a study to identify the correlates of pseudobulbar affect ... · parvizi j, coburn kl, shillcutt...
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A Study to Identify the Correlates of Pseudobulbar Affect in Patients with Parkinsonian Disorders and ALS Neepa Patel, M.D., Michele K. York, Ph.D., Cecile Phan, M.D. and Joohi Jimenez-Shahed, M.D.
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas Amyotrophic Lateral Sclerosis Association Center, Department of Neurology, Baylor College of Medicine, Houston, Texas
RESULTS (continued…)
DISCUSSION
REFERENCES
BACKGROUND Pseudobulbar affect (PBA) is a frontal disinhibition syndrome associated with
inappropriate laughter and crying to minor stimulus, independent of affective disturbance1.
PBA has been primarily studied in amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS)2,3. Recent studies have demonstrated PBA in other neurological conditions4 such as Parkinson’s disease (PD), and atypical parkinsonism (aP) such as corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA)5,6.
We have observed that PBA is more common in parkinsonian patients with associated cognitive impairment. However PBA has been observed in ALS patients with or without cognitive impairment
Our objective is to determine whether cognitive and psychiatric co-morbidities correlate with PBA in patients with PD, atypical parkinsonism (aP) and ALS. METHODS
We aimed to enroll 50 PD patients, 30 ALS patients and 30 aP (10 PSP, 10 MSA and 10 CBD). In this IRB approved study patients were recruited from the Parkinson’s disease or ALS centers.
Any person with a definite diagnosis of PD, aP or ALS identified through clinical practice was eligible to participate.
Exclusion criteria:
>30% of all questionnaire was incomplete Patients with advanced disease who are unable to communicate answers Non-English speaking patients
Participating subjects completed a series of self-report questionnaires:
Center for Neurological Study-Lability Scale for PBA (CNS-LS) Beck Depression Inventory-II (BDI) State-Trait Anxiety Inventory- Trait (STAI) Self and Other Apathy Evaluation Scales (AES) The Short Form-36 quality of life measure (SF36-QOL)
SF36 PCS = SF36- QOL physical component score; SF 36- QOL mental component score **statistically significant; * trend towards statistical significance
1. Moore, S.R., Gresham, L.S., Bromberg, M.B., Kasarkis, E.J., Smith, R.A., 1997. A self report measure of affective lability. J Neurol Neurosurg Psychiatry. 63, 89-93.
2. Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan Plus Ultra Low-Dose Quinidine Reduces Pseudobulbar Affect. Annals of neurology 2010;68:693-70
3. Garnock-Jones KP. Dextromethorphan/quinidine: in pseudobulbar affect. CNS drugs 2011;25:435-445. 4. Work SS, Colamonico JA, Bradley WG, Kaye RE. Pseudobulbar affect: an under-recognized and under-
treated neurological disorder. Advances in therapy 2011;28:586-601. 5. Strowd R, Cartwright M, Okun M, Haq I, Siddiqui M. Pseudobulbar affect: prevalence and quality of life
impact in movement disorders. Journal of Neurology 2010;257:1382-1387. 6. Alvarez-Gonzalez E, Maragoto-Rizo C, Arteche-Prior M, Perez-Parra S, Carballo M, Alvarez-Gonzalez L.
[A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy]. Revista de neurologia 2004;39:1006-1010.
7. Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Advances in therapy 2012;29:775-798.
8. Parvizi J, Coburn KL, Shillcutt SD, Coffey CE, Lauterbach EC, Mendez MF. Neuroanatomy of Pathological Laughing and Crying: A Report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2009;21:75-87
9. Garnock-Jones KP. Dextromethorphan/quinidine: in pseudobulbar affect. CNS drugs 2011;25:435-445.
RESULTS There were no statistically significant differences in degree of PBA as measured on the CNS-
LS scores between groups
There is increased cognitive impairment in the ALS and aP groups compared to the PD cohort.
Figure 1: Distribution of Diagnoses in the Recruited Cohorts
Table 2: Cognitive and Psychiatric correlates of PBA between groups PSP 38%
MSA 34%
CBD 28%
aP 27%
ALS 23%
PD 50% n=53
n=25
n=29 n=10
n=11 n=8
Figure 2 and Table 2: Prevalence of PBA and Mean Questionnaire Scores By Cohorts
Table 1: Patient Demographics
RESULTS (continued…) There was a positive correlation with PBA and anxiety scores in PD and aP
groups, this association was not found in the ALS group.
Depression scores and Mental Health QOL impairments positively correlate with PBA scores only in the PD group.
MoCA scores did not correlate with PBA for any of groups; however there are observed differences between the groups.
This study demonstrates that, despite its definition, PBA correlates with affective disturbance in PD and aP patients but not in ALS patients.
The results suggest that individuals with parkinsonian disorders and PBA symptoms should be evaluated and/or treated for co-morbid mood problems.
Previous studies have reported increased burden of illness7 associated with PBA and an association between depression and PBA in a movement disorders population5. In addition to these observations our study also demonstrates an association between PBA and anxiety in parkinsonian patients.
Limitations of this study include:
Small sample size Exclusion of patients with advanced disease due to impaired language
and communication in all groups MoCA scores may be artificially reduced to disease specific symptoms
affecting writing
There are no statistically significant differences in demographics between the aP subgroups measured through Chi-square/ t-tests and ANOVA.
PD ALS aP
PBA p-value PBA p-value PBA p-value
MoCA -0.193 0.166 -0.288 0.163 0.062 0.751
BDI 0.349 0.011** 0.090 0.670 0.337 0.074*
STAI 0.456 0.001** 0.253 0.222 0.456 0.013**
Self AES 0.033 0.816 0.050 0.812 0.002 0.993
Other AES -0.79 0.630 0.386 0.084 0.052 0.798
SF36 PCS -0.157 0.267 0.110 0.602 0.231 0.228
SF36 MCS -0.286 0.038** -0.129 0.540 -0.314 0.097*
There are no intragroup differences between the 3 subgroups recruited on demographic and individual questionnaires.
The proposed mechanism of PBA is disruption of inhibitory signals descending from the cerebral cortex to motor regions of the brainstem implicated in the regulation of emotional output8.
