Damian McNamara

HOLLYWOOD, FLA. — A cohort of 91 continent black women had a 22% higher maximal urethral closure pressure (mean 68.0 cm H₂O) than a group of 46 continent white women (55.8 cm H₂O) in a study.

Dr. John O. DeLancey and his colleagues previously assessed 335 community-dwelling women both with and without urge and stress urinary incontinence. They found the prevalence of urinary incontinence was 15% for black women and 33% for white women (J. Urol. 2008;179:1455-60).

The only other difference between groups was that 39% of white women with incontinence reported pure stress incontinence symptoms, compared with 25% of black women. In contrast, 24% of black women reported pure urge incontinence symptoms, compared with 11% of white women.

So they decided to search further. They conducted urethral pressure profilometry, the Q-tips test, a cystometrogram, Pelvic Organ Prolapse Quantification, and a vaginal closure force test for each of the 335 participants. The National Institutes of Health sponsored the research.

The white cohort consisted of 46 continent women, 55 with stress urinary incontinence, and 44 with urge urinary incontinence. The black cohort was composed of 91 continent women, 47 with stress urinary incontinence, and 52 with urge urinary incontinence. The inclusion of continent women was a strength of the study, Dr. DeLancey said at the annual meeting of the American Urogynecologic Society.

They found no significant differences between black and white women in terms of the Q-tips test results at rest or during a Kegel contraction or Valsalva maneuver. In addition, there were no significant differences between groups in ureterovaginal support on physical examination or the vaginal closure force test at rest or with contraction.

“When we asked women to perform a Kegel contraction, urge incontinent white women were less able to contract than stress incontinent white women,” said Dr. DeLancey, professor of obstetrics and gynecology and director of the Pelvic Floor Research Group at the University of Michigan in Ann Arbor. This difference was not found among black women.

In addition to overall differences in maximal urethral closure pressures (MUCPs) by race, they found some subgroup differences as well. For example, continent white women had 19% higher MUCPs than white women with either stress or urinary urge incontinence. Among white women, the group with urge urinary incontinence had the lowest increases in urethral closure pressure during muscle contraction, 45% lower than continent women and 43% lower than those with stress incontinence.

Disclosures: None was reported.

HOLLYWOOD, FLA. — A cohort of 91 continent black women had a 22% higher maximal urethral closure pressure (mean 68.0 cm H₂O) than a group of 46 continent white women (55.8 cm H₂O) in a study.

Dr. John O. DeLancey and his colleagues previously assessed 335 community-dwelling women both with and without urge and stress urinary incontinence. They found the prevalence of urinary incontinence was 15% for black women and 33% for white women (J. Urol. 2008;179:1455-60).

The only other difference between groups was that 39% of white women with incontinence reported pure stress incontinence symptoms, compared with 25% of black women. In contrast, 24% of black women reported pure urge incontinence symptoms, compared with 11% of white women.

So they decided to search further. They conducted urethral pressure profilometry, the Q-tips test, a cystometrogram, Pelvic Organ Prolapse Quantification, and a vaginal closure force test for each of the 335 participants. The National Institutes of Health sponsored the research.

The white cohort consisted of 46 continent women, 55 with stress urinary incontinence, and 44 with urge urinary incontinence. The black cohort was composed of 91 continent women, 47 with stress urinary incontinence, and 52 with urge urinary incontinence. The inclusion of continent women was a strength of the study, Dr. DeLancey said at the annual meeting of the American Urogynecologic Society.

They found no significant differences between black and white women in terms of the Q-tips test results at rest or during a Kegel contraction or Valsalva maneuver. In addition, there were no significant differences between groups in ureterovaginal support on physical examination or the vaginal closure force test at rest or with contraction.

“When we asked women to perform a Kegel contraction, urge incontinent white women were less able to contract than stress incontinent white women,” said Dr. DeLancey, professor of obstetrics and gynecology and director of the Pelvic Floor Research Group at the University of Michigan in Ann Arbor. This difference was not found among black women.

In addition to overall differences in maximal urethral closure pressures (MUCPs) by race, they found some subgroup differences as well. For example, continent white women had 19% higher MUCPs than white women with either stress or urinary urge incontinence. Among white women, the group with urge urinary incontinence had the lowest increases in urethral closure pressure during muscle contraction, 45% lower than continent women and 43% lower than those with stress incontinence.

Disclosures: None was reported.

HOLLYWOOD, FLA. — A cohort of 91 continent black women had a 22% higher maximal urethral closure pressure (mean 68.0 cm H₂O) than a group of 46 continent white women (55.8 cm H₂O) in a study.

Dr. John O. DeLancey and his colleagues previously assessed 335 community-dwelling women both with and without urge and stress urinary incontinence. They found the prevalence of urinary incontinence was 15% for black women and 33% for white women (J. Urol. 2008;179:1455-60).

The only other difference between groups was that 39% of white women with incontinence reported pure stress incontinence symptoms, compared with 25% of black women. In contrast, 24% of black women reported pure urge incontinence symptoms, compared with 11% of white women.

So they decided to search further. They conducted urethral pressure profilometry, the Q-tips test, a cystometrogram, Pelvic Organ Prolapse Quantification, and a vaginal closure force test for each of the 335 participants. The National Institutes of Health sponsored the research.

The white cohort consisted of 46 continent women, 55 with stress urinary incontinence, and 44 with urge urinary incontinence. The black cohort was composed of 91 continent women, 47 with stress urinary incontinence, and 52 with urge urinary incontinence. The inclusion of continent women was a strength of the study, Dr. DeLancey said at the annual meeting of the American Urogynecologic Society.

They found no significant differences between black and white women in terms of the Q-tips test results at rest or during a Kegel contraction or Valsalva maneuver. In addition, there were no significant differences between groups in ureterovaginal support on physical examination or the vaginal closure force test at rest or with contraction.

“When we asked women to perform a Kegel contraction, urge incontinent white women were less able to contract than stress incontinent white women,” said Dr. DeLancey, professor of obstetrics and gynecology and director of the Pelvic Floor Research Group at the University of Michigan in Ann Arbor. This difference was not found among black women.

In addition to overall differences in maximal urethral closure pressures (MUCPs) by race, they found some subgroup differences as well. For example, continent white women had 19% higher MUCPs than white women with either stress or urinary urge incontinence. Among white women, the group with urge urinary incontinence had the lowest increases in urethral closure pressure during muscle contraction, 45% lower than continent women and 43% lower than those with stress incontinence.

Disclosures: None was reported.

Major Finding: The combination of behavioral therapy and pessary placement for women with stress urinary incontinence is not significantly better than the single treatments alone.

Data Source: A multicenter study of 445 women with stress urinary incontinence.

Disclosures: None reported.

HOLLYWOOD, FLA. — A combination of clinical therapies is not always superior to a single treatment alone, as in the combined use of behavioral treatment and pessary placement for women with stress urinary incontinence, based on a multicenter study of 445 women.

“Because there was no significant difference versus behavioral therapy, we cannot say that combined therapy was better than single treatments,” Dr. Holly E. Richter said.

“Nonsurgical options should be offered, but there is surprisingly little evidence available for these options,” Dr. Richter said at the annual meeting of the American Urogynecologic Society.

To find out more, Dr. Richter and her associate Dr. Kathryn L. Burgio with the Pelvic Floor Disorder Network studied 445 women with stress urinary incontinence. They randomized 150 participants to combination therapy, 146 to behavioral treatment, and 149 to a pessary to determine if two treatments are, in fact, better than one.

At 3 months, they found no significant differences in the percentage reporting “much better” or “very much better” on the Patient Global Impression of Improvement (PGI-I) scale. This outcome was reported by 53% of the combination group, 49% of the behavioral group, and 40% of the pessary group in an intent-to-treat analysis of the data.

