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Sarcopenia as a marker of severity of Parkinson's disease
Vážná, Anna ; Růžička, Evžen (advisor) ; Dušek, Petr (referee)
The major focus of our study is use of the presence of sarcopenia as a marker for identification of Parkinson's disease in patients with RBD (REM sleep behaviour disorder). This intention is based on higher incidence of sarcopenia in patients with Parkinson's disease. We also evaluated connection of severity of Parkinson's disease and sarcopenia. In theoretical part of our thesis we present separately sarcopenia, Parkinson's disease and RBD for better understanding of these diseases and their connection. Our measurements of sarcopenia were based on literature review. We followed common approach of three component model of diagnosis of sarcopenia. Physical performance was evaluated based on gait characteristics. Low muscle strength was measured with handheld dynamometer. For estimation of body composition, we used two methods which were bioelectrical impedance analysis and anthropometry. In our research we measured these components in total on 72 males. This cohort was divided into three groups based on diagnosis. There were 32 patients with Parkinson's disease, 28 patients with RBD and 12 probands in control group. Based on our findings we defined suitable parameters and cut-off points for identification of sarcopenia as a marker of Parkinson's disease. In group of patients with Parkinson's disease...
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Eye Movement Metrics in the Differentiation of Parkinsonian Syndromes.
Bonnet, Cecilia ; Růžička, Evžen (advisor) ; Rokyta, Richard (referee) ; Jeřábek, Jaroslav (referee)
Eye Movement Metrics in the Differentiation of Parkinsonian Syndromes Cecilia Bonnet, MD Summary of thesis submitted for the degree of Ph.D., Charles University, Prague 2017 In this thesis we investigated conjugate and dis-conjugate eye movements (EM) in Parkinson's disease (PD) and other parkinsonian syndromes aiming to characterize and differentiate some aspects of their oculomotricity using infrared video-oculography. First of all we published a practical review for medical students and clinicians describing clinical examination of eye movements, and interpretation of principal findings. Then we examined principal saccadic eye movements and smooth pursuit in the horizontal and vertical directions with video-oculography in a large group of healthy subjects, aiming to help new oculomotor laboratories in the constitution of their own norms. We conclude that age influence EM metrics but not gender or education level. The latency of saccades and the error rate of antisaccaes increases, while the velocity and gain diminishes with age. Saccades should be investigated in the horizontal and vertical plane because they are influenced by the direction of the target, resulting in a right/left and up/down asymmetry. In a third project we focused on a frequent complain of PD patients, namely blurred near vision and...
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Olfactory impairment and other biomarkers of Alzheimer disease and other neurodegenerative diseases
Vyhnálek, Martin ; Jeřábek, Jaroslav (advisor) ; Růžička, Evžen (referee) ; Rusina, Robert (referee)
Early and differential diagnosis of Alzheimer's disease is associated mainly with the aim to depict hippocampal and mediotemporal impairment. Its massive impairment is present already in early stages. Given that mediotemporal lobe structures are anatomically and functionally closely associated with the olfactory brain, I was involved in examination of smell. In a group of patients with mild cognitive impairment (MCI) we found that olfactory identification is similarly impaired in amnestic (aMCI) which precedes commonly Alzheimer's dementia and in nonamnestic (naMCI) subtype, ), in which patients often also converted into other types of dementia. Olfactory impairment is proportional to cognitive impairment in aMCI but not in naMCI. In another study of olfactory identification with our original smell test called MHST we focused on the evaluation of patients with clinical subtypes of FTLD at the stage of mild dementia. We demonstrated impaired smell identification in all tested clinical subtypes. In another work, I tried to find a neuropsychological test reflecting selectively hippocampal impairment. I compared several standard memory tests in relation to the ability to reflect hippocampal atrophy in nondemented elderly and came to the conclusion that the Enhanced Cued recall test (ECR) with...
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Balance and gait disorders in movement disorders
Hoskovcová, Martina ; Růžička, Evžen (advisor) ; Mareš, Jan (referee) ; Čakrt, Ondřej (referee)
Gait and balance disorders and the resulting falls are a substantial part of Parkinson's disease (PD) and other movement disorders. Especially in the late stage of PD more than 80 % of the patients fall. History of falls remains the best predictor of falls nonetheless, but it can not be used in falls prevention. Dopaminergic pharmacotherapy improves postural stability and gait in PD only in the early stage and the dopaminergic responsiveness of these symptoms decreases significantly during the disease progression. The impact of this medication on future falls risk remains still unclear. The connection between balance and gait disorders and cognitive impairment in PD is also not fully understood. The current state of knowledge about gait and balance disorders and cognitive impairment in PD is not satisfactory. Therefore the aims of the experimental part of this thesis were prospective monitoring of risk factors and predictors of falls, observation of the impact of dopaminergic medication on future falls risk and verifying the relationship between gait and balance disorders and cognitive impairment in PD. The fourth aim of the thesis was to specify the type and severity of gait and balance disorders in patients with essential tremor (ET). Although ET is one of the most common neurological disorders,...
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Neuroanatomical aspects of nonGmotor effects of deep brain stimulation
Růžička, Filip ; Růžička, Evžen (advisor) ; Papežová, Hana (referee) ; Druga, Rastislav (referee)
Summery The underlying mechanisms of weight gain and other affective and cognitive changes after initiation of deep brain stimulation in Parkinson's disease are still unclear. Considering the functional organization within the subthalamic nucleus (STN); limbic, associative and sensorimotor regions residing in the medial, central and later STN respectively, we hypothesized that weight gain may be related to medial localization of stimulation, while motor improvement may be related to lateral localization of stimulation within the STN (study 1). We further hypothesized that stimulation close to the limbic and associative part of the STN may be associated with negative impact on limbic system leading to enhanced anxiety and changes in the hypothalamic- pituitary- adrenal axis (HPA)(study 2). Therefore, the primary aims our study were to assess changes in body weight (study 1) and the hypothalamic- pituitary- adrenal axis (HPA) (study 2) in relation to the position of the active stimulating contact within the nucleus. ...
