Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Amyotrophic lateral sclerosis (ALS) is a progressive and uniformly fatal neurodegenerative disease. A plethora of genetic factors have been identified that drive the degeneration of motor neurons in ALS, increase susceptibility to the disease or influence the rate of its progression. Emerging themes include dysfunction in RNA metabolism and protein homeostasis, with specific defects in nucleocytoplasmic trafficking, the induction of stress at the endoplasmic reticulum and impaired dynamics of ribonucleoprotein bodies such as RNA granules that assemble through liquid-liquid phase separation. Extraordinary progress in understanding the biology of ALS provides new reasons for optimism that meaningful therapies will be identified.

Decoding ALS: from genes to mechanism

Vitamin B12 deficiency causes reversible megaloblastic anemia, demyelinating disease, or both. Current assays have insufficient sensitivity and specificity; methylmalonic acid levels are useful to confirm diagnosis. Parenteral or high-dose oral vitamin B12 is effective therapy.

https://www.nejm.org/doi/pdf/10.1056/NEJMcp1113996

Vitamin B12 Deficiency

The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia. Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases. This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.

/pdf/long-term-health-benefits-of-physical-activity-a-systematic-3a83ak0w3l.pdf

Long-term health benefits of physical activity – a systematic review of longitudinal studies

Background 
Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail.

Do the Health Benefits of Cycling Outweigh the Risks

Quantitative description of SARS-CoV-2 RT-PCR, a cohort of 76 COVID-19 older hospitalized adults.

Service de médecine interne, endocrinologie et nutrition, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 trasbourg cedex, France Laboratoire d’hormonologie, LBMMS, Groupement hospitalier est, hospices civils de Lyon, 69677 Bron cedex, France Service EDN, CHU de Nancy, 54500 Vandoeuvre-les-Nancy, France Service de médecine nucléaire, Institut universitaire de cancérologie de Toulouse oncopole, 31059 Toulouse, France Groupement hospitalier est, Fédération d’endocrinologie, hospices civils de Lyon, Lyon, France Fédération des services de cardiologie, CHU de Rangueil, Toulouse, France Centre d’imagerie cardiaque, CHU de Toulouse, Toulouse, France Cabinet d’endocrinologie et diabétologie, 71, rue de La Louvière, 59000 Lille, France Endocrinologist, clinique Mathilde, 7, boulevard de l’Europe, 76100 Rouen, France Espace santé, 8, rue de Lattre de Tassigny, 69350 La Mulatiere, France Inserm U1016, CNRS UMR8104, service d’endocrinologie, université de Paris, Institut Cochin, hôpital Cochin, AP–HP, 75014 Paris, France Pôle de gériatrie, hôpitaux universitaires de Strasbourg, hôpital de la Robertsau, 67000 Strasbourg, France Service d’endocrinologie et maladies métaboliques, CHU de Larrey, 31059 Toulouse, France

Management of thyroid dysfunctions in the elderly. French Endocrine Society consensus 2019 guidelines. Short version.

[Biermer's anemia corrected by oral vitamin B12].

In the setting of vitamin B12 (cobalamin) deficiency, new routes (oral and nasal) of vitamin B12 replacement have being developed and studied. In Biermer’s disease, two prospective controlled randomized studies, a recent systematic review by the Cochrane group and four prospective studies were found and provide evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency. The efficacy was documented with a marked improvement in serum vitamin B12 levels or normalization of this latter. The clinical efficacy was also established with an improvement or a normalization of hematological parameters. The safety was documented in the majority of the studies. In this setting, oral replacement will be of interest for clinicians to avoid painful and administration difficulties, and cost of monthly injections. To date, effect of oral vitamin B12 treatment has not yet been adequately documented in patients presenting with severe neurological manifestations. *Correspondence to: E Andrès, Service de Médecine Interne, Diabète et Maladies Métaboliques, Clinique Médicale B, Hôpital Civil – Hôpitaux Universitaires de Strasbourg, 1 porte de l’Hôpital, 67091 Strasbourg Cedex, France, Tel: 33388115066; Fax: 33388116262; E-mail: Emmanuel.ANDRES@chru-strasbourg.fr

State of art of oral vitamin B12 (cobalamin) treatment in Biermer's disease (pernicious anemia)

Introduction: Parkinsonian gait in older persons is a major risk factor for recurrent falling. This prospective, longitudinal study (named EVAMAR-AGEX) aimed to validate the threshold value of two or more falls per year for distinguishing non-recurrent (NRF) from recurrent fallers (RF), to explore predictive factors for recurrent falling, and to identify factors which underlie the transition of patients from NRF to RF. The study took place over 2 years, with an intermediate analysis at 1 year of follow-up. Herein, we report results after 2 years of follow-up. Methods: Participants over the age of 65, diagnosed with parkinsonian gait, were followed over the course of 2 years. Induced parkinsonian syndrome and uncontrolled orthostatic hypotension were excluded. Assessments of motor, visual, and cognitive functions were carried out during visits at baseline. Between visits at 12 and 24 months of follow-up, data were collected by phone call every 2 months (falls, traumatic falls, hospitalizations, cognitive fluctuations, delirium, and mortality). Odds ratios (ORs) for a panel of predictive factors for recurrent falling were established using a Bayesian model. Results: Sixty-six of the 79 initially enrolled participants progressed to the second year of the study, with a mean age of 80.57 (SD 6.3), 56% male, presenting parkinsonian gait (53% Parkinson’s disease, 15% atypical neurodegenerative parkinsonism, 21% vascular parkinsonism, and 11% diffuse Lewy body disease). At 2 years of follow-up, 67% were RF. Univariate analysis revealed a previous history of falls to be the most significant predictive factor of recurrent falls (OR 13.16, credibility interval [CrI] [95%] 4.04–53.73), and this was reinforced at 2 years of follow-up compared to the intermediate 1-year analysis (OR 11.73, CrI [95%] 4.33–35.28). Multivariate analysis confirmed a previous history of falls (OR 13.20, CrI [95%] 3.29–72.08) and abnormal posture (OR 3.59, CrI [95%] 1.37–11.26) to be predictive factors for recurrent falling. Cognitive decline and fluctuating cognition were associated with the transition from NRF to RF (−3.5 MMSE points for participants transitioning from NRF to RF). Conclusion: Within this population of older persons presenting parkinsonian gait, a previous history of falls and abnormal posture may be used to easily identify individuals at risk of recurrent falls. Cognitive decline and fluctuations may underlie the transition of NRF to RF.

Georges Kaltenbach

Papers

Quantitative description of SARS-CoV-2 RT-PCR, a cohort of 76 COVID-19 older hospitalized adults.

Management of thyroid dysfunctions in the elderly. French Endocrine Society consensus 2019 guidelines. Short version.

[Biermer's anemia corrected by oral vitamin B12].

State of art of oral vitamin B12 (cobalamin) treatment in Biermer's disease (pernicious anemia)

Older Persons Displaying Parkinsonian Gait: Prediction and Explanation of the Recurrent Falling Phenomenon and Its Related Poor Prognosis