“How has this [study] changed your practice?” a meeting attendee asked. Dr. Richter replied, “It has changed my counseling of patients. This trial is giving us a little more insight into how we may address these treatments with our patients.” For example, even though a greater percentage of women reported improvement, “we know some women are not going to adhere to behavioral therapy.” Treatment of stress urinary incontinence with a pessary may be more appropriate for less-motivated patients, said Dr. Richter, professor of obstetrics and gynecology at the University of Alabama at Birmingham.

Behavioral therapy consisted of four visits at 2-week intervals conducted by centrally trained interventionists. The protocol included pelvic muscle training.

The pessary group had a continence ring or dish fitted by a physician or nurse.

Patients' mean age was 50 years. A total of 46% had stress-only incontinence, and 54% had stress-predominant mixed incontinence at baseline. A total of 21% reported a prior nonsurgical treatment, and 6% reported prior surgery for their stress urinary incontinence.

At 3 months, 44% in the combined group, 49% of the behavioral group, and 33% of the pessary patients reported no bothersome stress urinary incontinence.

A total of 79% of the combination group, 75% of the behavioral group, and 63% of the pessary group said they were satisfied with their treatment. “At 3 months, behavioral therapy resulted in fewer incontinence symptoms and greater satisfaction than a pessary,” Dr. Richter said. However, “the difference in outcome did not persist in any measure in any group up to 12 months.”

Major Finding: The combination of behavioral therapy and pessary placement for women with stress urinary incontinence is not significantly better than the single treatments alone.

Data Source: A multicenter study of 445 women with stress urinary incontinence.

Disclosures: None reported.

HOLLYWOOD, FLA. — A combination of clinical therapies is not always superior to a single treatment alone, as in the combined use of behavioral treatment and pessary placement for women with stress urinary incontinence, based on a multicenter study of 445 women.

“Because there was no significant difference versus behavioral therapy, we cannot say that combined therapy was better than single treatments,” Dr. Holly E. Richter said.

“Nonsurgical options should be offered, but there is surprisingly little evidence available for these options,” Dr. Richter said at the annual meeting of the American Urogynecologic Society.

To find out more, Dr. Richter and her associate Dr. Kathryn L. Burgio with the Pelvic Floor Disorder Network studied 445 women with stress urinary incontinence. They randomized 150 participants to combination therapy, 146 to behavioral treatment, and 149 to a pessary to determine if two treatments are, in fact, better than one.

At 3 months, they found no significant differences in the percentage reporting “much better” or “very much better” on the Patient Global Impression of Improvement (PGI-I) scale. This outcome was reported by 53% of the combination group, 49% of the behavioral group, and 40% of the pessary group in an intent-to-treat analysis of the data.

“How has this [study] changed your practice?” a meeting attendee asked. Dr. Richter replied, “It has changed my counseling of patients. This trial is giving us a little more insight into how we may address these treatments with our patients.” For example, even though a greater percentage of women reported improvement, “we know some women are not going to adhere to behavioral therapy.” Treatment of stress urinary incontinence with a pessary may be more appropriate for less-motivated patients, said Dr. Richter, professor of obstetrics and gynecology at the University of Alabama at Birmingham.

Behavioral therapy consisted of four visits at 2-week intervals conducted by centrally trained interventionists. The protocol included pelvic muscle training.

The pessary group had a continence ring or dish fitted by a physician or nurse.

Patients' mean age was 50 years. A total of 46% had stress-only incontinence, and 54% had stress-predominant mixed incontinence at baseline. A total of 21% reported a prior nonsurgical treatment, and 6% reported prior surgery for their stress urinary incontinence.

At 3 months, 44% in the combined group, 49% of the behavioral group, and 33% of the pessary patients reported no bothersome stress urinary incontinence.

A total of 79% of the combination group, 75% of the behavioral group, and 63% of the pessary group said they were satisfied with their treatment. “At 3 months, behavioral therapy resulted in fewer incontinence symptoms and greater satisfaction than a pessary,” Dr. Richter said. However, “the difference in outcome did not persist in any measure in any group up to 12 months.”

Major Finding: The combination of behavioral therapy and pessary placement for women with stress urinary incontinence is not significantly better than the single treatments alone.

Data Source: A multicenter study of 445 women with stress urinary incontinence.

Disclosures: None reported.

HOLLYWOOD, FLA. — A combination of clinical therapies is not always superior to a single treatment alone, as in the combined use of behavioral treatment and pessary placement for women with stress urinary incontinence, based on a multicenter study of 445 women.

“Because there was no significant difference versus behavioral therapy, we cannot say that combined therapy was better than single treatments,” Dr. Holly E. Richter said.

“Nonsurgical options should be offered, but there is surprisingly little evidence available for these options,” Dr. Richter said at the annual meeting of the American Urogynecologic Society.

To find out more, Dr. Richter and her associate Dr. Kathryn L. Burgio with the Pelvic Floor Disorder Network studied 445 women with stress urinary incontinence. They randomized 150 participants to combination therapy, 146 to behavioral treatment, and 149 to a pessary to determine if two treatments are, in fact, better than one.

At 3 months, they found no significant differences in the percentage reporting “much better” or “very much better” on the Patient Global Impression of Improvement (PGI-I) scale. This outcome was reported by 53% of the combination group, 49% of the behavioral group, and 40% of the pessary group in an intent-to-treat analysis of the data.

“How has this [study] changed your practice?” a meeting attendee asked. Dr. Richter replied, “It has changed my counseling of patients. This trial is giving us a little more insight into how we may address these treatments with our patients.” For example, even though a greater percentage of women reported improvement, “we know some women are not going to adhere to behavioral therapy.” Treatment of stress urinary incontinence with a pessary may be more appropriate for less-motivated patients, said Dr. Richter, professor of obstetrics and gynecology at the University of Alabama at Birmingham.

Behavioral therapy consisted of four visits at 2-week intervals conducted by centrally trained interventionists. The protocol included pelvic muscle training.

The pessary group had a continence ring or dish fitted by a physician or nurse.

Patients' mean age was 50 years. A total of 46% had stress-only incontinence, and 54% had stress-predominant mixed incontinence at baseline. A total of 21% reported a prior nonsurgical treatment, and 6% reported prior surgery for their stress urinary incontinence.

At 3 months, 44% in the combined group, 49% of the behavioral group, and 33% of the pessary patients reported no bothersome stress urinary incontinence.

A total of 79% of the combination group, 75% of the behavioral group, and 63% of the pessary group said they were satisfied with their treatment. “At 3 months, behavioral therapy resulted in fewer incontinence symptoms and greater satisfaction than a pessary,” Dr. Richter said. However, “the difference in outcome did not persist in any measure in any group up to 12 months.”

Major Finding: Older U.S. women received a growing proportion of surgeries for stress urinary incontinence on an inpatient basis between 1993 and 2006.

Data Source: A study of the Nationwide Inpatient Sample to ascertain trends in stress urinary incontinence surgeries.

Disclosures: None reported.

HOLLYWOOD, FLA. — Women 65 years and older account for a growing proportion of surgeries for stress urinary incontinence in the United States, based on a study of inpatient trends from 1993 to 2006.

“Providers are not shying away from procedures in the elderly,” Dr. Alison Catherine Weidner said at the annual meeting of the American Urogynecologic Society.

This study of the Nationwide Inpatient Sample (NIS) also reveals a dramatic increase in stress urinary incontinence (SUI) procedures around 2002. This spike in numbers coincides with the 2001 publication supporting the efficacy of midurethral slings, Dr. Weidner said (Int. Urogynecol. J. Pelvic Floor Dysfunct. 2001;12[suppl. 2]:S5-8).