Our findings suggest that an alternate pathophysiological mechanism for PBA may be present in ALS compared to parkinsonian patients.
Future studies should be directed toward evaluation of the pathophysiologic mechanism of PBA in each neurological conditions.
Additional testing of mood effects of dextromethorphan-quinidine (an FDA- approved treatment for PBA9), or effect of antidepressants on PBA should be considered in in patients with parkinsonian conditions.
CONCLUSION
PD ALS aP p-value
MoCA 25.1±3.94 23.3± 3.30 21.4±5.07 0.001**
PBA 10.1±3.83 11.2±7.00 11.7±5.23 0.378
BDI 10.7±9.36 11.3±6.64 14.1±7.74 0.192
STAI 36.4±10.54 35.9±8.03 37.9±10.1 0.733
Self AE
54.6±6.67 53.9±7.66 50.2±10.2 0.058*
Other AE
53.9±8.32 49.8±9.92 47.6±12.4 0.38
**statistically significant * trend towards statistical significance
OBJECTIVE
PD ALS aP p-value
Age (years) 63.4 ± 10.5 61.6 ± 8.7 68.8 ± 7.9 0.36
Duration of Illness 5.0±4.8 2.4±1.6 3.9±2.3 0.54
Gen
der Male 30 13 17
0.795 Female 23 13 12
Educ
atio
n 16 years 13 2 7
Ethn
icity
Caucasian 48 21 25
0.694 Hispanic 2 3 2
African American 2 1 1
Other 1 0 1
Poster available for download.
Slide Number 1
A Study to Identify the Correlates of Pseudobulbar Affect in Patients with Parkinsonian Disorders and ALS
Neepa Patel, M.D., Michele K. York, Ph.D., Cecile Phan, M.D. and Joohi Jimenez-Shahed, M.D.
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas
Amyotrophic Lateral Sclerosis Association Center, Department of Neurology, Baylor College of Medicine, Houston, Texas
RESULTS (continued…)
DISCUSSION
REFERENCES
BACKGROUND
Pseudobulbar affect (PBA) is a frontal disinhibition syndrome associated with inappropriate laughter and crying to minor stimulus, independent of affective disturbance1.
PBA has been primarily studied in amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS)2,3. Recent studies have demonstrated PBA in other neurological conditions4 such as Parkinson’s disease (PD), and atypical parkinsonism (aP) such as corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA)5,6.
We have observed that PBA is more common in parkinsonian patients with associated cognitive impairment. However PBA has been observed in ALS patients with or without cognitive impairment
Our objective is to determine whether cognitive and psychiatric co-morbidities correlate with PBA in patients with PD, atypical parkinsonism (aP) and ALS.
METHODS
We aimed to enroll 50 PD patients, 30 ALS patients and 30 aP (10 PSP, 10 MSA and 10 CBD). In this IRB approved study patients were recruited from the Parkinson’s disease or ALS centers.
Any person with a definite diagnosis of PD, aP or ALS identified through clinical practice was eligible to participate.
Exclusion criteria:
>30% of all questionnaire was incomplete
Patients with advanced disease who are unable to communicate answers
Non-English speaking patients
Participating subjects completed a series of self-report questionnaires:
Center for Neurological Study-Lability Scale for PBA (CNS-LS)
Beck Depression Inventory-II (BDI)
State-Trait Anxiety Inventory- Trait (STAI)
Self and Other Apathy Evaluation Scales (AES)
The Short Form-36 quality of life measure (SF36-QOL)
SF36 PCS = SF36- QOL physical component score; SF 36- QOL mental component score
**statistically significant; * trend towards statistical significance
Moore, S.R., Gresham, L.S., Bromberg, M.B., Kasarkis, E.J., Smith, R.A., 1997. A self report measure of affective lability. J Neurol Neurosurg Psychiatry. 63, 89-93.
Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan Plus Ultra Low-Dose Quinidine Reduces Pseudobulbar Affect. Annals of neurology 2010;68:693-70
Garnock-Jones KP. Dextromethorphan/quinidine: in pseudobulbar affect. CNS drugs 2011;25:435-445.
Work SS, Colamonico JA, Bradley WG, Kaye RE. Pseudobulbar affect: an under-recognized and under-treated neurological disorder. Advances in therapy 2011;28:586-601.
Strowd R, Cartwright M, Okun M, Haq I, Siddiqui M. Pseudobulbar affect: prevalence and quality of life impact in movement disorders. Journal of Neurology 2010;257:1382-1387.
Alvarez-Gonzalez E, Maragoto-Rizo C, Arteche-Prior M, Perez-Parra S, Carballo M, Alvarez-Gonzalez L. [A clinical and epidemiological description of a series of patients diagnosed as suffering from progressive supranuclear palsy]. Revista de neurologia 2004;39:1006-1010.
Colamonico J, Formella A, Bradley W. Pseudobulbar affect: burden of illness in the USA. Advances in therapy 2012;29:775-798.
Parvizi J, Coburn KL, Shillcutt SD, Coffey CE, Lauterbach EC, Mendez MF. Neuroanatomy of Pathological Laughing and Crying: A Report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2009;21:75-87
Garnock-Jones KP. Dextromethorphan/quinidine: in pseudobulbar affect. CNS drugs 2011;25:435-445.
RESULTS
There were no statistically significant differences in degree of PBA as measured on the CNS-LS scores between groups
There is increased cognitive impairment in the ALS and aP groups compared to the PD cohort.
Figure 1: Distribution of Diagnoses in the Recruited Cohorts
Table 2: Cognitive and Psychiatric correlates of PBA between groups
n=53
n=25
n=29
n=10
n=11
n=8
Figure 2 and Table 2: Prevalence of PBA and Mean Questionnaire Scores By Cohorts
Table 1: Patient Demographics
RESULTS (continued…)
There was a positive correlation with PBA and anxiety scores in PD and aP groups, this association was not found in the ALS group.
Depression scores and Mental Health QOL impairments positively correlate with PBA scores only in the PD group.
MoCA scores did not correlate with PBA for any of groups; however there are observed differences between the groups.
