Olfactory Testing and DAT Imaging May Lead to Early Detection of Parkinson’s Disease

STOCKHOLM—People who lose their sense of smell and have a deficit in dopamine transporter (DAT) imaging likely will develop clinical signs of Parkinson’s disease, according to a study presented at the 18th International Congress of Parkinson’s Disease and Movement Disorders.

Danna Jennings, MD, Clinical Research Director at the Institute for Neurodegenerative Disorders in New Haven, and colleagues initiated the Parkinson Associated Risk Syndrome (PARS) study to identify a large-scale cohort of individuals at risk for Parkinson’s disease using olfactory testing and DAT imaging.

Subjects in the study completed clinical evaluations at baseline and at two and four years. The evaluations were performed by investigators blinded to clinical data. No individuals with a reduced ability to smell and DAT deficit were diagnosed with Parkinson’s disease at baseline. However, 28% of the patients had phenoconverted or developed motor signs sufficient for diagnosis of Parkinson’s disease by the second year, and 46% had phenoconverted by the fourth year.

“Evaluating this enriched population, the investigators of the PARS trial demonstrated that 46% of individuals with loss of sense of smell combined with a deficit on the DAT scan develop the clinical features of Parkinson’s disease within four years,” said Anthony Lang, MD, Director of the Movement Disorders Clinic at Toronto Western Hospital. “It is likely that ongoing follow-up will show further phenoconversion to Parkinson’s disease of many of the remaining individuals fulfilling these criteria.”

The knowledge that comes from this study will have important implications for the recruitment of individuals for future neuroprotective trials, he added. These trials may have a greater chance of success than previous efforts that exclusively involved patients whose disease had already evolved to the stage of manifesting the clinical features of Parkinson’s disease.

Initiative Seeks Biomarkers of Disease Progression
Researchers participating in the Parkinson Progression Marker Initiative (PPMI) have found motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease. The PPMI aims to identify one or more biomarkers of Parkinson’s disease progression, which would aid the research and development of new and improved treatments for the disease.

The PPMI study assessed clinical imaging and CSF biomarkers of Parkinson’s disease in recently diagnosed patients, healthy volunteers, and people without evidence of dopaminergic deficit. Baseline data from PPMI in these untreated cohorts demonstrated motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease, compared with healthy volunteers.

A comprehensive longitudinal follow-up of the PPMI cohort is under way to characterize biomarker progression. Enrollment of prodromal patients with Parkinson’s disease has begun, and these individuals will be compared with the existing PPMI subjects who are undergoing longitudinal follow-up. All study data are integrated into the PPMI study database and are available at www.ppmi-info.org.

“There is a great need for studies to identify those at risk and then conduct clinical trials to examine the efficacy of treatments at presymptomatic stages,” said Philip Thompson, PhD, Professor of Neurology at the University of Adelaide and Royal Adelaide Hospital. “A number of biomarkers have been identified that may make possible a study of presymptomatic neurodegenerations, such as Parkinson’s disease. To be effective and widely applicable, such studies require considerable precision in identifying reliable predictors and biomarkers of the disease to recruit a cohort of homogeneous patients in the presymptomatic stages. “The results of this [long-term follow-up] study have the potential to change the way clinical trials in Parkinson’s disease are undertaken in the future and the way in which patients with prodromal premotor Parkinson’s disease are managed,” Professor Thompson concluded.

Acupuncture May Improve Patients’ Symptoms
Acupuncture and bee venom acupuncture may be promising alternative therapies for patients with Parkinson’s disease. Seung-Yeon Cho and colleagues at Kyung Hee University Hospital in Seoul, evaluated 43 adults with Parkinson’s disease who had been on a stable dose of antiparkinsonism medication for at least one month. Patients were randomly assigned to acupuncture, bee venom acupuncture, or no treatment. The groups underwent stimulation of 10 acupuncture points using acupuncture or bee venom acupuncture twice per week for eight weeks. The control group received no treatment during this period.

