Association of metabolic syndrome and change in Unified Parkinson's Disease Rating Scale scores

Leehey, Maureen A.; Luo, Sheng; Sharma, Saloni; Wills, Anne‐Marie; Bainbridge, Jacquelyn; Wong, Pei Shieen; Simon, David K.; Schneider, Jay S.; Zhang, Yunxi; Pérez, Adriana; Dhall, Rohit; Christine, Chadwick W.; Singer, Carlos; Cambi, Franca; Boyd, James T.

doi:10.1212/wnl.0000000000004572

Cited by 28 publications

(29 citation statements)

References 39 publications

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“…30,31 Although weight loss is often associated with a negative impact on PD severity, 32 a recent study has shown that patients with metabolic syndrome experience greater PD progression over time, mainly as a result of increased motor scores, compared to patients without metabolic syndrome. 33 Given that the average patient in both groups lost 4 to 5 kg, yet remained overweight at week 8, the observed weight loss may have contributed to the improved motor scores in both groups. In addition, the placebo effect may significantly impact motor symptoms in PD patients.…”

Section: Discussionmentioning

confidence: 93%

“…It is well documented that overweight patients on unrestricted low‐fat and low‐carbohydrate diets can still experience significant weight loss, which may relate to altered levels of energy‐regulating hormones such as insulin . Although weight loss is often associated with a negative impact on PD severity, a recent study has shown that patients with metabolic syndrome experience greater PD progression over time, mainly as a result of increased motor scores, compared to patients without metabolic syndrome . Given that the average patient in both groups lost 4 to 5 kg, yet remained overweight at week 8, the observed weight loss may have contributed to the improved motor scores in both groups.…”

Section: Discussionmentioning

confidence: 99%

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Low‐fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial

Murtagh²,

et al. 2018

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Background: Preliminary evidence suggests that diet manipulation may influence motor and nonmotor symptoms in PD, but conflict exists regarding the ideal fat to carbohydrate ratio. Objectives: We designed a pilot randomized, controlled trial to compare the plausibility, safety, and efficacy of a low‐fat, high‐carbohydrate diet versus a ketogenic diet in a hospital clinic of PD patients. Methods: We developed a protocol to support PD patients in a diet study and randomly assigned patients to a low‐fat or ketogenic diet. Primary outcomes were within‐ and between‐group changes in MDS‐UPDRS Parts 1 to 4 over 8 weeks. Results: We randomized 47 patients, of which 44 commenced the diets and 38 completed the study (86% completion rate for patients commencing the diets). The ketogenic diet group maintained physiological ketosis. Both groups significantly decreased their MDS‐UPDRS scores, but the ketogenic group decreased more in Part 1 (−4.58 ± 2.17 points, representing a 41% improvement in baseline Part 1 scores) compared to the low‐fat group (−0.99 ± 3.63 points, representing an 11% improvement) (P < 0.001), with the largest between‐group decreases observed for urinary problems, pain and other sensations, fatigue, daytime sleepiness, and cognitive impairment. There were no between‐group differences in the magnitude of decrease for Parts 2 to 4. The most common adverse effects were excessive hunger in the low‐fat group and intermittent exacerbation of the PD tremor and/or rigidity in the ketogenic group. Conclusions: It is plausible and safe for PD patients to maintain a low‐fat or ketogenic diet for 8 weeks. Both diet groups significantly improved in motor and nonmotor symptoms; however, the ketogenic group showed greater improvements in nonmotor symptoms. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Low‐fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial

Murtagh²,

et al. 2018

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“…Due to the importance of the hypothalamus in regulation of energy balance through physical activity and food intake, hypothalamic cell death shown by the conditioned media from CGNP-stimulated microglia supports prior data suggesting that chronic exposure to CGNP may also impact energy balance [ 65 , 66 ]. Additionally, hypothalamic dysfunction is often reported during the early onset of AD and PD, including non-cognitive deficits related to metabolic symptoms such as mid-life obesity and metabolic syndrome [ 67 , 68 ]. Our model could, thus, assist in the development of rapid biomarker screens to assist in early diagnosis for individuals at risk of neurological insults triggered by environmental pollution exposure [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

Microglial Immune Response to Low Concentrations of Combustion-Generated Nanoparticles: An In Vitro Model of Brain Health

et al. 2018

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The brain is the central regulator for integration and control of responses to environmental cues. Previous studies suggest that air pollution may directly impact brain health by triggering the onset of chronic neuroinflammation. We hypothesize that nanoparticle components of combustion-generated air pollution may underlie these effects. To test this association, a microglial in vitro biological sensor model was used for testing neuroinflammatory response caused by low-dose nanoparticle exposure. The model was first validated using 20 nm silver nanoparticles (AgNP). Next, neuroinflammatory response was tested after exposure to size-selected 20 nm combustion-generated nanoparticles (CGNP) collected from a modern diesel engine. We show that low concentrations of CGNPs promote low-grade inflammatory response indicated by increased pro-inflammatory cytokine release (tumor necrosis factor-α), similar to that observed after AgNP exposure. We also demonstrate increased production of reactive oxygen species and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) p65 phosphorylation in microglia after CGNP stimulation. Finally, we show conditioned media from CGNP-stimulated microglia significantly reduced hypothalamic neuronal survival in vitro. To our knowledge, this data show for the first time that exposure to AgNP and CGNP elicits microglial neuroinflammatory response through the activation of NF-κB.

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“…fatores de risco vascular, cancro, síndrome metabólica, baixo índice de massa corporal), o atingimento motor axial, a deterioração cognitiva e disfunção autonómica precoces têm sido apontados como fatores preditores independentes de pior prognóstico. [11][12][13][14][15][16] Recentemente, níveis baixos de vitamina B12 foram associados a pior prognóstico 17 . Este texto pretende ser um guia para os clínicos que habitualmente contactam com doentes com DP, com especial ênfase nas características clínicas da doença, critérios de diagnóstico atuais e as opções contemporâneas para o tratamento da doença.…”

Section: Introductionunclassified

Doença de Parkinson: Revisão Clínica e Atualização

2019

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Parkinson’s disease is the second most common neurodegenerative disorder, and a significant increase in its prevalence in the past three decades has been documented. Environmental and genetic factors contribute to the pathophysiology of this disease, and 5% – 10% of cases have a monogenic cause. The diagnosis relies on clinical findings, supported by adequate testing. There is no absolute method to diagnose Parkinson’s disease in vivo, except for genetic testing in specific circumstances, whose usefulness is limited to a minority of cases. New diagnostic criteria have been recently proposed with the aim of improving diagnostic accuracy, emphasizing findings that might point to other causes of parkinsonism. The available therapeutic options are clinically useful, as they improve the symptoms as well as the quality of life of patients. After the introduction of levodopa, deep brain stimulation emerged as the second therapy with an important symptomatic impact in the treatment of Parkinson’s disease. Non-motor symptoms and motor complications are responsible for a large proportion of disability, so these should be identified and treated. Current scientific research is focused on the identification of disease biomarkers allowing correct and timely diagnosis, and on creating more effective therapies, thus fulfilling current clinical unmet needs. This paper presents an updated review on Parkinson’s disease, guiding the readership through current concepts, and allowing their application to daily clinical practice.

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Association of metabolic syndrome and change in Unified Parkinson's Disease Rating Scale scores

Abstract: NCT00449865.

Cited by 28 publications

References 39 publications

Low‐fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial

Low‐fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial

Microglial Immune Response to Low Concentrations of Combustion-Generated Nanoparticles: An In Vitro Model of Brain Health

Doença de Parkinson: Revisão Clínica e Atualização

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