This study demonstrates that, despite its definition, PBA correlates with affective disturbance in PD and aP patients but not in ALS patients.
The results suggest that individuals with parkinsonian disorders and PBA symptoms should be evaluated and/or treated for co-morbid mood problems.
Previous studies have reported increased burden of illness7 associated with PBA and an association between depression and PBA in a movement disorders population5. In addition to these observations our study also demonstrates an association between PBA and anxiety in parkinsonian patients.
Limitations of this study include:
Small sample size
Exclusion of patients with advanced disease due to impaired language and communication in all groups
MoCA scores may be artificially reduced to disease specific symptoms affecting writing
There are no statistically significant differences in demographics between the aP subgroups measured through Chi-square/ t-tests and ANOVA.
There are no intragroup differences between the 3 subgroups recruited on demographic and individual questionnaires.
The proposed mechanism of PBA is disruption of inhibitory signals descending from the cerebral cortex to motor regions of the brainstem implicated in the regulation of emotional output8.
Our findings suggest that an alternate pathophysiological mechanism for PBA may be present in ALS compared to parkinsonian patients.
Future studies should be directed toward evaluation of the pathophysiologic mechanism of PBA in each neurological conditions.
Additional testing of mood effects of dextromethorphan-quinidine (an FDA- approved treatment for PBA9), or effect of antidepressants on PBA should be considered in in patients with parkinsonian conditions.
CONCLUSION
**statistically significant
* trend towards statistical significance
OBJECTIVE
Poster available for download.
PDALSaP
PBAp-valuePBAp-valuePBAp-value
MoCA-0.1930.166-0.2880.1630.0620.751
BDI0.3490.011**0.0900.6700.3370.074*
STAI0.4560.001**0.2530.2220.4560.013**
Self AES0.0330.8160.0500.8120.0020.993
Other AES-0.790.6300.3860.0840.0520.798
SF36 PCS-0.1570.2670.1100.6020.2310.228
SF36 MCS-0.2860.038**-0.1290.540-0.3140.097*
PDALSaPp-value
MoCA25.1±3.9423.3± 3.3021.4±5.070.001**
PBA10.1±3.8311.2±7.0011.7±5.230.378
BDI10.7±9.3611.3±6.6414.1±7.740.192
STAI36.4±10.5435.9±8.0337.9±10.10.733
Self AE54.6±6.6753.9±7.6650.2±10.20.058*
Other AE53.9±8.3249.8±9.9247.6±12.40.38
*
Chart1
PD
ALS
aP
%
% Diagnosed with PBA
20.8
29.2
34.5
Data
Subject IDDate evalAge onsetDOBeducationGEthnicityDiagnosisPsych hxPMHDA modulators5HT modulatorsmood stablizersDementiaAEDsAnxiolyticsSleep aidesStimulantsOtherMoCA TotMoCA ScoreVis/spatialNamingAttenLanguageAbstractionDelay recallorientPBAQ1PBAQ2PBAQ3PBAQ4PBAQ5PBAQ6PBAQ7PBA TotBDI Q1BDI Q2BDIQ3BDIQ4BDIQ5BDIQ6BDIQ7BDIQ8BDIQ9BDIQ10BDIQ11BDIQ12BDIQ13BDIQ14BDIQ15BDIQ16BDIQ17BDIQ18BDIQ19BDIQ20BDIQ21BDI TotAnxQ21AnxQ22AnxQ23AnxQ24AnxQ25AnxQ26AnxQ27AnxQ28AnxQ29AnxQ30AnxQ31AnxQ32AnxQ33AnxQ34AnxQ35AnxQ36AnxQ37AnxQ38AnxQ39AnxQ40AnxTotAnx Sd ScoreSF-36 PFSF-36 RPSF-36 BPSF-36 GHSF-36 VTSF-36 SFSF-36 RESF-36 MHSF-36 PSF-36 MSApQ1SApQ2SApQ3SApQ4SApQ5SApQ6SApQ7SApQ8SApQ9SApQ10SApQ11SApQ12SApQ13SApQ14SApQ15SApQ16SApQ17SApQ18SAptotOap relationOApQ1OApQ2OApQ3OApQ4OApQ5OApQ6OApQ7OApQ8OApQ9OApQ10OApQ11OApQ12OApQ13OApQ14OAp15OApQ16OApQ17OApQ18OApTotMoCA-PBA pDMoCA-noPBAPDBDI-PBA pDBDI-no PBA PDAnx-PBA PDAnx-no PBA PDSFPH-PBA PDSFPH-noPBA PDSFMC-PBA PDSFMC-no pBA PDSA-PBA PDSA-noPBA PDOap-PBA PDOap-noPBA PDMoCA-PBA ALSMoCA-noPBA ALSAnx-PBA ALSAnx-noPBA ALSSFPC-PBA ALSSFPC-noPBASFMC-PBAALSSFMC-noPBA ALSSA-PBA ALSSA-noPBA ALSOA-PBA ALSOA-no PBA ALSMoCA-PBA aPMoCA-noPBA aPBDI-PBA aPBDI-no PBA aPAnx-PBA aPAnx-no PBA aPSFPH-PBA aPSFPH-noPBA aPSFMC-PBA aPSFMC-no pBA aPSA-PBA aPSA-noPBA aPOap-PBA aPOap-noPBA aPBDI-PBA ALSBDI-noPBA-ALS
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MA0263/5/12591/29/53HSFC1depressionAzilect3026 +15351246211111180111001100010011001131322222422311212222322416242.347.0641.4136.2545.8556.8544.2252.8239.8652.9133322124413444343353--4443313441343434446019193116.5552.884261
LL0273/6/12579/7/51UMC1anxiety, depressionET, hypertensionneurontin302753622363332313181101000000--1111101100922132212212322223322415850.2732.3632.9641.0242.7235.0332.5635.9342.8233.6743332324423434332254wife2232222332243332224426155145.1351.026342
BA0283/7/12527/31/52BAFC1anxiety, depressionmigraineMirapexCymbalta302653632162333334211111201211112112122102523342333422333333333588429.6737.2637.1835.339.635.0332.5641.5634.239.5844444143311334343356sister444441444114444444632942447.0822.095648
BK0293/15/12657/30/46BAMC2nonelipidtrazodonemelatonin3024335224512332321602100121110001010110013323223--3232233233232486648.6139.7162.1245.7848.9745.9444.2247.1950.3345.273333--1--3313123333341wife222122222111133222331930264552628.9745.4521.8750.0245633557