The promotion of new tension-free vaginal tape systems for midurethral slings may account for some of the increase, a meeting attendee commented.

“It was increased clinical use in response to marketing, but also to good data,” replied Dr. Weidner, chief of the division of urogynecology in the department of obstetrics and gynecology at Duke University Medical Center, Durham, N.C. The database tracks the number of procedures by ICD-9 coding.

Another meeting attendee asked if any coding changes could account for the jump.

“Coding practices were actually quite stable,” Dr. Weidner said. “We compared ICD-9 coding books from year to year, and the wording did not change much.”

The total number of SUI inpatient surgeries increased over time—from about 18,500 in 1993 to 114,600 in 2002; the number fell slightly to about 95,600 in 2006, the last year of the study.

Dr. Weidner, lead author Dr. Jennifer M. Wu, and their associates assessed both urinary incontinence ICD-9 diagnosis code and ICD-9 SUI procedure codes to calculate the total number of such surgeries per year in women aged 20 and older.

The rates of SUI procedures in elderly versus nonelderly patients (defined as those younger than age 65 years) changed over time as well. “In 1993, rates were fairly similar,” Dr. Weidner said. But rates were significantly different in 2006: 124/100,000 elderly vs. 76/100,000 among nonelderly patients that year. Age-adjusted rates were calculated using 2000 U.S. census data.

“Since 1997, the introduction of the midurethral sling [has] changed practice patterns,” Dr. Weidner said. For example, in 1993, “other repair” of SUI accounted for 34% of procedures. “There was a dramatic shift in 2006 to other repair of SUI being most common at 72%,” Dr. Weidner said. In the first year of the study, retropubic suspensions comprised 45% of procedures but only 17% in 2006. At the same time significant decreases in “less effective” procedures such as Kelly plication and needle suspensions were observed, with rates dropping below 2% each in 2006.

Major Finding: Older U.S. women received a growing proportion of surgeries for stress urinary incontinence on an inpatient basis between 1993 and 2006.

Data Source: A study of the Nationwide Inpatient Sample to ascertain trends in stress urinary incontinence surgeries.

Disclosures: None reported.

HOLLYWOOD, FLA. — Women 65 years and older account for a growing proportion of surgeries for stress urinary incontinence in the United States, based on a study of inpatient trends from 1993 to 2006.

“Providers are not shying away from procedures in the elderly,” Dr. Alison Catherine Weidner said at the annual meeting of the American Urogynecologic Society.

This study of the Nationwide Inpatient Sample (NIS) also reveals a dramatic increase in stress urinary incontinence (SUI) procedures around 2002. This spike in numbers coincides with the 2001 publication supporting the efficacy of midurethral slings, Dr. Weidner said (Int. Urogynecol. J. Pelvic Floor Dysfunct. 2001;12[suppl. 2]:S5-8).

The promotion of new tension-free vaginal tape systems for midurethral slings may account for some of the increase, a meeting attendee commented.

“It was increased clinical use in response to marketing, but also to good data,” replied Dr. Weidner, chief of the division of urogynecology in the department of obstetrics and gynecology at Duke University Medical Center, Durham, N.C. The database tracks the number of procedures by ICD-9 coding.

Another meeting attendee asked if any coding changes could account for the jump.

“Coding practices were actually quite stable,” Dr. Weidner said. “We compared ICD-9 coding books from year to year, and the wording did not change much.”

The total number of SUI inpatient surgeries increased over time—from about 18,500 in 1993 to 114,600 in 2002; the number fell slightly to about 95,600 in 2006, the last year of the study.

Dr. Weidner, lead author Dr. Jennifer M. Wu, and their associates assessed both urinary incontinence ICD-9 diagnosis code and ICD-9 SUI procedure codes to calculate the total number of such surgeries per year in women aged 20 and older.

The rates of SUI procedures in elderly versus nonelderly patients (defined as those younger than age 65 years) changed over time as well. “In 1993, rates were fairly similar,” Dr. Weidner said. But rates were significantly different in 2006: 124/100,000 elderly vs. 76/100,000 among nonelderly patients that year. Age-adjusted rates were calculated using 2000 U.S. census data.

“Since 1997, the introduction of the midurethral sling [has] changed practice patterns,” Dr. Weidner said. For example, in 1993, “other repair” of SUI accounted for 34% of procedures. “There was a dramatic shift in 2006 to other repair of SUI being most common at 72%,” Dr. Weidner said. In the first year of the study, retropubic suspensions comprised 45% of procedures but only 17% in 2006. At the same time significant decreases in “less effective” procedures such as Kelly plication and needle suspensions were observed, with rates dropping below 2% each in 2006.

Major Finding: Older U.S. women received a growing proportion of surgeries for stress urinary incontinence on an inpatient basis between 1993 and 2006.

Data Source: A study of the Nationwide Inpatient Sample to ascertain trends in stress urinary incontinence surgeries.

Disclosures: None reported.

HOLLYWOOD, FLA. — Women 65 years and older account for a growing proportion of surgeries for stress urinary incontinence in the United States, based on a study of inpatient trends from 1993 to 2006.

“Providers are not shying away from procedures in the elderly,” Dr. Alison Catherine Weidner said at the annual meeting of the American Urogynecologic Society.

This study of the Nationwide Inpatient Sample (NIS) also reveals a dramatic increase in stress urinary incontinence (SUI) procedures around 2002. This spike in numbers coincides with the 2001 publication supporting the efficacy of midurethral slings, Dr. Weidner said (Int. Urogynecol. J. Pelvic Floor Dysfunct. 2001;12[suppl. 2]:S5-8).

The promotion of new tension-free vaginal tape systems for midurethral slings may account for some of the increase, a meeting attendee commented.

“It was increased clinical use in response to marketing, but also to good data,” replied Dr. Weidner, chief of the division of urogynecology in the department of obstetrics and gynecology at Duke University Medical Center, Durham, N.C. The database tracks the number of procedures by ICD-9 coding.

Another meeting attendee asked if any coding changes could account for the jump.

“Coding practices were actually quite stable,” Dr. Weidner said. “We compared ICD-9 coding books from year to year, and the wording did not change much.”

The total number of SUI inpatient surgeries increased over time—from about 18,500 in 1993 to 114,600 in 2002; the number fell slightly to about 95,600 in 2006, the last year of the study.

Dr. Weidner, lead author Dr. Jennifer M. Wu, and their associates assessed both urinary incontinence ICD-9 diagnosis code and ICD-9 SUI procedure codes to calculate the total number of such surgeries per year in women aged 20 and older.

The rates of SUI procedures in elderly versus nonelderly patients (defined as those younger than age 65 years) changed over time as well. “In 1993, rates were fairly similar,” Dr. Weidner said. But rates were significantly different in 2006: 124/100,000 elderly vs. 76/100,000 among nonelderly patients that year. Age-adjusted rates were calculated using 2000 U.S. census data.

“Since 1997, the introduction of the midurethral sling [has] changed practice patterns,” Dr. Weidner said. For example, in 1993, “other repair” of SUI accounted for 34% of procedures. “There was a dramatic shift in 2006 to other repair of SUI being most common at 72%,” Dr. Weidner said. In the first year of the study, retropubic suspensions comprised 45% of procedures but only 17% in 2006. At the same time significant decreases in “less effective” procedures such as Kelly plication and needle suspensions were observed, with rates dropping below 2% each in 2006.

Major Finding: Quality of life among women with lower urinary tract symptoms varied by ethnic group, as did the prevalence of these symptoms.

Data Source: Interviews with 2,270 African American, Asian, white, and Hispanic women about lower urinary tract symptoms and a review of their medical records.

