , and fall incidence were evaluated pre- , post- , and 10–12 weeks postintervention . The authors evaluated differences using t tests and analyses of variance . Twenty-three tango and 8 education participants finished . Tango participants improved on disease severity ( p = .008 ) , and spatial cognition ( p = .021 ) compared with education participants . Tango participants also improved in balance ( p = .038 ) , and executive function ( p = .012 ) . Gains were maintained 10–12 weeks postintervention . Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD BACKGROUND CONTEXT There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson 's disease ( PD ) . PURPOSE This study aim ed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD , and the risk factors for poor outcomes . STUDY DESIGN This is a retrospective matched-pair cohort study . PATIENT SAMPLE Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination data base , a nationwide inpatient data base in Japan . OUTCOME MEASURES In-hospital mortality and occurrence of postoperative complications . METHODS For each patient with PD , we r and omly selected up to four age- and sex-matched controls in the same hospital in the same year . The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls . A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications ( surgical site infection , sepsis , pulmonary embolism , respiratory complications , cardiac events , stroke , and renal failure ) . Multiple imputation was used for missing data . RESULTS Among 154,278 patients undergoing spinal surgery , 1,423 patients with PD and 5,498 matched controls were identified .  Crude in-hospital mortality was higher in patients with PD than in controls ( 0.8 % vs. 0.3 % , respectively ) . The crude proportion of major complications was also higher in patients with PD ( 9.8 % vs. 5.1 % in controls ) . Postoperative delirium was more common in patients with PD ( 30.3 % ) than in controls ( 4.3 % ) . Parkinson 's disease was a significant predictor of major postoperative complications , even after adjusting for other risk factors ( odds ratio , 1.74 ; 95 % confidence intervals , 1.37 - 2.22 ; p<.001 ) . CONCLUSIONS Patients with PD had a significantly increased risk of postoperative complications following spinal surgery .  Postoperative delirium was the most frequently observed complication In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed Abstract Levodopa ( LD ) provides the most effective symptomatic treatment for Parkinson 's disease ( PD ) . Long-term treatment with LD , however , is often associated with the development of response fluctuations . Previous evidence suggests that the short half-life of LD is a major contributor to the development of response fluctuations and the wearing-off phenomenon in particular . Entacapone , a peripheral catechol-O-methyltransferase inhibitor has been shown to reduce OFF time and increase ON time in several therapeutic trials on PD patients treated with LD experiencing motor fluctuations . However , data are missing on the tolerability and efficacy of entacapone in elderly PD patients . This is of particular relevance , as most PD patients develop LD-related motor fluctuations after several years of disease duration . Here we report that addition of entacapone in a group of 45 elderly PD patients with LD-related motor fluctuations is well tolerated and efficacious in reducing the time , frequency and severity of the OFF periods . These data suggest that the drug can be used safely and efficaciously in elderly PD patients It has been demonstrated that physical training increases serum brain-derived neurotrophic factor ( BDNF ) in healthy people . The aim of this study was to establish the effect of physical training on the basal serum level of the BDNF in the Parkinson 's disease patients ( PD patients ) in relation to their health status . Twelve PD patients ( mean ± S.E.M : age 70 ± 3 years ; body mass 70 ± 2 kg ; height 163 ± 3 cm ) performed a moderate-intensity interval training ( three 1-hour training sessions weekly ) , lasting 8 weeks . Basal serum BDNF in the PD patients before training amounted to 10,977 ± 756 pg x mL(-1 ) and after 8 weeks of training it has increased to 14,206 ± 1256 pg x mL(-1 ) ( i.e. by 34 % , P=0.03 ) . This was accompanied by an attenuation of total Unified Parkinson 's Disease Rating Scale ( UPDRS ) ( P=0.01 ) . The training result ed also in a decrease of basal serum soluble vascular cell adhesion molecule 1 ( sVCAM-1 ) ( P=0.001 ) and serum tumor necrosis factor-α ( TNF-α ) ( P=0.03 ) levels . We have concluded that the improvement of health status of the Parkinson 's disease patients  after training could be related to the increase of serum BDNF level caused by the attenuated inflammation in those patients
Low vitamin D levels are associated with an increased risk of PD
Abstract To estimate the associations between vitamin D status and Parkinson ’s disease ( PD ) .