Participants who received bee venom acupuncture showed significant improvement in Unified Parkinson’s Disease Rating Scale (UPDRS) scores, the Berg Balance Scale, and time taken to walk 30 meters. Compared with the control group, patients receiving bee venom acupuncture demonstrated significantly greater improvement in UPDRS scores. In the acupuncture group, the UPDRS and Beck Depression Inventory scores showed significant improvement. The control group showed no significant changes in any outcome measure after the first eight weeks.

“The results showed significant improvement of movement outcomes in the bee venom acupuncture group that was superior to the results with acupuncture treatment alone,” said Louis Tan, MD, Senior Consultant Neurologist at the National Neuroscience Institute in Singapore. “These results are important, as it has been found that up to 70% of patients in some countries use complementary therapies for the management of Parkinson’s disease. In addition to traditional acupuncture, the Korean group has ventured into a new field of bee venom acupuncture treatment. Such carefully planned clinical studies are important to the Parkinson’s community, as they provide much needed evidence to guide the recommendation of such therapies to our patients with Parkinson’s disease.”

Neurologist Care Linked to Decreased Death Risk in Parkinson’s Disease
Treatment by a neurologist improves overall care for patients with Parkinson’s disease and ultimately may reduce the risk of death.

Peter Schmidt, PhD, Vice President of Research Programs at the National Parkinson Foundation in Miami, and colleagues conducted data analysis to identify the incidence of death for patients with Parkinson’s disease treated by a neurologist, in comparison with patients treated by a primary care physician. Using the empirical Bayes method, Drs. Schmidt and Willis calculated the fraction of the population treated by a neurologist, combined with the relative risk of death for individuals with Parkinson’s disease who are treated by a neurologist versus those managed in primary care. According to the model, improved survival for patients receiving neurologist care prevented 4,645 deaths in 2011, and the extension of neurologist care to patients not receiving it would have reduced overall mortality further by 6,967 patients.

“Parkinson’s disease is not a particularly common disorder that generalists will see on an everyday basis,” said Christopher G. Goetz, MD, Director of the Parkinson’s Disease and Movement Disorder program at Rush University Medical Center in Chicago. “In contrast, in a neurologic practice, community or academic, Parkinson’s disease is a common disorder, so that neurologists have much more exposure to patients in all stages of the disease. Further, educational efforts related to Parkinson’s disease are part of almost all general neurology meetings, local, regional, and national. The data from this current study may be debated in terms of the details of the analysis, but they strongly show that neurologic care and expertise favors a positive outcome for patients affected by Parkinson’s disease.”

STOCKHOLM—People who lose their sense of smell and have a deficit in dopamine transporter (DAT) imaging likely will develop clinical signs of Parkinson’s disease, according to a study presented at the 18th International Congress of Parkinson’s Disease and Movement Disorders.

Danna Jennings, MD, Clinical Research Director at the Institute for Neurodegenerative Disorders in New Haven, and colleagues initiated the Parkinson Associated Risk Syndrome (PARS) study to identify a large-scale cohort of individuals at risk for Parkinson’s disease using olfactory testing and DAT imaging.

Subjects in the study completed clinical evaluations at baseline and at two and four years. The evaluations were performed by investigators blinded to clinical data. No individuals with a reduced ability to smell and DAT deficit were diagnosed with Parkinson’s disease at baseline. However, 28% of the patients had phenoconverted or developed motor signs sufficient for diagnosis of Parkinson’s disease by the second year, and 46% had phenoconverted by the fourth year.

“Evaluating this enriched population, the investigators of the PARS trial demonstrated that 46% of individuals with loss of sense of smell combined with a deficit on the DAT scan develop the clinical features of Parkinson’s disease within four years,” said Anthony Lang, MD, Director of the Movement Disorders Clinic at Toronto Western Hospital. “It is likely that ongoing follow-up will show further phenoconversion to Parkinson’s disease of many of the remaining individuals fulfilling these criteria.”