Disclosures: None reported.

HOLLYWOOD, FLA. — Consider cultural sensitivity and context when counseling women who report lower urinary tract symptoms, researchers advised, based on their study of more than 2,000 ethnically diverse women.

Dr. Kier C. Van Remoortere and her colleagues interviewed 2,270 African American, Asian, white, and Hispanic women using a standardized questionnaire about lower urinary tract symptoms (LUTS), and also reviewed their medical records.

The prevalence of LUTS ranges from 17% to 67% in the literature, Dr. Van Remoortere said at the annual meeting of the American Urogynecologic Society.

Up to 40% of affected women are significantly bothered by their symptoms and report decreased quality of life.

Increases in emergency department visits, hospitalizations, and depression have been linked with LUTS, she said, but prior studies were limited to predominantly white or Asian patient populations.

Overall prevalence of any LUTS symptom was 37% in this study, said Dr. Van Remoortere, a fourth-year resident in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

The study cohort was 44% white, 20% African American, 18% Asian, 17% Hispanic, and 1% Native American/other. All participants were adults, aged 40-79 years.

The participants ranked symptoms bothering them from “not at all” to “extreme.”

Quality of life factors varied between groups. For example, Hispanic women reported a greater impairment of quality of life if they had increased diurnal frequency, nocturia, or urgency, after household income, education level, age, body mass index, history of hysterectomy, and diabetes were controlled for.

Hispanic women were bothered more by increased diurnal frequency, for example, compared with African American women (odds ratio 2.0) and compared with whites (OR 1.5), according to a multivariate analysis.

This group also was more bothered by urgency symptoms than were African American (OR 1.9), Asian (OR 1.9), or white women (OR 1.5). “Overactive bladder wet,” however, did not have a significant impact on quality of life by ethnicity.

“It is important for clinicians to be sensitive to these cultural differences,” Dr. Van Remoortere said.

They also looked at differences in the prevalence of LUTS by ethnicity. The most distressing symptoms to patients—wetness from an overactive bladder (reported by 41%) and urgency (cited by 26%)—did not differ significantly by race in the study, Dr. Van Remoortere said.

African American women reported increased nocturia, compared with Hispanic (OR 2.1), white (OR 1.8), or Asian women (OR 1.6). These differences among groups were statistically significant.

At the same time, African American women were significantly less likely to report distressing diurnal frequency symptoms, compared with Hispanic (OR 0.4), white (OR 0.5), or Asian women (OR 0.6).

LUTS were self-reported and no standardized metric exists to assess these symptoms in women, a potential limitation of the study, Dr. Van Remoortere said.

In addition, the investigators had no information about participant profession. “Information on career [might be important because] control over one's schedule is likely related to bother over lower urinary tract symptoms.”

Major Finding: Quality of life among women with lower urinary tract symptoms varied by ethnic group, as did the prevalence of these symptoms.

Data Source: Interviews with 2,270 African American, Asian, white, and Hispanic women about lower urinary tract symptoms and a review of their medical records.

Disclosures: None reported.

HOLLYWOOD, FLA. — Consider cultural sensitivity and context when counseling women who report lower urinary tract symptoms, researchers advised, based on their study of more than 2,000 ethnically diverse women.

Dr. Kier C. Van Remoortere and her colleagues interviewed 2,270 African American, Asian, white, and Hispanic women using a standardized questionnaire about lower urinary tract symptoms (LUTS), and also reviewed their medical records.

The prevalence of LUTS ranges from 17% to 67% in the literature, Dr. Van Remoortere said at the annual meeting of the American Urogynecologic Society.

Up to 40% of affected women are significantly bothered by their symptoms and report decreased quality of life.

Increases in emergency department visits, hospitalizations, and depression have been linked with LUTS, she said, but prior studies were limited to predominantly white or Asian patient populations.

Overall prevalence of any LUTS symptom was 37% in this study, said Dr. Van Remoortere, a fourth-year resident in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

The study cohort was 44% white, 20% African American, 18% Asian, 17% Hispanic, and 1% Native American/other. All participants were adults, aged 40-79 years.

The participants ranked symptoms bothering them from “not at all” to “extreme.”

Quality of life factors varied between groups. For example, Hispanic women reported a greater impairment of quality of life if they had increased diurnal frequency, nocturia, or urgency, after household income, education level, age, body mass index, history of hysterectomy, and diabetes were controlled for.

Hispanic women were bothered more by increased diurnal frequency, for example, compared with African American women (odds ratio 2.0) and compared with whites (OR 1.5), according to a multivariate analysis.

This group also was more bothered by urgency symptoms than were African American (OR 1.9), Asian (OR 1.9), or white women (OR 1.5). “Overactive bladder wet,” however, did not have a significant impact on quality of life by ethnicity.

“It is important for clinicians to be sensitive to these cultural differences,” Dr. Van Remoortere said.

They also looked at differences in the prevalence of LUTS by ethnicity. The most distressing symptoms to patients—wetness from an overactive bladder (reported by 41%) and urgency (cited by 26%)—did not differ significantly by race in the study, Dr. Van Remoortere said.

African American women reported increased nocturia, compared with Hispanic (OR 2.1), white (OR 1.8), or Asian women (OR 1.6). These differences among groups were statistically significant.

At the same time, African American women were significantly less likely to report distressing diurnal frequency symptoms, compared with Hispanic (OR 0.4), white (OR 0.5), or Asian women (OR 0.6).

LUTS were self-reported and no standardized metric exists to assess these symptoms in women, a potential limitation of the study, Dr. Van Remoortere said.

In addition, the investigators had no information about participant profession. “Information on career [might be important because] control over one's schedule is likely related to bother over lower urinary tract symptoms.”

Major Finding: Quality of life among women with lower urinary tract symptoms varied by ethnic group, as did the prevalence of these symptoms.

Data Source: Interviews with 2,270 African American, Asian, white, and Hispanic women about lower urinary tract symptoms and a review of their medical records.

Disclosures: None reported.

HOLLYWOOD, FLA. — Consider cultural sensitivity and context when counseling women who report lower urinary tract symptoms, researchers advised, based on their study of more than 2,000 ethnically diverse women.

Dr. Kier C. Van Remoortere and her colleagues interviewed 2,270 African American, Asian, white, and Hispanic women using a standardized questionnaire about lower urinary tract symptoms (LUTS), and also reviewed their medical records.

The prevalence of LUTS ranges from 17% to 67% in the literature, Dr. Van Remoortere said at the annual meeting of the American Urogynecologic Society.

Up to 40% of affected women are significantly bothered by their symptoms and report decreased quality of life.

Increases in emergency department visits, hospitalizations, and depression have been linked with LUTS, she said, but prior studies were limited to predominantly white or Asian patient populations.

Overall prevalence of any LUTS symptom was 37% in this study, said Dr. Van Remoortere, a fourth-year resident in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

The study cohort was 44% white, 20% African American, 18% Asian, 17% Hispanic, and 1% Native American/other. All participants were adults, aged 40-79 years.

The participants ranked symptoms bothering them from “not at all” to “extreme.”

Quality of life factors varied between groups. For example, Hispanic women reported a greater impairment of quality of life if they had increased diurnal frequency, nocturia, or urgency, after household income, education level, age, body mass index, history of hysterectomy, and diabetes were controlled for.

Hispanic women were bothered more by increased diurnal frequency, for example, compared with African American women (odds ratio 2.0) and compared with whites (OR 1.5), according to a multivariate analysis.

This group also was more bothered by urgency symptoms than were African American (OR 1.9), Asian (OR 1.9), or white women (OR 1.5). “Overactive bladder wet,” however, did not have a significant impact on quality of life by ethnicity.