JB0303/21/12559/30/56UMC1nonelipid302743632361111111700000000000000001000012321132131121232221254057.0356.8562.1250.5548.9756.8555.8847.1958.7849.1433443133313434343456not completed--------------------------------------2853050.155.283763
VW0313/22/124911/13/59UFAA1nonelipid302543332462221311120111100003130132211332744--11434132233231213436414.9417.6719.8630.5345.8513.2255.8841.5610.2452.8833444144314324344459daughter4244414421422423445522133431.9326.294262
RL0323/22/12543/26/33collegeMC1dementia, depressionAzilect, Stalevoariceptseroquel301223122013222211131102001100113033123332932221432231234132131456314.9417.6737.1823.3845.857.769.2347.1921.7232.3221121313143423211136daughter112113122322221211302322753.0452.196257
RN0333/26/12693/17/4018yrsMC3htn, lipidSinemettrazodone30242363226111111170300101000000111011111232331421122222221322425931.7827.4741.8328.1542.7235.0320.8941.5633.6735.6444--33134413434433354daughter44433133311444334456222887312735.2453.1434.7460.9957595144
VW0343/30/12775/1/30MAFC1mcisinemetlyrica301923422062121112101101102101100022010231921211322121113112112314919.1517.6719.8661.5120.8713.2255.8852.8216.5551.0242112124211433432242daughter2322112221142131223427165063.0157.195863
SB0354/2/12498/2/60collegeFU1depression/anxietyMirapexZoloft,xanax302643522463221211120001001101112111011111533322422232243232232517531.7827.4746.0645.7842.7235.03-2.4335.9345.1322.0944444444311444443363spouse434441443114444444612512551.7657.285451
JW0364/2/12682/8/43MAMC1nonelipid, htn3029536324611111117000000000001001000110411111311111113111111243950.7251.9651.1345.7839.656.8551.9961.2747.0855.2844334124--11423443356daughter4444444441143444446528165067.5935.985357
KT0374/5/12564/5/55collegeMC1ADHDlipid, hypotestosteroneVyvance, Intuniv, Dextrostatlunesta30213261126214213114010100000001001010000532211331222232122121385554.9354.451.1343.448.9729.5855.8850.0151.3445.1434343114311443244453wife344442344113323443562783455.5842.336153
WF0384/5/12849/19/2318yrsMC1noneTIA, cardiac valve replacementRequip, sinemetativan3028535324611111117000000000000001101110511111221113111214122304640.242.1641.8348.1745.8535.03-2.4350.0150.126.2944233124411334--------37not completed--------------------------------------2693255.82256.965758
CS0394/10/12753/21/33collegeMC1mci, EtOH abuseSinemetclonazepam302243522163131111110000000000033011002211313111123112114332111345027.5739.7141.4142.4533.3645.9455.8844.3831.9352.1932224324321223212242wife3342113242111343224228164739.4451.8347
FG0404/11/126012/5/50collegeMC1DM, lipid, hypothyroid30234352216112121210000000000000000100100212231321111111111111274257.0347.0662.1250.5555.2156.8555.8858.4653.0457.2844444134411444444462not completed--------------------------------------2552949.3541.552
EB0414/16/12408/15/69BAMC1anxietyxanax302753532361112213110110101201111111101101622232223323333232323506757.0356.8562.1250.5545.8545.9440.3341.5663.0135.9843344134312444443358??444441434114444433601642735.6843.5859
EM0424/17/12638/1/45collegemC2PBAlipidambiennuedexta302443522262424324210110110110111111111111723232332222223222222456340.239.7151.1343.448.9735.0332.5635.9347.4834.8433333232223332233348??343223223231122222412326147443237.8123.0941.6638.3755474961
RW0434/19/12683/2/38collegeMC2lipidSinemet3013034111322111119110110000301312--021232231331441141333333331516927.5717.6762.1238.6330.2429.5820.8938.7437.8129.911111311123431111128daughter121112111334322111311622189454627.6139.2325.6448.3137605434
GB0445/8/12747/18/33collegeFC1htn, polymyalgia rheumaticazilect30255362216212132112000000000000001000000122211112111111111112254146.5149.5155.3648.1742.7245.9444.2244.3851.7642.3344343133311334443354------------------------------------2502348.1547.3463
PC0455/9/12492/14/62collegeMC1anxietybasal cellativan30285363236111111171101101100111012021101633342332231233231232506857.0356.8562.1255.3245.8540.4932.5633.1167.5926.9633444134311333343353------------------------------------222046.2357.4554
DM0465/9/12499/27/60collegeMC1htnazilect30275353236112121210010000010010101201000823111323211121112222345054.9356.8562.1243.452.0956.8555.8850.0155.5851.8344444134411444344461wife4444313441144444446127482428.6563.5159
BB0475/9/12749/4/36HSMC13025+1534223622111119000100000010101100112914131121111412111113324844.4149.5162.1248.1752.0956.8540.3335.9355.8241.533442344413443233357spouse334222123213323222422104258.2755.0656
LG0485/14/12487/28/63collegeFC1anxiety, migranes, depressionhtnlexaproimitrex3028536224632212121301001000001100101011191211132231111211112284257.0351.9651.1352.9345.8545.9455.8850.0153.5448.4744433244411444333358spouse4443313421131444435326122043.9159.5152
GS0495/21/12534/6/48HSMC1hyperlipid, sleep apnea, COPDrequip, Sinemet, Comtan, Amantidine3027+14352256111111170111101000011111111211632332432221234222221476529.6737.2655.3635.345.8545.9432.5644.3839.4443.5843433223213223332247wife444221243113133433482523351.8655.0161