The knowledge that comes from this study will have important implications for the recruitment of individuals for future neuroprotective trials, he added. These trials may have a greater chance of success than previous efforts that exclusively involved patients whose disease had already evolved to the stage of manifesting the clinical features of Parkinson’s disease.

Initiative Seeks Biomarkers of Disease Progression
Researchers participating in the Parkinson Progression Marker Initiative (PPMI) have found motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease. The PPMI aims to identify one or more biomarkers of Parkinson’s disease progression, which would aid the research and development of new and improved treatments for the disease.

The PPMI study assessed clinical imaging and CSF biomarkers of Parkinson’s disease in recently diagnosed patients, healthy volunteers, and people without evidence of dopaminergic deficit. Baseline data from PPMI in these untreated cohorts demonstrated motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease, compared with healthy volunteers.

A comprehensive longitudinal follow-up of the PPMI cohort is under way to characterize biomarker progression. Enrollment of prodromal patients with Parkinson’s disease has begun, and these individuals will be compared with the existing PPMI subjects who are undergoing longitudinal follow-up. All study data are integrated into the PPMI study database and are available at www.ppmi-info.org.

“There is a great need for studies to identify those at risk and then conduct clinical trials to examine the efficacy of treatments at presymptomatic stages,” said Philip Thompson, PhD, Professor of Neurology at the University of Adelaide and Royal Adelaide Hospital. “A number of biomarkers have been identified that may make possible a study of presymptomatic neurodegenerations, such as Parkinson’s disease. To be effective and widely applicable, such studies require considerable precision in identifying reliable predictors and biomarkers of the disease to recruit a cohort of homogeneous patients in the presymptomatic stages. “The results of this [long-term follow-up] study have the potential to change the way clinical trials in Parkinson’s disease are undertaken in the future and the way in which patients with prodromal premotor Parkinson’s disease are managed,” Professor Thompson concluded.

Acupuncture May Improve Patients’ Symptoms
Acupuncture and bee venom acupuncture may be promising alternative therapies for patients with Parkinson’s disease. Seung-Yeon Cho and colleagues at Kyung Hee University Hospital in Seoul, evaluated 43 adults with Parkinson’s disease who had been on a stable dose of antiparkinsonism medication for at least one month. Patients were randomly assigned to acupuncture, bee venom acupuncture, or no treatment. The groups underwent stimulation of 10 acupuncture points using acupuncture or bee venom acupuncture twice per week for eight weeks. The control group received no treatment during this period.

Participants who received bee venom acupuncture showed significant improvement in Unified Parkinson’s Disease Rating Scale (UPDRS) scores, the Berg Balance Scale, and time taken to walk 30 meters. Compared with the control group, patients receiving bee venom acupuncture demonstrated significantly greater improvement in UPDRS scores. In the acupuncture group, the UPDRS and Beck Depression Inventory scores showed significant improvement. The control group showed no significant changes in any outcome measure after the first eight weeks.

“The results showed significant improvement of movement outcomes in the bee venom acupuncture group that was superior to the results with acupuncture treatment alone,” said Louis Tan, MD, Senior Consultant Neurologist at the National Neuroscience Institute in Singapore. “These results are important, as it has been found that up to 70% of patients in some countries use complementary therapies for the management of Parkinson’s disease. In addition to traditional acupuncture, the Korean group has ventured into a new field of bee venom acupuncture treatment. Such carefully planned clinical studies are important to the Parkinson’s community, as they provide much needed evidence to guide the recommendation of such therapies to our patients with Parkinson’s disease.”

Neurologist Care Linked to Decreased Death Risk in Parkinson’s Disease
Treatment by a neurologist improves overall care for patients with Parkinson’s disease and ultimately may reduce the risk of death.