“It is important for clinicians to be sensitive to these cultural differences,” Dr. Van Remoortere said.

They also looked at differences in the prevalence of LUTS by ethnicity. The most distressing symptoms to patients—wetness from an overactive bladder (reported by 41%) and urgency (cited by 26%)—did not differ significantly by race in the study, Dr. Van Remoortere said.

African American women reported increased nocturia, compared with Hispanic (OR 2.1), white (OR 1.8), or Asian women (OR 1.6). These differences among groups were statistically significant.

At the same time, African American women were significantly less likely to report distressing diurnal frequency symptoms, compared with Hispanic (OR 0.4), white (OR 0.5), or Asian women (OR 0.6).

LUTS were self-reported and no standardized metric exists to assess these symptoms in women, a potential limitation of the study, Dr. Van Remoortere said.

In addition, the investigators had no information about participant profession. “Information on career [might be important because] control over one's schedule is likely related to bother over lower urinary tract symptoms.”

Major Finding: Patients with Parkinson's disease who received early treatment with pramipexole had a mean UPDRS score only 0.4 points different from patients who initiated treatment 6-9 months later.

Data Source: Phase I/II study on 535 patients with Parkinson's disease.

Disclosures: The study was sponsored by Boehringer Ingelheim. Dr. Schapira reported no relevant disclosures.

MIAMI BEACH — The early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to data from a phase I/II study.

“Pramipexole is an effective symptomatic drug for Parkinson's, but the findings from this study do not show that early treatment is disease modifying,” Dr. Anthony Schapira reported at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole (Mirapex) is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for moderate-to-severe primary restless legs syndrome.

A total 261 patients were randomized to 6 to 9 months of pramipexole and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months.

The primary outcome of the PRamipexole On Underlying Disease (PROUD) Phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline scores.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients took the dopamine agonist only; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said.

The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London.

Assessment of differences in UPDRS scores at 6 to 9 months and on the Parkinson's Disease Questionnaire (PDQ-39), a 39-item questionnaire that measures health status, were secondary outcomes.

These two measures were significantly different between early and delayed treatment groups—a 4.8 unit adjusted mean difference in UPDRS total score and improved PDQ-39 scores each favored early treatment with pramipexole over placebo.

In addition, a subset of 123 patients underwent single-photon emission computed tomography with the radiopharmaceutical agent DaTSCAN (

“There were no differences in striatal DaTSCAN uptake,” Dr. Schapira said. “About 15% showed uptake in both groups.”

Major Finding: Patients with Parkinson's disease who received early treatment with pramipexole had a mean UPDRS score only 0.4 points different from patients who initiated treatment 6-9 months later.

Data Source: Phase I/II study on 535 patients with Parkinson's disease.

Disclosures: The study was sponsored by Boehringer Ingelheim. Dr. Schapira reported no relevant disclosures.

MIAMI BEACH — The early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to data from a phase I/II study.

“Pramipexole is an effective symptomatic drug for Parkinson's, but the findings from this study do not show that early treatment is disease modifying,” Dr. Anthony Schapira reported at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole (Mirapex) is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for moderate-to-severe primary restless legs syndrome.

A total 261 patients were randomized to 6 to 9 months of pramipexole and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months.

The primary outcome of the PRamipexole On Underlying Disease (PROUD) Phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline scores.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients took the dopamine agonist only; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said.

The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London.

Assessment of differences in UPDRS scores at 6 to 9 months and on the Parkinson's Disease Questionnaire (PDQ-39), a 39-item questionnaire that measures health status, were secondary outcomes.

These two measures were significantly different between early and delayed treatment groups—a 4.8 unit adjusted mean difference in UPDRS total score and improved PDQ-39 scores each favored early treatment with pramipexole over placebo.

In addition, a subset of 123 patients underwent single-photon emission computed tomography with the radiopharmaceutical agent DaTSCAN (

“There were no differences in striatal DaTSCAN uptake,” Dr. Schapira said. “About 15% showed uptake in both groups.”

Major Finding: Patients with Parkinson's disease who received early treatment with pramipexole had a mean UPDRS score only 0.4 points different from patients who initiated treatment 6-9 months later.

Data Source: Phase I/II study on 535 patients with Parkinson's disease.

Disclosures: The study was sponsored by Boehringer Ingelheim. Dr. Schapira reported no relevant disclosures.

MIAMI BEACH — The early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to data from a phase I/II study.

“Pramipexole is an effective symptomatic drug for Parkinson's, but the findings from this study do not show that early treatment is disease modifying,” Dr. Anthony Schapira reported at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole (Mirapex) is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for moderate-to-severe primary restless legs syndrome.

A total 261 patients were randomized to 6 to 9 months of pramipexole and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months.

The primary outcome of the PRamipexole On Underlying Disease (PROUD) Phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline scores.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients took the dopamine agonist only; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said.

The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London.

Assessment of differences in UPDRS scores at 6 to 9 months and on the Parkinson's Disease Questionnaire (PDQ-39), a 39-item questionnaire that measures health status, were secondary outcomes.

These two measures were significantly different between early and delayed treatment groups—a 4.8 unit adjusted mean difference in UPDRS total score and improved PDQ-39 scores each favored early treatment with pramipexole over placebo.

In addition, a subset of 123 patients underwent single-photon emission computed tomography with the radiopharmaceutical agent DaTSCAN (

“There were no differences in striatal DaTSCAN uptake,” Dr. Schapira said. “About 15% showed uptake in both groups.”

MIAMI BEACH — Widespread screening for early Parkinson's disease with olfactory testing followed by neurologic imaging holds promise but is not yet practical, based on studies that have revealed the limitations of each method.

Olfactory impairment is common enough in premotor Parkinson's disease that some researchers propose using it as an early predictor of risk (Ann. Neurol. 2008;63:167–73).

However, olfactory testing has not garnered widespread adoption because it lacks sufficient specificity for population-based screening, Dr. Henk W. Berendse said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

He and others have proposed coupling olfactory testing with highly specific brain imaging, such as dopamine transporter single photon emission computed tomography (DAT SPECT).

There is a catch, though. The imaging would have to be done in a large number of individuals, many of whom would not develop Parkinson's disease, said Dr. Berendse, head of the movement disorders service at the VU University Medical Centre in Amsterdam.

In a subsequent presentation at the meeting, Dr. Andrew D. Siderowf of the department of neurology at Pennsylvania Hospital in Philadelphia called population screening for Parkinson's disease a “numbers game.” The incidence of Parkinson's disease is low, so the number of potentially identifiable cases in a population at any given time also is low, he said.

In 2005, the worldwide prevalence of the disease was estimated to be between 4.1 million and 4.6 million (Neurology 2007;68:384–6).

Dr. Berendse calculated that “If you expect to detect 125 patients in the premotor phase [of Parkinson's disease], somewhere between 1,000 and 7,000 individuals would have to undergo SPECT scans. Assuming a 10% prevalence of hyposmia, we would need to screen 70,000 individuals.” He based the 10% prevalence of hyposmia on the results of a study he coauthored that screened 361 asymptomatic, 50- to 75-year-old relatives of patients who had idiopathic Parkinson's disease. All of the relatives underwent olfactory testing, and the 40 who tested positive also underwent serial

He and his colleagues recently published the 5-year data for this cohort (J. Neurol. Neurosurg. Psychiatry 2009 Dec. 3 [doi:10.1136/jnnp.2009.183715

Those two studies support use of two-step olfactory and SPECT scanning in first-degree relatives because all of the five hyposmic individuals who developed Parkinson's disease had an abnormal baseline SPECT scan.

