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  1. Article ; Online: Frequency of suicidal ideation and associated clinical features in Lewy body dementia.

    Armstrong, Melissa J / Moore, Kathryn / Jacobson, Charles E / Bedenfield, Noheli / Patel, Bhavana / Sullivan, Jennifer L

    Parkinsonism & related disorders

    2021  Volume 90, Page(s) 33–37

    Abstract: Introduction: Neuropsychiatric disturbance is common in individuals with Lewy body dementia (LBD). Despite this, there is minimal research regarding suicide risks in this population.: Methods: This study was a retrospective review of a prospectively- ... ...

    Abstract Introduction: Neuropsychiatric disturbance is common in individuals with Lewy body dementia (LBD). Despite this, there is minimal research regarding suicide risks in this population.
    Methods: This study was a retrospective review of a prospectively-collected database at a tertiary movement disorders clinic. Database participants with an LBD diagnosis at their most recent visit and at least one complete Beck Depression Inventory-II (BDI-II) were included. Additional measures included demographics and measures of cognition, psychiatric symptoms, motor function, and the Parkinson Disease Questionnaire-39. The frequency of suicidal ideation was assessed using question 9 of the BDI-II. Features associated with a BDI-II score greater than zero were assessed using logistic regression.
    Results: The database included 95 individuals with LBD and at least one BDI-II (visit years 2010-2020). Most participants were older men who identified as white. Eighteen individuals (18.9%; 95% CI 12.3%-28.0%) reported thoughts of killing themselves without an intent to carry them out (BDI-II = 1). No participants reported a desire or plan to kill themselves. The presence of SI was associated with measures of depression, anxiety, and emotional well-being, but not with demographics, measures of disease severity, or other psychiatric concerns.
    Conclusion: These findings emphasize the importance of routine screening for psychiatric symptoms in LBD and intervention when such concerns are identified. Interventions could include pharmacologic (e.g. depression treatment) and non-pharmacologic (e.g. firearm screening) approaches. More research is needed to assess suicidal ideation and suicide risks in large and more diverse LBD populations. Prospective studies should include measures of additional potential contributors to suicidality.
    MeSH term(s) Aged ; Databases, Factual ; Female ; Humans ; Lewy Body Disease/psychology ; Logistic Models ; Longitudinal Studies ; Male ; Prospective Studies ; Retrospective Studies ; Severity of Illness Index ; Suicidal Ideation ; Suicide/statistics & numerical data
    Language English
    Publishing date 2021-07-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1311489-x
    ISSN 1873-5126 ; 1353-8020
    ISSN (online) 1873-5126
    ISSN 1353-8020
    DOI 10.1016/j.parkreldis.2021.07.029
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  2. Article ; Online: What does the Dementia Rating Scale-2 measure? The relationship of neuropsychological measures to DRS-2 total and subscale scores in non-demented individuals with Parkinson's disease.

    Lopez, Francesca V / Kenney, Lauren E / Ratajska, Adrianna / Jacobson, Charles E / Bowers, Dawn

    The Clinical neuropsychologist

    2021  Volume 37, Issue 1, Page(s) 174–193

    Abstract: Objective: The Dementia Rating Scale-2 (DRS-2) is recommended for assessing global cognition in Parkinson's disease (PD) by the Movement Disorder Society. However, empirical evidence is limited regarding the degree to which the DRS-2 corresponds to ... ...

    Abstract Objective: The Dementia Rating Scale-2 (DRS-2) is recommended for assessing global cognition in Parkinson's disease (PD) by the Movement Disorder Society. However, empirical evidence is limited regarding the degree to which the DRS-2 corresponds to traditional neurocognitive domains (i.e., construct validity) in PD. Thus, this study aims to determine the construct validity of the DRS-2 in a non-demented sample of PD patients.
    Method: Patients with PD (n = 359; mean age = 64.50 ± 8.53, education = 14.97 ± 2.73, disease duration = 8.48 ± 4.87, UPDRS Part III motor scale scores = 25.23 ± 10.17) completed the DRS-2 as part of a comprehensive neuropsychological assessment consisting of attention/working memory, executive function, language, delayed recall, and visuoperceptual-spatial skills.Bootstrapped bias-corrected Spearman rho's correlations andhierarchical linear regressions were performed to examine construct validity of DRS-2 total and subscale scores.
    Results: Speeded measures of set-shifting, rapid word generation to letter and semantic cues, and simple visuoperceptual skills largely accounted for variance in DRS-2 total scores. Most DRS-2 subscale scores showed weak relationships with theoretically related neuropsychological measures.
    Conclusions: DRS-2 total scores reflect impairment across a range of cognitive domains (i.e., executive, language, and visuoperception), while DRS-2 subscale scores have limited construct validity. Together, the DRS-2 does not appear to have utility beyond screening for global cognition in PD.
    MeSH term(s) Humans ; Middle Aged ; Aged ; Neuropsychological Tests ; Cognition Disorders/diagnosis ; Parkinson Disease/psychology ; Cognition ; Mental Status and Dementia Tests
    Language English
    Publishing date 2021-11-15
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639080-8
    ISSN 1744-4144 ; 0920-1637 ; 1385-4046
    ISSN (online) 1744-4144
    ISSN 0920-1637 ; 1385-4046
    DOI 10.1080/13854046.2021.1999505
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  3. Article ; Online: Spatiotemporal gait parameters and tremor distribution in essential tremor.