Peter Schmidt, PhD, Vice President of Research Programs at the National Parkinson Foundation in Miami, and colleagues conducted data analysis to identify the incidence of death for patients with Parkinson’s disease treated by a neurologist, in comparison with patients treated by a primary care physician. Using the empirical Bayes method, Drs. Schmidt and Willis calculated the fraction of the population treated by a neurologist, combined with the relative risk of death for individuals with Parkinson’s disease who are treated by a neurologist versus those managed in primary care. According to the model, improved survival for patients receiving neurologist care prevented 4,645 deaths in 2011, and the extension of neurologist care to patients not receiving it would have reduced overall mortality further by 6,967 patients.

“Parkinson’s disease is not a particularly common disorder that generalists will see on an everyday basis,” said Christopher G. Goetz, MD, Director of the Parkinson’s Disease and Movement Disorder program at Rush University Medical Center in Chicago. “In contrast, in a neurologic practice, community or academic, Parkinson’s disease is a common disorder, so that neurologists have much more exposure to patients in all stages of the disease. Further, educational efforts related to Parkinson’s disease are part of almost all general neurology meetings, local, regional, and national. The data from this current study may be debated in terms of the details of the analysis, but they strongly show that neurologic care and expertise favors a positive outcome for patients affected by Parkinson’s disease.”

STOCKHOLM—People who lose their sense of smell and have a deficit in dopamine transporter (DAT) imaging likely will develop clinical signs of Parkinson’s disease, according to a study presented at the 18th International Congress of Parkinson’s Disease and Movement Disorders.

Danna Jennings, MD, Clinical Research Director at the Institute for Neurodegenerative Disorders in New Haven, and colleagues initiated the Parkinson Associated Risk Syndrome (PARS) study to identify a large-scale cohort of individuals at risk for Parkinson’s disease using olfactory testing and DAT imaging.

Subjects in the study completed clinical evaluations at baseline and at two and four years. The evaluations were performed by investigators blinded to clinical data. No individuals with a reduced ability to smell and DAT deficit were diagnosed with Parkinson’s disease at baseline. However, 28% of the patients had phenoconverted or developed motor signs sufficient for diagnosis of Parkinson’s disease by the second year, and 46% had phenoconverted by the fourth year.

“Evaluating this enriched population, the investigators of the PARS trial demonstrated that 46% of individuals with loss of sense of smell combined with a deficit on the DAT scan develop the clinical features of Parkinson’s disease within four years,” said Anthony Lang, MD, Director of the Movement Disorders Clinic at Toronto Western Hospital. “It is likely that ongoing follow-up will show further phenoconversion to Parkinson’s disease of many of the remaining individuals fulfilling these criteria.”

The knowledge that comes from this study will have important implications for the recruitment of individuals for future neuroprotective trials, he added. These trials may have a greater chance of success than previous efforts that exclusively involved patients whose disease had already evolved to the stage of manifesting the clinical features of Parkinson’s disease.

Initiative Seeks Biomarkers of Disease Progression
Researchers participating in the Parkinson Progression Marker Initiative (PPMI) have found motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease. The PPMI aims to identify one or more biomarkers of Parkinson’s disease progression, which would aid the research and development of new and improved treatments for the disease.

The PPMI study assessed clinical imaging and CSF biomarkers of Parkinson’s disease in recently diagnosed patients, healthy volunteers, and people without evidence of dopaminergic deficit. Baseline data from PPMI in these untreated cohorts demonstrated motor and nonmotor deficits and a reduction in CSF and imaging biomarkers in patients with Parkinson’s disease, compared with healthy volunteers.

A comprehensive longitudinal follow-up of the PPMI cohort is under way to characterize biomarker progression. Enrollment of prodromal patients with Parkinson’s disease has begun, and these individuals will be compared with the existing PPMI subjects who are undergoing longitudinal follow-up. All study data are integrated into the PPMI study database and are available at www.ppmi-info.org.