Dr. Siderowf said he remained optimistic about screening first-degree relatives of people with Parkinson's disease as a higher-risk group even though widespread screening would be cost-prohibitive. “The numbers start to look really good” when two-stage screening is considered for first-degree relatives, particularly those with multiple risk factors, he said.

However, he noted that access to DAT SPECT is restricted. It is costly and not commercially available in the United States.

In addition to DAT SPECT, researchers have proposed other imaging modalities to follow olfactory testing. For example, German researchers assessed transcranial sonography and assessed patients at 4 years (Mov. Disord. 2007;22:839–42).

“So far, transcranial sonography does not seem to be the way to go,” Dr. Berendse said. “Two patients who progressed to Parkinson's disease did not have initial transcranial abnormalities, for example, but more studies are on the way.”

Dr. Siderowf said the optimal screening strategy remains unknown. “Not only do these tests need to be used, but they have to be used repeatedly. What is the optimal screening frequency? The time at which imaging becomes abnormal varies—some say 5 years.”

Dr. Berendse said that ideally, he would like to find a noninvasive marker of early Parkinson's disease risk with a higher specificity than olfactory dysfunction and a less costly second screening step.

Neither Dr. Berendse nor Dr. Siderowf had relevant financial disclosures.

MIAMI BEACH — Widespread screening for early Parkinson's disease with olfactory testing followed by neurologic imaging holds promise but is not yet practical, based on studies that have revealed the limitations of each method.

Olfactory impairment is common enough in premotor Parkinson's disease that some researchers propose using it as an early predictor of risk (Ann. Neurol. 2008;63:167–73).

However, olfactory testing has not garnered widespread adoption because it lacks sufficient specificity for population-based screening, Dr. Henk W. Berendse said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

He and others have proposed coupling olfactory testing with highly specific brain imaging, such as dopamine transporter single photon emission computed tomography (DAT SPECT).

There is a catch, though. The imaging would have to be done in a large number of individuals, many of whom would not develop Parkinson's disease, said Dr. Berendse, head of the movement disorders service at the VU University Medical Centre in Amsterdam.

In a subsequent presentation at the meeting, Dr. Andrew D. Siderowf of the department of neurology at Pennsylvania Hospital in Philadelphia called population screening for Parkinson's disease a “numbers game.” The incidence of Parkinson's disease is low, so the number of potentially identifiable cases in a population at any given time also is low, he said.

In 2005, the worldwide prevalence of the disease was estimated to be between 4.1 million and 4.6 million (Neurology 2007;68:384–6).

Dr. Berendse calculated that “If you expect to detect 125 patients in the premotor phase [of Parkinson's disease], somewhere between 1,000 and 7,000 individuals would have to undergo SPECT scans. Assuming a 10% prevalence of hyposmia, we would need to screen 70,000 individuals.” He based the 10% prevalence of hyposmia on the results of a study he coauthored that screened 361 asymptomatic, 50- to 75-year-old relatives of patients who had idiopathic Parkinson's disease. All of the relatives underwent olfactory testing, and the 40 who tested positive also underwent serial

He and his colleagues recently published the 5-year data for this cohort (J. Neurol. Neurosurg. Psychiatry 2009 Dec. 3 [doi:10.1136/jnnp.2009.183715

Those two studies support use of two-step olfactory and SPECT scanning in first-degree relatives because all of the five hyposmic individuals who developed Parkinson's disease had an abnormal baseline SPECT scan.

Dr. Siderowf said he remained optimistic about screening first-degree relatives of people with Parkinson's disease as a higher-risk group even though widespread screening would be cost-prohibitive. “The numbers start to look really good” when two-stage screening is considered for first-degree relatives, particularly those with multiple risk factors, he said.

However, he noted that access to DAT SPECT is restricted. It is costly and not commercially available in the United States.

In addition to DAT SPECT, researchers have proposed other imaging modalities to follow olfactory testing. For example, German researchers assessed transcranial sonography and assessed patients at 4 years (Mov. Disord. 2007;22:839–42).

“So far, transcranial sonography does not seem to be the way to go,” Dr. Berendse said. “Two patients who progressed to Parkinson's disease did not have initial transcranial abnormalities, for example, but more studies are on the way.”

Dr. Siderowf said the optimal screening strategy remains unknown. “Not only do these tests need to be used, but they have to be used repeatedly. What is the optimal screening frequency? The time at which imaging becomes abnormal varies—some say 5 years.”

Dr. Berendse said that ideally, he would like to find a noninvasive marker of early Parkinson's disease risk with a higher specificity than olfactory dysfunction and a less costly second screening step.

Neither Dr. Berendse nor Dr. Siderowf had relevant financial disclosures.

MIAMI BEACH — Widespread screening for early Parkinson's disease with olfactory testing followed by neurologic imaging holds promise but is not yet practical, based on studies that have revealed the limitations of each method.

Olfactory impairment is common enough in premotor Parkinson's disease that some researchers propose using it as an early predictor of risk (Ann. Neurol. 2008;63:167–73).

However, olfactory testing has not garnered widespread adoption because it lacks sufficient specificity for population-based screening, Dr. Henk W. Berendse said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

He and others have proposed coupling olfactory testing with highly specific brain imaging, such as dopamine transporter single photon emission computed tomography (DAT SPECT).

There is a catch, though. The imaging would have to be done in a large number of individuals, many of whom would not develop Parkinson's disease, said Dr. Berendse, head of the movement disorders service at the VU University Medical Centre in Amsterdam.

In a subsequent presentation at the meeting, Dr. Andrew D. Siderowf of the department of neurology at Pennsylvania Hospital in Philadelphia called population screening for Parkinson's disease a “numbers game.” The incidence of Parkinson's disease is low, so the number of potentially identifiable cases in a population at any given time also is low, he said.

In 2005, the worldwide prevalence of the disease was estimated to be between 4.1 million and 4.6 million (Neurology 2007;68:384–6).

Dr. Berendse calculated that “If you expect to detect 125 patients in the premotor phase [of Parkinson's disease], somewhere between 1,000 and 7,000 individuals would have to undergo SPECT scans. Assuming a 10% prevalence of hyposmia, we would need to screen 70,000 individuals.” He based the 10% prevalence of hyposmia on the results of a study he coauthored that screened 361 asymptomatic, 50- to 75-year-old relatives of patients who had idiopathic Parkinson's disease. All of the relatives underwent olfactory testing, and the 40 who tested positive also underwent serial

He and his colleagues recently published the 5-year data for this cohort (J. Neurol. Neurosurg. Psychiatry 2009 Dec. 3 [doi:10.1136/jnnp.2009.183715

Those two studies support use of two-step olfactory and SPECT scanning in first-degree relatives because all of the five hyposmic individuals who developed Parkinson's disease had an abnormal baseline SPECT scan.

Dr. Siderowf said he remained optimistic about screening first-degree relatives of people with Parkinson's disease as a higher-risk group even though widespread screening would be cost-prohibitive. “The numbers start to look really good” when two-stage screening is considered for first-degree relatives, particularly those with multiple risk factors, he said.

However, he noted that access to DAT SPECT is restricted. It is costly and not commercially available in the United States.

In addition to DAT SPECT, researchers have proposed other imaging modalities to follow olfactory testing. For example, German researchers assessed transcranial sonography and assessed patients at 4 years (Mov. Disord. 2007;22:839–42).

“So far, transcranial sonography does not seem to be the way to go,” Dr. Berendse said. “Two patients who progressed to Parkinson's disease did not have initial transcranial abnormalities, for example, but more studies are on the way.”

Dr. Siderowf said the optimal screening strategy remains unknown. “Not only do these tests need to be used, but they have to be used repeatedly. What is the optimal screening frequency? The time at which imaging becomes abnormal varies—some say 5 years.”

