Management of Urologic and Sexual Dysfunction in Parkinson Disease

Margolesky, Jason; Betté, Sagari; Singer, Carlos

doi:10.1016/j.cger.2019.09.011

Cited by 12 publications

(4 citation statements)

References 20 publications

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“…Wherever possible, it would be recommended to stop the offending drug [69,88,111]. Because APs have long half-lives, the improvement in AIP will not be immediate [107].…”

Section: Stop the Antipsychoticmentioning

confidence: 99%

“…Some have also argued that persistent parkinsonism after drug withdrawal may be due to a direct toxic effect on the dopaminergic system [106]. Early differentiation of IPD from AIP is crucial as it has vastly different prognostic implications [111]: receptor imaging studies have shown that over a third of patients with DIP have nigrostriatal dopaminergic dysfunction [73]; and structural imaging studies revealed that microstructural white matter changes are present over various brain regions in patients with DIP [65]. A study measuring functional connectivity (FC) in DIP showed that FC between the sensorimotor network and the cerebellum or prefrontal region was lower in the group of DIP patients with partial recovery following drug withdrawal compared to the complete recovery group; hence, it was a predictor of whether patients with DIP would recover within 3 months of withdrawal of the offending drug [66].…”

Section: Prognosis Of Aipmentioning

confidence: 99%

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Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

Wisidagama

Selladurai

et al. 2021

Medicines

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Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment.

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“…Wherever possible, it would be recommended to stop the offending drug [69,88,111]. Because APs have long half-lives, the improvement in AIP will not be immediate [107].…”

Section: Stop the Antipsychoticmentioning

confidence: 99%

Section: Prognosis Of Aipmentioning

confidence: 99%

Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

Wisidagama

Selladurai

et al. 2021

Medicines

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“…Although the clinical management of PD is typically centered on the treatment of the cardinal motor symptoms, these often coexist with non-motor symptoms such as fatigue ( Friedman et al, 2007 ; Herlofson and Kluger, 2017 ; Siciliano et al, 2018 ), depression ( Cummings, 1992 ; Schrag, 2006 ; Reijnders et al, 2008 ), anxiety ( Richard et al, 1996 ; Richard, 2005 ; Ray and Agarwal, 2020 ), apathy ( den Brok et al, 2015 ; Pagonabarraga and Kulisevsky, 2017 ; D’Iorio et al, 2018 ), sleep disorders ( Comella, 2007 ; Zhang et al, 2020 ; Maggi et al, 2021 ), urological dysfunctions ( Blackett et al, 2009 ; Yeo et al, 2012 ; Margolesky et al, 2020 ), and cognitive impairments ( Padovani et al, 2006 ; Litvan et al, 2012 ; Yang et al, 2016 ) ranging from mild deficits to overt dementia.…”

Section: Introductionmentioning

confidence: 99%

The assessment of executive functions to test the integrity of the nigrostriatal network: A pilot study

Ilardi¹,

Maio

Villano

et al. 2023

Front. Psychol.

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BackgroundParkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by motor and non-motor symptoms. The latter mainly include affective, sleep, and cognitive deficits. Non-demented PD patients often demonstrate impairments in several executive domains following neuropsychological evaluation. The current pilot study aims at assessing the discriminatory power of the Frontal Assessment Battery-15 (FAB15) in differentiating (i) non-demented PD patients and healthy controls and (ii) PD patients with more and less pronounced motor symptoms.MethodsThirty-nine non-demented early-stage PD patients in the “on” dopamine state (26 females, mean age = 64.51 years, SD = 6.47, mean disease duration = 5.49 years, SD = 2.28) and 39 healthy participants (24 females, mean age = 62.60 years, SD = 5.51) were included in the study. All participants completed the FAB15. Motor symptoms of PD patients were quantified via the Unified Parkinson’s Disease Rating Scale-Part III (UPDRS-Part III) and Hoehn and Yahr staging scale (H&Y).ResultsThe FAB15 score, adjusted according to normative data for sex, age, and education, proved to be sufficiently able to discriminate PD patients from healthy controls (AUC = 0.69 [95% CI 0.60–0.75], SE = 0.06, p = 0.04, optimal cutoff = 11.29). Conversely, the battery lacked sufficient discriminative capability to differentiate PD patients based on the severity of motor symptoms.ConclusionThe FAB15 may be a valid tool for distinguishing PD patients from healthy controls. However, it might be less sensitive in identifying clinical phenotypes characterized by visuospatial impairments resulting from posteroparietal and/or temporal dysfunctions. In line with previous evidence, the battery demonstrated to be not expendable in the clinical practice for monitoring the severity of PD-related motor symptoms.

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“…As an NGD, notable symptoms are speech impairments, cognitive decline, gait deterioration, falls, gastrointestinal and genitourinary changes, and swallowing impairment [2]. In addition to these, literature evidence from Margolesky et al [3] characteristically indicates that urinary dysfunction is common in PD patients.…”

Section: Introductionmentioning

confidence: 99%

The voiding efficiency in rat models with dopaminergic brain lesions induced through unilateral and bilateral intrastriatal injections

et al. 2020

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Bladder dysfunction is a common phenomenon in Parkinson’s disease (PD) patients. A research attempt was made to analyze the voiding efficiency (VE) and bladder functions in rats with PD induced by unilateral or bilateral injections of 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle. PD rats were divided into unilateral- and bilateral-injected groups and subjected to rotation and beam walking tests. Further, the experimental rats underwent cystometric measurements for analyses of bladder dysfunction and VE. Immunohistochemical analysis was performed to analyze the dopaminergic neuron depletion on the target area. Outcomes of the rotation and beam walking tests revealed the extent of parkinsonism in the experimental rats. Urodynamic observations denoted that rats with unilateral PD exhibited a significantly decreased VE (from 68.3±3.5% to 32.7±5.8%), while rats with bilateral PD displayed a much-reduced and substantially lower level of VE of 18.3±5.1% compared to the control value and to that of rats with unilateral PD. Rats with bilateral PD showed more-extensive behavioral deficits and urodynamic changes than did rats with unilateral PD. These significant changes in motor, behavioral, bladder function and VE were due to an extensive degeneration of dopaminergic neurons in the substantia nigra region on both sides of the brain. The obtained results were substantiated with appropriate immunohistochemical results.

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Management of Urologic and Sexual Dysfunction in Parkinson Disease

Cited by 12 publications

References 20 publications

Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

The assessment of executive functions to test the integrity of the nigrostriatal network: A pilot study

The voiding efficiency in rat models with dopaminergic brain lesions induced through unilateral and bilateral intrastriatal injections

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