    Roper, Jaimie A / Terza, Matthew J / De Jesus, Sol / Jacobson, Charles E / Hess, Christopher W / Hass, Chris J

    Gait & posture

    2019  Volume 71, Page(s) 32–37

    Abstract: Background: Essential Tremor is characterized by an action tremor of the upper extremities, which may or may not be accompanied by a head, voice, leg or trunk tremor. Problems with gait and balance have also been identified in persons with Essential ... ...

    Abstract Background: Essential Tremor is characterized by an action tremor of the upper extremities, which may or may not be accompanied by a head, voice, leg or trunk tremor. Problems with gait and balance have also been identified in persons with Essential Tremor. Therefore, understanding gait performance is an important area of focus for clinicians and researchers.
    Research question: We sought to 1) conduct a factor analysis on a broad spectrum of spatiotemporal gait parameters 2) build upon the normative database of gait measures in persons with Essential Tremor 3) understand the influence of age on gait speed in persons with Essential Tremor and 4) identify the relationships between gait performance and clinical measures of disease severity.
    Methods: Gait data and Tremor Rating Scale scores were retrospectively collected from one hundred and forty-two ambulatory participants with a diagnosis of Essential Tremor. A factor analysis was used to characterize spatiotemporal gait parameters and regression models were applied to associate tremor scores to gait performance factors.
    Results: Three domains of gait performance factors were identified in persons with Essential Tremor. Specifically, we observed a pace, rhythm, and stability factor. In sum, these factors accounted for 91.9% of the variance in gait performance. Only the pace and stability factors were associated with disease severity, suggesting these factors are most sensitive to disease severity compared to the rhythm factor. Our linear regression analysis revealed a significant influence of age on gait speed. Gait speed decreased with age significantly by 0.64 cm/s/year.
    Significance: Reference values for 12 gait parameters will be highly useful for assessing gait performance in individuals with Essential Tremor. Our observations suggest that a clinical assessment of gait and balance would be an important measure to consider in routine clinical practice when treating persons with Essential Tremor.
    MeSH term(s) Aged ; Essential Tremor/complications ; Essential Tremor/physiopathology ; Factor Analysis, Statistical ; Female ; Gait Disorders, Neurologic/complications ; Humans ; Male ; Middle Aged ; Reference Values ; Regression Analysis ; Retrospective Studies ; Walking Speed
    Language English
    Publishing date 2019-04-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 1162323-8
    ISSN 1879-2219 ; 0966-6362
    ISSN (online) 1879-2219
    ISSN 0966-6362
    DOI 10.1016/j.gaitpost.2019.04.004
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  4. Article ; Online: Converting the UPDRS part III to the Hoehn and Yahr staging may not be adequate for a research database.

    Fernandez, Hubert H / Jacobson, Charles E / Okun, Michael S

    Parkinsonism & related disorders

    2010  Volume 16, Issue 2, Page(s) 150; author reply 151–2

    MeSH term(s) Databases, Factual ; Disability Evaluation ; Humans ; Parkinson Disease/diagnosis ; Research/statistics & numerical data ; Severity of Illness Index
    Language English
    Publishing date 2010-02
    Publishing country England
    Document type Comment ; Letter
    ZDB-ID 1311489-x
    ISSN 1873-5126 ; 1353-8020
    ISSN (online) 1873-5126
    ISSN 1353-8020
    DOI 10.1016/j.parkreldis.2009.10.002
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  5. Article ; Online: Lessons learned from a large single center cohort of patients referred for DBS management.