Dr. Berendse said that ideally, he would like to find a noninvasive marker of early Parkinson's disease risk with a higher specificity than olfactory dysfunction and a less costly second screening step.

Neither Dr. Berendse nor Dr. Siderowf had relevant financial disclosures.

MIAMI BEACH — Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorová, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of the hippocampus probably predicts a switch to dementia,” said Dr. Rektorová, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorová provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported grey matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorová, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorová asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorová said.

A study using

In a study currently in preparation, Dr. Rektorová and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test (see image above). During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus. “It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorová said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorová said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices. However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorová said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. However, participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity whereas controls showed deactivation in these regions.

In the Stroop test, brain activity in some areas decreased in medicated PD patients without cognitive dysfunction (above), relative to healthy controls, despite similar performances.

Source Images courtesy Irena Rektorová, Ph.D.

MIAMI BEACH — Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorová, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of the hippocampus probably predicts a switch to dementia,” said Dr. Rektorová, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorová provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported grey matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorová, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorová asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorová said.

A study using

In a study currently in preparation, Dr. Rektorová and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test (see image above). During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus. “It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorová said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorová said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices. However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorová said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. However, participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity whereas controls showed deactivation in these regions.

In the Stroop test, brain activity in some areas decreased in medicated PD patients without cognitive dysfunction (above), relative to healthy controls, despite similar performances.

Source Images courtesy Irena Rektorová, Ph.D.

MIAMI BEACH — Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorová, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of the hippocampus probably predicts a switch to dementia,” said Dr. Rektorová, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorová provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported grey matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorová, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorová asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorová said.

A study using

In a study currently in preparation, Dr. Rektorová and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test (see image above). During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus. “It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorová said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorová said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices. However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorová said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. However, participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity whereas controls showed deactivation in these regions.

In the Stroop test, brain activity in some areas decreased in medicated PD patients without cognitive dysfunction (above), relative to healthy controls, despite similar performances.

Source Images courtesy Irena Rektorová, Ph.D.

MIAMI BEACH — A patient with REM sleep behavior disorder has about a 50/50 chance for developing Parkinson's disease within 12 years, according to a recently published report.

REM sleep behavior disorder (RBD) “is a striking parasomnia very common in Parkinson's disease,” Dr. Ronald Postuma said. Also, because RBD often precedes the onset of symptoms of Parkinson's disease, patients with this sleep disorder should be closely followed and counseled about their increased risk, he said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

RBD is characterized by speech and body movement during the rapid eye movement phase of sleep. “Normally, we are paralyzed when we dream. You lose this in RBD,” he said. Other phases of sleep appear normal. Apnea, sleep walking, and sleep talking are part of the differential diagnosis, said Dr. Postuma, who is on the neurology faculty at McGill University, Montreal, and is a neurologist at Montreal General Hospital.

Dr. Postuma and his colleagues conducted follow-up with 93 patients diagnosed with RBD at the Hôpital du Sacré-Coeur in Montreal (Neurology 2009;72:1296–300). During follow-up, 26 of these patients developed a neurodegenerative disease—14 developed Parkinson's disease; 7, Lewy body dementia; 4, dementia; and 1, multiple system atrophy. Based on these findings, the estimated 5-year risk of neurodegenerative disease was 18%, the estimated 10-year risk was 41%, and the estimated 12-year risk was 52%. A diagnosis of RBD, therefore, carries important counseling implications.

The consensus is that about 35% of patients with Parkinson's disease have RBD, Dr. Postuma said. Prevalence estimates are higher from polysomnography studies, with reports that 40%–60% of Parkinson's disease patients have signs.

“An important clinical question is: Do you need polysomnography to diagnose RBD?” he said. Proponents point out that mimics of RBD can have consequences and some are treatable, such as apnea. Opponents say that patient history is often reliable for diagnosis and polysomnography is expensive. Dr. Postuma's approach is a compromise of sorts: With the relatively rare RBD, “the stakes are high” and he always recommends polysomnography.

Medication may be worthwhile, particularly if a patient has violent RBD.

He had no financial disclosures.

MIAMI BEACH — A patient with REM sleep behavior disorder has about a 50/50 chance for developing Parkinson's disease within 12 years, according to a recently published report.

REM sleep behavior disorder (RBD) “is a striking parasomnia very common in Parkinson's disease,” Dr. Ronald Postuma said. Also, because RBD often precedes the onset of symptoms of Parkinson's disease, patients with this sleep disorder should be closely followed and counseled about their increased risk, he said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

RBD is characterized by speech and body movement during the rapid eye movement phase of sleep. “Normally, we are paralyzed when we dream. You lose this in RBD,” he said. Other phases of sleep appear normal. Apnea, sleep walking, and sleep talking are part of the differential diagnosis, said Dr. Postuma, who is on the neurology faculty at McGill University, Montreal, and is a neurologist at Montreal General Hospital.

Dr. Postuma and his colleagues conducted follow-up with 93 patients diagnosed with RBD at the Hôpital du Sacré-Coeur in Montreal (Neurology 2009;72:1296–300). During follow-up, 26 of these patients developed a neurodegenerative disease—14 developed Parkinson's disease; 7, Lewy body dementia; 4, dementia; and 1, multiple system atrophy. Based on these findings, the estimated 5-year risk of neurodegenerative disease was 18%, the estimated 10-year risk was 41%, and the estimated 12-year risk was 52%. A diagnosis of RBD, therefore, carries important counseling implications.

The consensus is that about 35% of patients with Parkinson's disease have RBD, Dr. Postuma said. Prevalence estimates are higher from polysomnography studies, with reports that 40%–60% of Parkinson's disease patients have signs.

“An important clinical question is: Do you need polysomnography to diagnose RBD?” he said. Proponents point out that mimics of RBD can have consequences and some are treatable, such as apnea. Opponents say that patient history is often reliable for diagnosis and polysomnography is expensive. Dr. Postuma's approach is a compromise of sorts: With the relatively rare RBD, “the stakes are high” and he always recommends polysomnography.

Medication may be worthwhile, particularly if a patient has violent RBD.

He had no financial disclosures.

MIAMI BEACH — A patient with REM sleep behavior disorder has about a 50/50 chance for developing Parkinson's disease within 12 years, according to a recently published report.

REM sleep behavior disorder (RBD) “is a striking parasomnia very common in Parkinson's disease,” Dr. Ronald Postuma said. Also, because RBD often precedes the onset of symptoms of Parkinson's disease, patients with this sleep disorder should be closely followed and counseled about their increased risk, he said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

RBD is characterized by speech and body movement during the rapid eye movement phase of sleep. “Normally, we are paralyzed when we dream. You lose this in RBD,” he said. Other phases of sleep appear normal. Apnea, sleep walking, and sleep talking are part of the differential diagnosis, said Dr. Postuma, who is on the neurology faculty at McGill University, Montreal, and is a neurologist at Montreal General Hospital.

Dr. Postuma and his colleagues conducted follow-up with 93 patients diagnosed with RBD at the Hôpital du Sacré-Coeur in Montreal (Neurology 2009;72:1296–300). During follow-up, 26 of these patients developed a neurodegenerative disease—14 developed Parkinson's disease; 7, Lewy body dementia; 4, dementia; and 1, multiple system atrophy. Based on these findings, the estimated 5-year risk of neurodegenerative disease was 18%, the estimated 10-year risk was 41%, and the estimated 12-year risk was 52%. A diagnosis of RBD, therefore, carries important counseling implications.

The consensus is that about 35% of patients with Parkinson's disease have RBD, Dr. Postuma said. Prevalence estimates are higher from polysomnography studies, with reports that 40%–60% of Parkinson's disease patients have signs.