DT0505/23/12505/2/61BSMC1Azilect3025536122611111117000000000001001001110512131321111113111121294552.8247.0646.0655.3242.7240.4944.2258.4649.3547.3423333224311433344452----------------------------------------2462838.5933.6850
LF0515/24/12785/23/32HSMC1MCIlipid, htnsinemetxanax3015+1323110511111117000000000000001000111422111331111111111112274240.249.5132.9640.0639.656.8555.8852.8235.6857.4544434114411444444459--444441444114444444632854361.516157
SE0525/24/12661/24/44BSFC3hypotension, lipid30305363256212111210010000000000011000010411111111211211212212264229.6737.2662.1257.748.9756.8528.6755.6445.4550.0243444443411444344463husband4443414441144444446227121415462741.9340.4938.7725.8649375060
MS0536/5/12621/10/42CollegeFC1thyroid,htnAzilect, Stalevo3025335323611111117000000000000000000000011141111111111111111233940.256.8555.3652.9367.756.8555.8858.4648.1563.5144444144411444444463none--------------------------------------2992824.0934.7948
MN0546/11/12587/6/5111yrs HSmC1Sinemet, Comtan3021+14352225111111170000000000011111111111111111111203442.342.1662.1260.0848.9729.5855.8864.0946.2355.064314434421434432454wife4344414441144444446226451.9939.1459
TB0556/11/12448/29/50JDMC1thyroidSinemet CR, comtan, azilect30275352246111111170000000000100012101104811111221111121111112243838.0932.3637.1836.2558.3329.5855.8858.4628.6559.5143444143312444443359--4344414241143344345748.4
ST0566/12/126411/25/41MDMC1htn, DM, CADSinemet, Amantidine3021325022611111117000000000000000000000057.0356.8562.1260.0870.8229.5855.8864.0958.2755.0144444331312333334456daughter4444413441443444346351.12
MW0576/13/12537/9/55FC2RLSRequip, amantidine30285353156222112111000100001001101010001712111221211112112211274448.6154.455.3662.4764.5856.8555.8858.4653.1460.9934444134312443344459husband43443134411443443357272784222224.4136.4650.958.2362626355
RM0586/14/128110/16/27MDMC2thrombosis, lipidSinemet3026535223611211118000000001001001101011711221322122112122121324821.2632.3637.1813.8536.4818.6728.6747.1923.0938.3732344323311332422247daughter4333312221133223334414243013472840.2715.5320.4768.7152575344
TT0596/14/12618/12/45collegemC1BPHRequip XL, Sinemet30264363226211121191001001000111011111101233221342232112222122425950.7247.0629.1537.6845.8518.6744.2235.9343.9133.684343313341144443352wife3443313331133444451
MS0606/21/127812/16/32collegeFC1lipid, PN3025536320611111117000000000000001000010211111111111111111111203548.6156.8551.1362.4758.3356.8555.8861.2751.866144444134411444344461none--------------------------------------
JR0616/19/12528/13/56collegeFC3depression, insomiaSinemet, amantidinetrazadoneneurontinoxybutynin3022333223631211211110103000000011001010923233432222222222222466814.9447.0662.1245.7836.4851.432.5652.8239.2348.3144433134411444444460--4443314441144444446116254844.08344850
GM0626/28/12651/1/42collegeMC1CADAzilect, mirapexlyrica3024426322611111117000000000000001201011612141312121212121131334927.5734.8137.1845.7839.645.94-2.4355.6438.5934.7933233233322433323350spouse33332232411444333351
RR0637/2/124910/13/54JDMC1alzect, mirapex, amantidinelexaproklonapin3028536323611111117000000000000000301100522411411111111111111284557.0351.9662.1263.945.8529.5844.2252.8261.5139.1443344144311423444457wife43444134411333344457
JD0645/15/125711/19/40HSMC1htnSinemet, requipklonapinFlexeril, quinine302143322254241414200010000000333123012312322441213111332123123426338.0937.2646.0640.0648.9729.5840.3352.8231.146.2924312333412344414250wife43322222422433322247
MM0657/5/125411/18/508thMH1lipid, stroke, DMStalevo, mirapex, azilectneurontin3016+103211363421132161311002003330011112332933342343432233132341568117.0520.1229.1525.7645.8529.5820.8941.5620.3540.4733213333411444443353wife33322334412443443355
MF0667/9/12564/4/5212thFC1htnsinemetartane3028+15353236313112112010100010000002110110923221432321133222131438017.0529.9132.9636.2542.7240.4928.6750.0124.0948.433333123312433332348--43233133411433344453
SW0677/11/12515/12/59college 2yrMC1htn, DMAzilect,celexaSeroquel3026535223621211119010000000000001101000413211221211211112111284354.9349.5155.3648.1748.9751.455.8850.0151.9951.1244444134413413344459spouse44433134411434444358
DK0687/11/12472/17/63UMC1OSA30265343236113222314000100000001001000100412111311111122111111253954.9356.8555.3655.3255.2129.5855.8858.4654.8349.8144444144413423434461
EC0697/10/12468/25/58UMC3depressionRBDSinemet, nuedextaZoloft,midodrine, florinef30192342035344443325130200000023202221123263434133443113324342557414.9417.6737.1836.2536.4813.229.2327.4828.9721.873222224421433431345--2231212411432412351444422.9459.14921
MG0707/12/12719/15/39HSMC2htn3021+14362106313122315000000000100001101112812111311114141121112314723.3629.9151.1332.9152.0918.6728.6735.9335.2434.7422422344413443444357wife2241122232344444435122152427.3974.815662
CC0717/18/125310/5/55UFC3migraines, RLSSinemetmidrinmidodrine, florinef302313632463223133170101000003111012010201422321442312313112223446648.6144.6137.1825.76336.3629.5855.8841.5637.8141.6644434114311434443355husband3342313441142323334921112831.2643.185943
