Showing papers by "Bastiaan R. Bloem published in 2017"
TL;DR: The limitations that people with Parkinson's disease may encounter despite optimal medical management are addressed, and both the unique and shared approaches that physical therapists and occupational therapists can apply in treating these limitations are clarified.
Abstract: Current medical management is only partially effective in controlling the symptoms of Parkinson's disease. As part of comprehensive multidisciplinary care, physical therapy and occupational therapy aim to support people with Parkinson's disease in dealing with the consequences of their disease in daily activities. In this narrative review, we address the limitations that people with Parkinson's disease may encounter despite optimal medical management, and we clarify both the unique and shared approaches that physical therapists and occupational therapists can apply in treating these limitations.
92 citations
TL;DR: Cognitive domains are assessed using fMRI among NMC of both LRRK2 and GBA mutations to better understand pre-motor cognitive functions in these populations and could indicate that the higher activation patterns in the incongruent Stroop condition among GBA-NMC compared to L RRK2-N MC and NMNC may represent a compensatory mechanism that enables adequate cognitive performance.
Abstract: Mutations in the GBA and LRRK2 genes account for one-third of the prevalence of Parkinson's disease (PD) in Ashkenazi Jews. Non-manifesting carriers (NMC) of these mutations represent a population at risk for future development of PD. PD patient who carry mutations in the GBA gene demonstrates more significant cognitive decline compared to idiopathic PD patients. We assessed cognitive domains using fMRI among NMC of both LRRK2 and GBA mutations to better understand pre-motor cognitive functions in these populations. Twenty-one LRRK2-NMC, 10 GBA-NMC, and 22 non-manifesting non-carriers (NMNC) who participated in this study were evaluated using the standard questionnaires and scanned while performing two separate cognitive tasks; a Stroop interference task and an N-Back working memory task. Cerebral activation patterns were assessed using both whole brain and predefined region of interest (ROI) analysis. Subjects were well matched in all demographic and clinical characteristics. On the Stroop task, in spite of similar behavior, GBA-NMC demonstrated increased task-related activity in the right medial frontal gyrus and reduced task-related activity in the left lingual gyrus compared to both LRRK2-NMC and NMNC. In addition, GBA-NMC had higher activation patterns in the incongruent task compared to NMNC in the left medial frontal gyrus and bilateral precentral gyrus. No whole-brain differences were noted between groups on the N-Back task. Paired cognitive and task-related performance between GBA-NMC, LRRK2-NMC, and NMNC could indicate that the higher activation patterns in the incongruent Stroop condition among GBA-NMC compared to LRRK2-NMC and NMNC may represent a compensatory mechanism that enables adequate cognitive performance.
20 citations
TL;DR: A retrospective study of all outpatients of the vertigo outpatient clinic of the Department of Neurology as well as the German Center for Vertigo and Balance Disorders, Munich University Hospital between 2004 and 2013 with primary diagnoses of BPPV, MD, and VN finds that the diagnostic criteria for all three peripheral vestibular syndromes followed the national guidelines.
Abstract: Patients in advanced (sometimes earlier) stages of Parkinson’s disease (PD) frequently have balance and gait disorders with consecutive falls. The pathophysiology is multifactorial, involving several contributing factors, e.g., freezing, festination, frontal executive dysfunction, and medication side effects [1]. Dizziness in PD is often attributed to orthostatic hypotension; however, the role of vestibular causes of vertigo and dizziness in this particular patient group is largely unknown. A carefully conducted cohort study in a parkinsonism outpatient clinic recently reported that 5.3% of patients with PD (mean age 72 years) and up to 11% of PD patients who reported dizziness symptoms may have benign paroxysmal positional vertigo (BPPV) [2]. BPPV is a mechanical disorder of the inner ear mostly caused by dislodged otoconia that move from the otolith macula beds into a semicircular canal (canalolithiasis) [3, 4]. Characteristically, brief attacks of vertigo are elicited by rapid changes in head position relative to gravity. The reasons for the increased prevalence of BPPV in PD (up to 11%) are unclear; hypo-/bradykinesia is suggested to predispose to canaloand cupulolithiasis [3] and/or to reduce spontaneous repositioning maneuvers during physiological head movements. A multicenter observational study found that recurrent BPPV significantly increased comorbid disorders in the elderly (i.e., hypertension and diabetes) [5]. It was suggested that a systemic disease might negatively affect the posterior labyrinth, frequently causing otolith detachment [5]. Consequently, the presence of the systemic disease PD might also be an independent risk factor for BPPV. The Dutch study [2] raised two questions: is the prevalence of PD increased in patients with diagnosed BPPV, and does it differ from that in patients with other peripheral vestibular syndromes, e.g., Menière’s disease (MD) or vestibular neuritis (VN)? To answer these questions, we conducted a retrospective study of all outpatients of the vertigo outpatient clinic of the Department of Neurology as well as the German Center for Vertigo and Balance Disorders, Munich University Hospital, between 2004 and 2013 with primary diagnoses of BPPV, MD, and VN (total of 4551 patients). The diagnostic criteria for all three peripheral vestibular syndromes followed the national guidelines (German Society of Neurology, http://www.dgn.org/leitlinien) and the consensus statements of the International Barany Society for Neuro-Otology (http://www.baranysociety.nl). All patients routinely underwent a complete clinical neurological workup including patient history taking and neurological examination concerning symptoms of parkinsonism (e.g., disturbance of smell, rigidity, tremor, bradykinesia, posture, retro-/propulsion, mikrographia, etc.) and a detailed neuro-ophthalmological and neuro-otological work-up (e.g., Frenzel’s glasses, fundus photography by a laser ophthalmoscope, standardized testing for tilt of the & Sandra Becker-Bense sandra.bense@med.uni-muenchen.de
4 citations