“An important clinical question is: Do you need polysomnography to diagnose RBD?” he said. Proponents point out that mimics of RBD can have consequences and some are treatable, such as apnea. Opponents say that patient history is often reliable for diagnosis and polysomnography is expensive. Dr. Postuma's approach is a compromise of sorts: With the relatively rare RBD, “the stakes are high” and he always recommends polysomnography.

Medication may be worthwhile, particularly if a patient has violent RBD.

He had no financial disclosures.

MIAMI BEACH — Early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to a phase I/II study with 535 participants.

“Pramipexole is an effective symptomatic drug, but this study does not show that early treatment is disease modifying,” Dr. Anthony Schapira said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for primary restless legs syndrome.

A total 261 patients were randomized to 6–9 months of pramipexole (Mirapex) and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months. The primary outcome of the Pramipexole on Underlying Disease (PROUD) phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline. The study was sponsored by the manufacturer of Mirapex, Boehringer Ingelheim GmbH. The drug also is available in generic form.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients only took the dopamine agonist; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said. The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London. He had no relevant disclosures.

MIAMI BEACH — Early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to a phase I/II study with 535 participants.

“Pramipexole is an effective symptomatic drug, but this study does not show that early treatment is disease modifying,” Dr. Anthony Schapira said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for primary restless legs syndrome.

A total 261 patients were randomized to 6–9 months of pramipexole (Mirapex) and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months. The primary outcome of the Pramipexole on Underlying Disease (PROUD) phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline. The study was sponsored by the manufacturer of Mirapex, Boehringer Ingelheim GmbH. The drug also is available in generic form.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients only took the dopamine agonist; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said. The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London. He had no relevant disclosures.

MIAMI BEACH — Early treatment of people with Parkinson's disease with the dopamine receptor agonist pramipexole does not significantly modify the course of disease at 15 months, according to a phase I/II study with 535 participants.

“Pramipexole is an effective symptomatic drug, but this study does not show that early treatment is disease modifying,” Dr. Anthony Schapira said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

Pramipexole is approved by the Food and Drug Administration for the treatment of the signs and symptoms of idiopathic Parkinson's disease and for primary restless legs syndrome.

A total 261 patients were randomized to 6–9 months of pramipexole (Mirapex) and comprised the early treatment group. Another 274 patients took a placebo during this phase, and then all of the patients took pramipexole up to 15 months. The primary outcome of the Pramipexole on Underlying Disease (PROUD) phase I/II study was the change in Unified Parkinson's Disease Rating Scale (UPDRS) total score at the end of 15 months compared with baseline. The study was sponsored by the manufacturer of Mirapex, Boehringer Ingelheim GmbH. The drug also is available in generic form.

The mean age in each group was 62 years, and the mean duration of Parkinson's disease at baseline was 1.8 years. Total UPDRS scores were based on parts I, II, and III of the instrument. Treated patients only took the dopamine agonist; no rescue drugs were allowed.

The dopamine agonist was dosed at 1.5 mg/day. “At this dose of pramipexole, there was no difference in UPDRS or imaging finding between early and late onset,” Dr. Schapira said. The difference in adjusted mean total score between groups was only 0.4 UPDRS units at 15 months, a nonsignificant finding.

“Early improvement was seen in the early [treatment] group, but then there was a decline. In the late group, [the patients] were initially worse but responded and ultimately ended up at the same point at 15 months,” said Dr. Schapira, head of the department of clinical neurosciences at University College London. He had no relevant disclosures.

MIAMI BEACH – Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorové, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of hippocampus probably predicts a switch to dementia,” said Dr. Rektorové, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorové provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported gray matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorové, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorové asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorové said.

A study using

In a study currently in preparation, Dr. Rektorové and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test. During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus.

“It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorové said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorové said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices.

However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorové said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. But participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity, whereas controls showed deactivation in these regions.

MIAMI BEACH – Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorové, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of hippocampus probably predicts a switch to dementia,” said Dr. Rektorové, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorové provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported gray matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorové, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorové asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorové said.

A study using

In a study currently in preparation, Dr. Rektorové and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test. During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus.

“It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorové said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorové said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices.

However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorové said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. But participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity, whereas controls showed deactivation in these regions.

MIAMI BEACH – Changes in brain volume and networks could someday predict which patients with Parkinson's disease are at highest risk to develop dementia, according to recent studies.

It has been known for some time that hippocampal atrophy, for example, is a common feature of Parkinson's disease with dementia. However, a recent study is the first to show that the decrease in hippocampal volume could predict which patients are at a higher risk for development of dementia, Irena Rektorové, Ph.D., said at the World Federation of Neurology World Congress on Parkinson's Disease and Related Disorders.

“What is important from a practical point of view is that atrophy of hippocampus probably predicts a switch to dementia,” said Dr. Rektorové, who is on the neurology faculty at Masaryk University in Brno, Czech Republic.

A Swiss research team calculated that the risk for dementia increases almost 25% with every 0.1 mL decrease in hippocampal volume, based on a study of 70 patients who had subthalamic deep brain stimulation (Parkinsonism Relat. Disord. 2009;15:521–4). The 14 patients in this cohort who later developed dementia had significantly smaller preoperative hippocampal volumes than did those who did not develop dementia.

Dr. Rektorové provided some additional perspective on the extent of volume changes. “Hippocampal atrophy is definitely present in those with Parkinson's disease, and especially those with Parkinson's disease dementia, but it is lower than atrophy with Alzheimer's disease.”

Using voxel-based morphometry, other researchers have reported gray matter loss in the frontal areas of the brain in patients with Parkinson's disease that extends to the temporal, occipital, and subcortical areas with comorbid dementia (Brain 2004;127:791–800). Occipital atrophy, in particular, may be an important distinction between Parkinson's patients with and without dementia.

Mild cognitive impairment (MCI) is common among people affected by Parkinson's disease. A goal for researchers is to identify “the malignant form” of MCI that will progress to dementia, said Dr. Rektorové, who had no relevant disclosures.

“Would brain imaging of mild cognitive impairment or dementia in Parkinson's disease be of any help?” Dr. Rektorové asked. It is possible, she said, based on the promising results of multiple studies using

“These studies show posterior rather than anterior cortical involvement in Parkinson's disease dementia versus Parkinson's disease alone,” Dr. Rektorové said.

A study using

In a study currently in preparation, Dr. Rektorové and her colleagues found decreased activity in certain brain areas of patients with Parkinson's disease, compared with controls, while performing the Stroop test. During this measure of executive function, decreases were seen in the cuneus, middle temporal gyrus, inferior parietal lobule, insula, and medial dorsal nucleus of thalamus.

“It is worth mentioning that these Parkinson's disease patients were medicated and they had no cognitive impairment in this task,” Dr. Rektorové said. “They actually performed as well as healthy controls.”

It also could be that what is not turned off during executive functioning in Parkinson's disease plays a role in cognitive impairment, Dr. Rektorové said. During executive task performance in healthy volunteers, fMRI shows deactivation of the medial prefrontal cortex, posterior cingulate cortex, precuneus, and medial temporal cortices.

However, this imaging also shows that people with Parkinson's disease may fail to shut off this resting brain activity, called the “default mode network.” Dr. Rektorové said the full function of the default mode network is not yet known.

For the first time, other researchers have used fMRI to assess the potential contribution of the default mode network in patients with Parkinson's disease (Arch. Neurol. 2009;66:877–83). They demonstrated a decrease in ventral medial prefrontal cortex activity similar to controls during executive functioning. But participants with Parkinson's disease featured increased precuneus and posterior cingulate cortex activity, whereas controls showed deactivation in these regions.