MH0727/18/12636/25/46UFC425163201464133113160100001111112122011111832321332231213332132456317.0517.6729.1545.7833.3613.2213.1233.1127.6125.6411211111122432443337husband3343323431243343335418124544.2430.945224
EM0732/17/12608/30/50HSFC5amitriptyline, trazadonetopiramateRiluzole3016+1314110612113111001101110030--002--020101313223343111122331141425925.4732.3637.1836.2542.7240.4928.6750.0129.8645.7632323343433444443359husband321213121334323211382217374251.6829.8640.345.7662595938513
AJ0742/17/126/25/52MastersFAA5zolipedemRiluzole3022234322611111117000000000000002201110721111311122111113212294614.9517.6732.9632.9127.1113.229.2338.7424.0425.5443333133413444444459daughter443321224114234333492522352934.0224.0446.4425.546059604967
LL0752/17/124/13/6412th gradeFC5neurontinprovigilneudexta, tizanidine3021+113332362155135220101100001011020101111212111113111121111211253921.2627.4729.1535.348.977.7624.7858.4622.8843.2244444134413444444464daughter444341244134444444622322435125.4423.3627.6437.9615533491524
GS0762/17/1211/23/55UFH5lexapro302233420461112011000131122111132412422442311334332124518114.9420.1232.9636.2542.7224.1317.0144.3823.3637.922444124412443443355son433221432214322344491822414034.5953.4848.1350.8349645768
RL0776/8/129/16/50college 1yrMC5riluzole, baclofen301913431161122115130001002001100021110201222211331111122431121355114.9417.6737.1845.7839.618.679.2341.5628.2930.73332124311334333345--333221233132243333462217294941.5238.2440.9426.38496261519
RB0784/13/126/7/60college 1yrMC5Celexaxanaxriluzole3022336220611111117000101000011010110001823232222321222221212405754.9349.5162.1240.0667.740.4951.9950.0153.4850.8344443444323433344464--34433134323333344457302732.5361.459594
BG0794/13/12439/21/6712FH5headache, PBAcelexaneurontinriluzole, guanfacine3024+133631263434444261111111113111112121222723242313323322323323516714.9417.6762.1225.7639.613.229.2341.5631.2527.123131333313422322241?cousin44444444411444443364273427.3262.459516
JV0803/16/126/5/57college3.5yrMH5PBAneudexta, riluzole30224341235345355530000000000001000111010523121332323111112212375552.8251.9637.18505552.09404944.2238.7451.6840.334444144412444443462263923.8147.68503514
LG0813/16/125/28/3211thMC5htncymbaltaneuontin3016+12342104112111181001001000111122021231923322422322223232242496752.8222.5732.9629.136.4818.6720.8941.5638.2426.384344414441144444446243444144411444344461283235.4351.27514912
LP0826/8/121/1/42FC5lipid, htnneudexta, riluzole, provigil3030536325611112118000110000001001000000412111211112213112111274419.1549.5155.3638.6345.8545.9455.8858.4632.5361.44433414241144444445944444144213332444459222725.4629.71535810
JD0838/30/12659/12/44mastersMC4stroke, hyperlipidSinemettrazodonepropranolol2512312204111111170000000000003033003121521111311121123111111274250.7217.6751.1332.9136.487.769.2358.4640.9425.86313341332333211137spouse3122141212222322113415284421.9845.5527
WH0848/29/12664/29/42collegeMC3sinemetmelatoninFlexeril, vesicare3027436324511211118000000000000001200010412111111112111111111223746.5139.7141.4136.2548.9751.451.9958.4636.4658.2343444134422444434462wife33434133433444434360
DK0858/24/12553/15/4912thFC2htnmetoprolol3023+11362236111111170120110000011112001011312121111212111112141284319.1517.6729.1537.6864.5851.444.2258.4615.5368.7141344334313444423357wife43444223412444422255
CP0868/29/12669/25/42masterMInd3htn, cholesterol, RASinemetmidodrine, coQ, methotrexate301622400352131121111212101211001121111232532332333331123222232486657.0325.0255.3628.1527.1140.4944.2235.9344.083432333223222432333348wife22322223222432333244
CF0874/13/12551/26/55collegeFC5nudexta, flexeril, sudafed30273363246111211180001000000100110101061211121111141144142345319.1532.3650.2948.1748.8540.4955.8858.4627.3262.443434134412444443359spouse43223242412444422251243153.0549.066149
SS0888/24/12462/28/6412thMC5DMamitriptylineneurontinTizanidine3024+1534212632431316011000000100001100010612221222121122222222355127.5729.9155.3629.152.0940.4932.5647.1934.0246.4433444134411444444460none263550.9648.424130
CW0897/13/12618/5/46collegeFC5DMtazodoneriluzole, baclofen30263363236212111190101000000010122011131422221332121232221222395917.0517.6746.0645.7830.2429.5840.3350.0123.8147.6831433233313334432250husband21311321131242421135223632.0936.315341
LD0909/21/12606/5/47F5htnlexapronuedexta302333610463232121140011012310100110000121512412332122144212132436410.7315.2245.6428.1533.3624.1313.1230.325.4427.6432444144412444444461spouse43434144411424444459232825.5947.6345
JK0915/13/123/28/50collegeMC5cognitiveamitriptylineLithiumnorco, nudexta, riluzole2418534015352333322000000000100101011010642311321111144122241415814.9456.5841.8341.0542.7235.0355.8835.9334.5948.1333333322212334333349son44423244421434443460242429.3357.4362
DS0927/13/12569/13/52collegeFC5neurontinTizanidine30285353246111111171010001000100210101121212111221211231221114325017.0537.2651.1343.461.4651.424.7850.0135.4351.274423343431144323351son33233222332344422249
