BackgroundParkinsonism (PD) is a common neurodegenerative disorders into which dysphagia occurs mainly in the late stage and to a lesser extent in an early stage. Diagnosis of dysphagia particularly in early idiopathic Parkinson’s disease (IPD) is important as dysphagia affects the quality of life of patients and most of the patients are unaware of this important symptom.MethodFifty-four patients were enrolled in this study presented with early IPD attending to the outpatient clinic of Sohag University Hospital. All PD patients were assessed by using Unified Parkinson’s Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale. IPD patients were classified into tremor dominant (TD) and postural instability/gait disorder (PIGD) phenotypes. Swallowing disturbance questionnaire (SDQ) and fiberoptic endoscopic evaluation of swallowing (FEES) were used to evaluate dysphagia.ResultsThirty-five percent of patients experienced dysphagia when the patients were questioned, and this percent rises to 40% on using FEES. The results of SDQ were significantly correlated to the results of more accurate FEES. The percentage of dysphagia was higher in patients with PIGD than TD phenotype. Dysphagia was significantly associated with the mean of the Mini-Mental State Examination (MMSE), UPDRS, and modified Hoehn and Yahr scale.ConclusionsDysphagia is a prevalent symptom in early IPD and significantly correlated with Parkinsonism phenotype, UPDRS, and modified Hoehn and Yahr scale.Electronic supplementary materialThe online version of this article (10.1186/s41983-018-0031-1) contains supplementary material, which is available to authorized users.

Cognitive decline in breast cancer patients can occur treatment related or nontreatment related. Disturbance of cognition can occur before start of any cancer therapy or in association with breast cancer therapy (e.g., radiation, hormonal therapy). Risk factors include a patient's characteristics, such as psychological and genetic parameters other than the impact of cancer and cancer therapy. Incidence of cognitive disturbance in patients who receive chemotherapy is higher than patients receiving hormonal therapy, according to several surveys. Hypothesis of cognitive dysfunction includes increased systemic inflammation, mitochondrial dysfunction in neurons and Oxidative damage. Symptoms of cognitive dysfunction were more frequent in women who received high-dose chemotherapy, so that cognitive impairment is considered as treatment toxicity. Cognitive dysfunction was common among breast cancer patients as a toxic effect of chemotherapy. Complex attention, executive function, learning and memory are common affected domains. Pharmacologic treatment of cognitive dysfunction includes medication for dementia but without conclusive efficacy. Also, physical exercise is considered a suitable intervention, but has not been efficiently evaluated.

Peripheral neuropathy induced by chemotherapy is considered the most common neurological disorder associated with chemotherapy. Different sites are involved in the mechanism of chemotherapy induced peripheral neuropathy and considered multifactorial. 68% of cases develop CIPN during the first month following the start of chemotherapy, 60% of cases develop CIPN within 3 months after chemotherapy and only 30% after 6 months. CIPN is caused by chemotherapeutic agents which include taxanes, platinum analogs, and vinca alkaloids. The clinical presentation of CIPN includes multiple symptoms that may cause functioning impairment and may require reduction of the dose of chemotherapy. CIPN considered a common sequel of different agents of chemotherapy and may last from months to years after chemotherapy completion. CIPN can be diagnosed by a detailed history and clinical examination. Clinical examination of a patient with CIPN can be done by the use of nerve conduction studies. Antidepressant includes tricyclic antidepressants and serotonin-noradrenaline reuptake inhibitors are common drugs used for CIPN. Patients may require reductions, substitutions, or stopping of chemotherapeutic agents according to the severity of symptoms.

Abnormal activity in a neuronal network in which the cerebellum is included is coherent with continuous tremor oscillation. Within the cortico-Olivo-cerebella-thalamic circuit, the inferior olive could be an oscillator by having pacemaker properties. Despite that, the olivary pacemaker hypothesis faces many contradicting findings against the concept of a single oscillator. The attention has changed from the interactions between the elements and structures of the neural network in which the oscillators are contained to concentrate on its features. These features include the intensity and direction of the connection. Deficiency in the glutamatergic system in ET may be a better explanation for abnormal cerebellar function in ET. A reduction in dentate GABA receptor levels could be a basic defect in this disease. This may be explained by the reduced production of GABA from Purkinje cells at the postsynaptic neurons. This results in the release of deep cerebellar nuclei from previous inhibition. The correlation between genetic abnormalities and cerebellar dysfunction may explain this in the future.

Essential tremor (ET) is defined as an action tremor syndrome with a duration of more than three years in both upper limbs with or without tremor in other areas and with no other neurological signs. ET's non-motor characteristics add to the evidence of clinical variability in ET, a disease with a wide range of pathological and etiological characteristics. Problems in frontal-executive function, comparable to Parkinson's disease (PD), were one of the most common patterns of cognitive affection in ET. ET individuals who started tremor after the age of 65 were 64 to 70% more likely than control subjects to develop dementia, but ET cases who started tremor before the age of 65 have an equal chance to develop dementia as controls. Depression rates were considerably higher in ET than controls and more severe depression is found. A strong evidence linking anxiety and ET. Many studies have documented sleep disturbances in ET.