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Genetics and phenotypic characteristics of early-onset Parkinson's disease
Fiala, Ondřej ; Růžička, Evžen (advisor) ; Seeman, Pavel (referee) ; Bojar, Martin (referee)
Objective: Mutations in the parkin (PARK2) gene have been associated with autosomal recessive early-onset Parkinson's disease (EOPD) with various frequencies in different populations. The aim of the study is to describe phenotypic characteristics of Czech EOPD patients, to evaluate the influence of environmental risk factors, and to determine the frequency of parkin allelic variants in patients and healthy controls. Methods: A total of 70 EOPD patients (age at onset ≤ 40 years) and 75 controls were phenotyped and screened for the sequence variants and exon rearrangements in the parkin gene. Results: The main features in the phenotype of the patients' sample were: the absence of cognitive deficit, high occurrence of dystonia, depression, hyperhidrosis, an excellent response to dopaminergic therapy, early onset of dyskinesia and motor fluctuation. Patients with mutations in the parkin gene had significantly lower age at onset. The agricultural occupation and work with chemicals increased the risk of EOPD, however the coffee drinking appeared to be a protective factor. Parkin mutations were identified in five patients (7.1%): the p.R334C point mutation was present in one patient, four patients had exon deletions. The detected mutations were observed in the heterozygous state except one homozygous...
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Cognitive Impairment in Parkinson's Disease
Bezdíček, Ondřej ; Růžička, Evžen (advisor) ; Papežová, Hana (referee) ; Hort, Jakub (referee)
Cognitive impairment is considered as essential feature of non-motor symptoms in Parkinson's disease (PD). It is a result of underlying pathological processes in the brain of PD patients and it leads to decreased quality of life. In this thesis an analysis of the structure and profile of cognitive impairment is presented with special emphasis on executive functions and memory. We take diagnostic entities developed for the description of PD cognitive spectrum such as mild cognitive impairment (PD-MCI) and dementia (PD-D) as examples of heterogeneity and different severity of cognitive impairment in PD. However, neuropsychological methods in Czech version that would measure these diagnotic units were not adequatly validated. In the experimental part we test a hypothesis, if gait disorder with falls in PD is interconnected with cognitive impairment, and if PD-fallers have more severe cognitive deficit than PD-non-fallers. On the basis of nine validity or normative data studies we show psychometric properties and clinical utility of several basic neuropsychological methods in the Czech population for memory (Rey Auditory Verbal Learning Test, California Verbal Learning Test, Second Edition, Memory For Intentions Screening Test and Enhanced Cued Recall Test), sustained attention and executive functions...
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The effects of deep brain stimulation of the subthalamic nucleus on emotional and motivational processing in Parkinson's disease patients
Serranová, Tereza ; Růžička, Evžen (advisor) ; Horáček, Jiří (referee) ; Mareš, Jan (referee)
Summary: The mechanisms of weight gain or behavioral and affective changes known to occur in patients with Parkinson's disease (PD) treated with deep brain stimulation of the subthalamic nucleus (STN DBS) are incompletely understood. We hypothesize that some of these non-motor side-effects may be related to changes in motivational processing due to STN DBS. Motivational processing to appetitive and aversive stimuli can be assessed using subjective evaluation of emotional relevance (i.e. incentive salience attribution) or affective modulation of the auditory blink reflex (ABR). The latter provides an objective measure of changes in emotional reactivity: ABRs are physiologically potentiated by unpleasant and inhibited by pleasant stimuli, reflecting activation of the aversive and appetitive motivational systems. Our aim was to assess the effects of STN DBS on motivational processing of pictures from 4 categories, two representing primary rewards, erotica and food, one aversive fearful and one neutral, using the subjective evaluation of motivational relevance (Study 1.) and the modulation of the ABR reactivity (Study 2.) in off-medicated PD patients with DBS switched ON and OFF. The results were compared with those obtained in healthy controls using the same paradigms. Study 1. Twenty PD patients in bilateral...
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Pathophysiology and clinical aspects of eye movements in basal ganglia disorders.
Hanuška, Jaromír ; Růžička, Evžen (advisor) ; Vymazal, Josef (referee) ; Jeřábek, Jaroslav (referee)
This dissertation is a collection of a total of seven publications that deal with eye movement disorders in patients with basal ganglia disorders. We obtained normative data for videooculography in healthy individuals. We have described the eye movement evolution during a human life such as the increase of latency, movements become hypometric and antisaccadic error rate increases. We have shown that sex and education do not affect the eye movements. Our study highlighted the asymmetry in the eye movement performance. As the first, we studied the vergence in patients with Parkinson's disease (PN) using videooculography (VOG). We devised and defined a paradigm for this examination and saw that in patients with PN there is a prolonged latency and hypometry of divergence. In patients with ephedrone induced parkinsonism (EP), we were the first who examined eye movements and found that it was possible to identify between this toxic Parkinson's syndrome and PN on the basis of a videooculography. In EP patients, we described velocity decsrease and hypometry in horizontal saccades, prolonged latency in horizontal saccades, and higher error rate in the antisacadic task. Behavioral disorder in REM sleep (RBD) as a prodromal stage of PN leads to impaired eye movement. In the evaluation with PN patients, we...
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