DC0936/8/12607/9/52collegeMC5mucinex, riluzole30225340236413113114000000000001001101010531311331111121111111294544.4127.4762.1237.6830.2435.0332.5658.4641.5240.944442213331342433349wife232111321242232233
AS0945/12/12715/12/379th/GEDMC5htn, DMpaxilriluzole, atenolol, mucinex302233411451111111701010000000000220103010111131222211132111274214.9417.6750.292133.3618.679.2344.3825.4629.7141144234411443433353wife44424124412443434458
LF09510/12/12741/8/37college 2yrFAA4dementia, depression, anxietyhtn,Sinemetpaxil, busparexalon, nameda3014032122411111117011000000000000000101421221332222233232232446614.9434.8129.1541.0258.3345.9444.2247.1922.9459.132332134313434333149daughter42133233332224433350
RB09610/12/12665/6/46MAMC2depress, hallucinationStalevo, Sinemet CR, ParcopanamedaKeppra302743632363241242180211001101010112000111421332322231231333232466440.234.1841.4145.7842.7240.4928.6744.3841.9338.7732234234413223323349wife32434243413223422250
NR09711/8/12726/29/40MC2htnSinemet30221342246111111170302000030000023000021511141111112111111111243914.9437.2662.1236.2570.8256.8555.8864.0927.3974.813344433331144444456daughter111111111212411121
LA09810/17/12524/14/561 yr collegeFC3depressionmirapexeffexor30274353246313112213010000000110001011110812111111111111111112223717.0520.1246.0641.0239.6404936.4450.0124.4150.943444144411444444462spouse43444144412444444463
RB09911/8/12736/4/35high schoolMC3htnmidodrine30213342026111111170001000000011110001231121121221111113212111284321.2617.6762.1233.8736.4845.949.2361.2731.2643.1842443134421444434459wife43333344421444444462
BF10011/8/12677/27/434yr collegeMC4lipidazilect30180352115111111171101002000010110100121232332332131133231132456329.6734.8162.1235.339.635.0336.4424.6644.2430.9432444324311334143352wife23333323311232232243
GR1011/24/135511/4/4710 yearsMH2dementia, depressionhypertensionsinemet CR, azilectcelexanamenda, aricept30143311005345223322132222130130211110130304341324122134142132476525.4725.0262.1225.7633.3624.1317.0124.6640.2720.473112241224444444335221112114444444444453
RM1021/10/13715/28/363rd gradeMH2depressionhtnmirapexcelexanamenda30151321006111111170003000000133032133332841141421141144131141446114.9417.6751.1335.327.1124.1355.8835.9321.9845.5511111411143111211127daughter11111111144111111124
NC10311/10/125510/25/5513 yrFC5Cymbaltariluzole30244363116111111170000000000000010020104111111111111211111111314950.7256.8551.1357.758.3324.1355.8855.6453.0549.0643444134411444444461
KC10411/9/12586/16/5412yrsMC5cholesterolriluzole3026336223611111117010000000000000000010222322232221111122211355154.9347.0662.1237.6852.0940.4951.9952.8250.9648.4234211133313312332241spouse44433134311113433349
BF10510/12/12676/22/45FC5ativan3022334312611211118010100000000011301121112111321221224112142365517.0527.4750.2942.4539.618.6713.1255.6432.0936.3133333143312444333353
RL1068/24/127411/13/37MC5htnlexaprogabapentinriluzole, ultram30234352126111111170101000030000020011331511221321121111111221284331.7827.4746.0625.7627.1124.1351.9952.8225.5947.6331233322312444421145wife21121111322321411130
RA1071/30/13672/15/45MBAMC4aphasiacholesterol3022325312611111117000000000000000000101211114114411111111114324840.247.0662.1217.1827.1129.5851.99-0.6850.7717.3244444134134434344462
HM1082/8/13581/27/53MC5ambien3024536211611111117010000100000011000011621121211111111121111243925.4725.0262.1235.348.9735.0355.8852.8229.3357.4343444144411444444462son4232312111434422241
25 ALS
8 CBD
11 PSP
10 MSA
Cecilia Santa-Maria8/9/12FH425/293352out of 2156mail back questionaire
Cecilia Santa-Maria8/9/12FH425/293352out of 2156mail back questionaire
Sward, Shirley9/12/12>12yrsF3will mail in survey18 out 25--352125mail back questions
Phothivongsa-Jordan, Manilay11/30/12FA2will mail in survey21/305151036mail back questions
Beale, Thomas10/15/12collegeMC4
PD 1
PSP 2
MSA 3
CBD 4
ALS 5
Failed
NG004172223106
Dilworth, Paula3/12/12417/28/68collegeFC1nonenone274362246NOT COMPLETED
Eagan, Ronald3/22/12695/19/42collegeMC1depressionlipid, htn, cog impSinemet15/290/4311023NOT COMPLETED
Ciavarella, susan7/5/12BSF254353226
William Knight MSA
ID
Subject IDfirst namelast name
HB001HowardBurch
SM 002MarciaSaade
JW 003JohnWest
SL 004SandraLankford
DT 005DianaTaylor
TL 006TracyLewis
OM 007OthaMayton
BM 008BeverlyMaffett
DH009DonaldHolloway
PF010PatriciaFurru
LW011LindaWygoda
AS012AnneSullivan
DW013DavidWilhem
CM014CarlMcGinnis
TS015ThomasSparkman
WC016WilliamCrutcher
KC017KathleenCarney
CH018ChristineHemingway
DV019VerlinDouglas
PR020PaulineRab
AC021CortezAnn
JC022JanetCarpenter
KK023KathrynKohlhaas
JP024JamesPate
PP025PatriciaPennington
MA026MargaretAltman
LL027LarryLevien
BA028BarbaraAlford
BK029BillKeene
JB030JohnBowman
VW031VanessaWatley
RL032RobertLee
RN033RichardNewell
VW034VertieWard
SB035ShannonBayard
JW036JohnWorden
KT037KurtThomas
WF038WilliamFagan
CS039CharlesSterling
FG040FrankGargallo
EB041EricBurger
EM042EricMartindell