    Kluger, Benzi M / Foote, Kelly D / Jacobson, Charles E / Okun, Michael S

    Parkinsonism & related disorders

    2011  Volume 17, Issue 4, Page(s) 236–239

    Abstract: Background: Deep brain stimulation surgery (DBS) for movement disorders has become commonplace and patients are beginning to present to specialized centers for second opinions. We aimed to uncover reasons for referral by analyzing a large single center ... ...

    Abstract Background: Deep brain stimulation surgery (DBS) for movement disorders has become commonplace and patients are beginning to present to specialized centers for second opinions. We aimed to uncover reasons for referral by analyzing a large single center cohort of DBS patients referred for management.
    Methods: Data were collected prospectively on a cohort of one hundred and eight patients who presented to the UF Movement Disorders Center for management following implantation at outside DBS centers. Data collected included referral reasons, pre-operative evaluation, DBS programming thresholds, DBS placement, need for optimization of therapy, and ultimate patient outcomes.
    Results: Ninety percent of patients reported at least one area of symptomatic dissatisfaction with the results of their DBS. Common issues included pre-operative misdiagnosis (28%), presence or exacerbation of symptoms not addressable by current DBS technology (48%), lead misplacement (43%), and need for medication (27%) or DBS programming (37%) optimization. Compared with leads placed using microelectrode recording (MER), leads placed without MER were strongly associated with misplacement (p = 0.03). Overall, 42% of subjects had no improvement, 37% slight improvement and 21% large improvement after medical and/or surgical management.
    Conclusions: This study reveals common reasons why DBS patients may seek follow-up care at another institution. Although 90% of patients reported one or more problematic areas, many of these could not be addressed by current DBS technology. Similar to prior studies, we found that lead misplacement was prominent, as was the need for optimization of medicines and/or stimulation.
    MeSH term(s) Cohort Studies ; Deep Brain Stimulation/adverse effects ; Deep Brain Stimulation/instrumentation ; Deep Brain Stimulation/methods ; Electrodes, Implanted ; Humans ; Microelectrodes ; Middle Aged ; Movement Disorders/therapy ; Patient Satisfaction/statistics & numerical data ; Referral and Consultation
    Language English
    Publishing date 2011-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1311489-x
    ISSN 1873-5126 ; 1353-8020
    ISSN (online) 1873-5126
    ISSN 1353-8020
    DOI 10.1016/j.parkreldis.2010.05.003
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  6. Article ; Online: Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery.

    Morishita, Takashi / Okun, Michael S / Burdick, Adam / Jacobson, Charles E / Foote, Kelly D

    Neuromodulation : journal of the International Neuromodulation Society

    2013  Volume 16, Issue 5, Page(s) 407–13; discussion 413

    Abstract: Object: Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery.: Methods: The diagnosis of venous ... ...

    Abstract Object: Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery.
    Methods: The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan.
    Results: Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between July 2002 and August 2009. All four patients had Parkinson's disease. Their DBS leads were implanted in the subthalamic nucleus (n = 2), and the globus pallidus internus (n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast-enhanced preoperative magnetic resonance (MR) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively.
    Conclusion: Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures.
    MeSH term(s) Aged ; Brain Infarction/diagnostic imaging ; Brain Infarction/etiology ; Deep Brain Stimulation/adverse effects ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Parkinson Disease/therapy ; Radiography ; Retrospective Studies ; Tomography Scanners, X-Ray Computed
    Language English
    Publishing date 2013-06-05
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1500372-3
    ISSN 1525-1403 ; 1094-7159
    ISSN (online) 1525-1403
    ISSN 1094-7159
    DOI 10.1111/ner.12052
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  7. Article ; Online: Carbidopa/levodopa dose elevation and safety concerns in Parkinson's patients: a cross-sectional and cohort design.

    Brodell, David W / Stanford, Nicole T / Jacobson, Charles E / Schmidt, Peter / Okun, Michael S

    BMJ open

    2012  Volume 2, Issue 6

    Abstract: Objective: Sinemet, a combination drug containing carbidopa and levodopa is considered the gold standard therapy for the treatment of Parkinson's disease (PD). When approved by the Food and Drug Administration (FDA) in 1988, a maximum daily dosage limit ...