“There is a great need for studies to identify those at risk and then conduct clinical trials to examine the efficacy of treatments at presymptomatic stages,” said Philip Thompson, PhD, Professor of Neurology at the University of Adelaide and Royal Adelaide Hospital. “A number of biomarkers have been identified that may make possible a study of presymptomatic neurodegenerations, such as Parkinson’s disease. To be effective and widely applicable, such studies require considerable precision in identifying reliable predictors and biomarkers of the disease to recruit a cohort of homogeneous patients in the presymptomatic stages. “The results of this [long-term follow-up] study have the potential to change the way clinical trials in Parkinson’s disease are undertaken in the future and the way in which patients with prodromal premotor Parkinson’s disease are managed,” Professor Thompson concluded.

Acupuncture May Improve Patients’ Symptoms
Acupuncture and bee venom acupuncture may be promising alternative therapies for patients with Parkinson’s disease. Seung-Yeon Cho and colleagues at Kyung Hee University Hospital in Seoul, evaluated 43 adults with Parkinson’s disease who had been on a stable dose of antiparkinsonism medication for at least one month. Patients were randomly assigned to acupuncture, bee venom acupuncture, or no treatment. The groups underwent stimulation of 10 acupuncture points using acupuncture or bee venom acupuncture twice per week for eight weeks. The control group received no treatment during this period.

Participants who received bee venom acupuncture showed significant improvement in Unified Parkinson’s Disease Rating Scale (UPDRS) scores, the Berg Balance Scale, and time taken to walk 30 meters. Compared with the control group, patients receiving bee venom acupuncture demonstrated significantly greater improvement in UPDRS scores. In the acupuncture group, the UPDRS and Beck Depression Inventory scores showed significant improvement. The control group showed no significant changes in any outcome measure after the first eight weeks.

“The results showed significant improvement of movement outcomes in the bee venom acupuncture group that was superior to the results with acupuncture treatment alone,” said Louis Tan, MD, Senior Consultant Neurologist at the National Neuroscience Institute in Singapore. “These results are important, as it has been found that up to 70% of patients in some countries use complementary therapies for the management of Parkinson’s disease. In addition to traditional acupuncture, the Korean group has ventured into a new field of bee venom acupuncture treatment. Such carefully planned clinical studies are important to the Parkinson’s community, as they provide much needed evidence to guide the recommendation of such therapies to our patients with Parkinson’s disease.”

Neurologist Care Linked to Decreased Death Risk in Parkinson’s Disease
Treatment by a neurologist improves overall care for patients with Parkinson’s disease and ultimately may reduce the risk of death.

Peter Schmidt, PhD, Vice President of Research Programs at the National Parkinson Foundation in Miami, and colleagues conducted data analysis to identify the incidence of death for patients with Parkinson’s disease treated by a neurologist, in comparison with patients treated by a primary care physician. Using the empirical Bayes method, Drs. Schmidt and Willis calculated the fraction of the population treated by a neurologist, combined with the relative risk of death for individuals with Parkinson’s disease who are treated by a neurologist versus those managed in primary care. According to the model, improved survival for patients receiving neurologist care prevented 4,645 deaths in 2011, and the extension of neurologist care to patients not receiving it would have reduced overall mortality further by 6,967 patients.

“Parkinson’s disease is not a particularly common disorder that generalists will see on an everyday basis,” said Christopher G. Goetz, MD, Director of the Parkinson’s Disease and Movement Disorder program at Rush University Medical Center in Chicago. “In contrast, in a neurologic practice, community or academic, Parkinson’s disease is a common disorder, so that neurologists have much more exposure to patients in all stages of the disease. Further, educational efforts related to Parkinson’s disease are part of almost all general neurology meetings, local, regional, and national. The data from this current study may be debated in terms of the details of the analysis, but they strongly show that neurologic care and expertise favors a positive outcome for patients affected by Parkinson’s disease.”