RW043RobertWoodbridge
GB044GoldaBaker
PC045PhillipCallahan
DM046DouglasMaclay
BB047BobbyBrewer
LG048LisaGary-Jones
GS049GeraldStutsman
DT050DanielThixton
LF051LeeFazzino
SE052SharonEddins
MS053Mary HelenSherrod
MN054MichealNall
TB055TomBeasley
ST056SenenTorres-Dbrasis
MW057MarshaWeets
RM058RobertManning
TT059TommyTrantham
MS060MarilynSweger
JR061JaneRodgers
GM062GeorgeMixson
RR063RichardRikard
JD064JulesDock
MM065martinMorales
MF066MayFreeman
SW067SamWright
DK068DarrellKurtz
EC069EddieChancy
MG070MurphyGuillory
CC071ConnieChambers
MH072MaryHight
EM073ElizabethMetcalf
AJ074AngelaJohnson
LL075LauraLee
GS076GracieSanchez
RL077RoyceLucas
RB078RickBodish
BG079BrendaGonzalez
JV080Joseph CruzValdez
LG081LillianGautreaux
LP082LouisePettigrove
JD083JamesDepoe
WH084WilliamHiltpold
DK085DonaldKonrad
CP086ChanduPatel
CF087ColleenFried
SS088SteveSourders
CW089CherylWarren
LD090LindaDoucette
JK091JamesKrystaponis
DS092DeborahSimmons
DC093DavidComstock
AS094AuburnScheffer
LF095LeocadiaFusilier
RB096RobertBaker
NR097NorbertRobson
LA098LindaAdams
RB099RaymondBrown
BF100BillFugit
GR101GeorgeRivas
RM102RambaldoMartinez
NC103NancyCarmack
KC104KennyCassell
BF105BenneFisher
RL106RobertLimbaugh
RA107RussellAdams
pts-wk
Total patientsParkinsonismEnrolledScreen fail/incomplete
1/24/12-1/27/1211631- incomplete
1/30/12-2/3/1218721-incomplete
2/6/12-2/10/122274FB-not enrolling
2/13/12-2/17/121475FB-not enrolling
2/20/12-2/24/121665FB- missed 1
2/27/12-3/2/121511
3/5/12-3/9/121653FB-missed 1 declined
3/12/12-3/16/1211412 cant read, 1 MK didn’t complete
3/19/12-3/23/1219431-NP not complete
3/26/12-3/30/121533MK, RM- missed
4/2/12-4/6/1217541-no english
4/9/12-4/13/121122
4/16/12-4/20/122322
4/23/12-4/28/12000AAN
04/30/12-5/4/1218511- no eng, 1- decline, FB-2
5/7/12-5/11/121654
5/14/12-5/18/121662
5/21/12-5/25/121874
5/28/12-6/1/12610
6/4/12-6/8/121221
6/11/12-6/15/121665
6/18/12-6/22/12730
6/25/12-6/30-121441
7/2/12-7/6/121252
analysis
DiagnosisnMoCA-PBA PDMoCA-noPBA PDBDI-PBA PDBDI-no PBA PDAnx-PBA PDAnx-no PBA PDSFPH-PBA PDSFPH-noPBA PDSFMC-PBA PDSFMC-no pBA PDSA-PBA PDSA-noPBA PDOap-PBA PDOap-noPBA PDMoCA-PBA ALSMoCA-noPBA ALSBDI-PBA ALSBDI-noPBA-ALSAnx-PBA ALSAnx-noPBA ALSSFPC-PBA ALSSFPC-noPBASFMC-PBAALSSFMC-noPBA ALSSA-PBA ALSSA-noPBA ALSOA-PBA ALSOA-no PBA ALSMoCA-PBA aPMoCA-noPBA aPBDI-PBA aPBDI-no PBA aPAnx-PBA aPAnx-no PBA aPSFPH-PBA aPSFPH-noPBA aPSFMC-PBA aPSFMC-no pBA aPSA-PBA aPSA-noPBA aPOap-PBA aPOap-noPBA aP
PSP11aPD292428137354920.2431.3640.348.45563554422241223254722.8833.1343.2228.326440624229181124433029.618.7441.7945.454355832
MSA10ALS262829215513751.0851.6944.0250.695957616319281217354028.2922.3430.738.984546465321221324284826.9730.6367.9229.6759436156
CBD8PD532428159553260.1243.6931.3551.49605455462526278512731.2526.3927.1261.74152645024241312484250.3333.6745.2735.6441543331
PD532217513374251.6829.8640.345.766259593824131722455147.4837.8134.8429.948284162
ALS2627251810414542.8224.3933.6741.454534458252267352934.0224.0446.4425.54605960491930264552628.9745.4521.8750.0245633557
aP292614217582934.242.6239.5844.195653635323221524435125.4423.3627.6437.96155334927121415462741.9340.4938.7725.8649375060
182268414034.5953.4848.1350.83496457222887312735.2453.1434.7460.9957595144
%PBAntotal%2217519294941.5238.2440.9426.384962612326147443237.8123.0941.6638.3755474961
PD115320.83042732.5361.459591622189454627.6139.2325.6448.3137605434
ALS72629.21229131452421.7236.6832.3250.79365830582763427.3262.45951272784222224.4136.4650.958.2362626355
aP102934.52129149384051.3456.745.1448.325361564226143923.8147.68503514243013472840.2715.5320.4768.7152575344
28123235.4351.27514916254844.08344850
%PBAPDALSaP22102725.4629.7153581444422.9459.14921
%20.829.234.528281312284053.5454.5748.4748.815841536022152427.3974.815662
2122202424231.145.1246.2962.355060475121112831.2643.185943
1725165562520.3539.2540.4751.745355555918124544.2430.945224
15284421.9845.5527
26291423256154.8322.5949.8138.23614161243153.0549.066149
23103634.8344.025260263550.9648.424130
3073250.8230.365555223632.0936.315341
2873144.4254.796334232825.5947.6345
2853340.443.76361242429.3357.4362
27134139.8636.625365
2712558.7852.915642
25274310.2449.145960
19193116.5552.884261
26155145.1351.026342
2942447.0822.095648
2853050.155.283763
22133431.9326.294262
2322753.0452.196257
27165063.0157.195863
2512551.7657.285451
28165067.5935.985357
2783455.5842.336153
2693255.82256.965758
28164739.4451.8347
2552949.3541.552
1642735.6843.5859
2502348.1547.3463
222046.2357.4554
27482428.6563.5159
2104258.2755.0656
26122043.9159.5152
2523351.8655.0161
2462838.5933.6850
2854361.516157
2992824.0934.7948
26451.9939.1459
mean23.090909090925.61904761916.18181818189.24390243943.090909090934.560975609840.121818181843.888571428641.038181818248.4
sd5.00908265963.49181887723.25017482058.762934690511.17546012889.721236496715.135437105112.73709075256.423598396851.12
analysis
%
% Diagnosed with PBA
Prevalence of PBA