    Abstract Objective: Sinemet, a combination drug containing carbidopa and levodopa is considered the gold standard therapy for the treatment of Parkinson's disease (PD). When approved by the Food and Drug Administration (FDA) in 1988, a maximum daily dosage limit of 800 mg (eight tablets) of the 25/100 carbidopa/levodopa formulation was introduced. Overall, the FDA approval was a historic success; however, the pill limit has been hardcoded into many online medical record systems. This study investigates the 800 mg threshold by using a prospectively collected database of patient information.
    Design: A retrospective cohort study: (Part I) cross-sectional, (Part II) longitudinal.
    Setting and participants: PD patients at a Movement Disorders Center in a large academic, tertiary medical setting.
    Outcome measures: An analysis was performed using carbidopa/levodopa at dosages below and above the 800 mg threshold. A secondary analysis was then performed using two consecutive clinic visits to determine the effects of crossing the 800 mg threshold. Comparisons were made on standardised scales.
    Results: There was no significant difference in motor, mood and quality-of-life scores in patients consuming below and above the 800 mg carbidopa/levodopa threshold, though a mild worsening in dyskinesia duration was noted without worsening in dyskinesia pain and disability. In PD patients who crossed the 800 mg threshold between two consecutive clinic visits, a significant improvement in depressive symptoms and quality-of-life measures was demonstrated, and in these patients there was no worsening of motor fluctuations or dyskinesia.
    Conclusions: The data suggest that PD patients have the potential for enhanced clinical benefits when eclipsing the 800 mg carbidopa/levodopa threshold. Many patients will likely need to eclipse the 800 mg threshold and pharmacies and insurance companies should be aware of the requirements that may extend beyond approval limits.
    Language English
    Publishing date 2012-12-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2012-001971
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  8. Article ; Online: Should we consider Vim thalamic deep brain stimulation for select cases of severe refractory dystonic tremor.

    Morishita, Takashi / Foote, Kelly D / Haq, Ihtsham U / Zeilman, Pamela / Jacobson, Charles E / Okun, Michael S

    Stereotactic and functional neurosurgery

    2010  Volume 88, Issue 2, Page(s) 98–104

    Abstract: Dystonic tremor, which may present with many different clinical presentations (rhythmic oscillations, abnormal posture, pain, and/or a null point) has proven to be a challenge for the clinician to effectively treat. Although recent studies have ... ...

    Abstract Dystonic tremor, which may present with many different clinical presentations (rhythmic oscillations, abnormal posture, pain, and/or a null point) has proven to be a challenge for the clinician to effectively treat. Although recent studies have demonstrated excellent outcomes in select cases following deep brain stimulation (DBS) of the internal globus pallidus, the optimal target for dystonia and particularly for dystonic tremor remains unknown. We report 3 cases of dystonic tremor which were successfully addressed through the use of ventral intermediate nucleus (Vim) DBS. We also review the literature concerning the efficacy of Vim DBS for addressing dystonia. This case series illustrates the potential use of Vim DBS for select cases of dystonic tremor.
    MeSH term(s) Adult ; Aged ; Databases, Factual ; Deep Brain Stimulation/methods ; Dystonic Disorders/physiopathology ; Dystonic Disorders/therapy ; Female ; Humans ; Male ; Middle Aged ; Severity of Illness Index ; Tremor/physiopathology ; Tremor/therapy ; Ventral Thalamic Nuclei/physiology
    Language English
    Publishing date 2010
    Publishing country Switzerland
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000289354
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  9. Article ; Online: Impact of discontinuing tremor suppressing medications following thalamic deep brain stimulation.

    Favilla, Christopher G / Topiol, Dan D / Zesiewicz, Theresa A / Wagle Shukla, Aparna / Foote, Kelly D / Jacobson, Charles E / Okun, Michael S

    Parkinsonism & related disorders

    2013  Volume 19, Issue 2, Page(s) 171–175

    Abstract: Background: Many essential tremor patients continue to require tremor suppressing medications following deep brain stimulation. The true incidence of medication usage in the years following surgery remains unclear, and the use of medications has not ... ...

    Abstract Background: Many essential tremor patients continue to require tremor suppressing medications following deep brain stimulation. The true incidence of medication usage in the years following surgery remains unclear, and the use of medications has not been included in the post-operative analyses of tremor severity and also quality of life.
    Methods: Among 28 essential tremor patients treated with deep brain stimulation at a single center between January 2002 and April 2010, we analyzed the prevalence and dosage of pre-operative tremor suppressing medications versus post-operative medications at 12 and 36 months following surgery. We also assessed the influence of medication continuation on clinical outcome measures, such as the Fahn-Tolosa-Marin Tremor Rating Scale, and the 36 item short-form health quality of life survey.
    Results: Both unilateral and bilateral deep brain stimulation resulted in a decrease in primidone use (p = 0.0082, 0.046, respectively), and bilateral deep brain stimulation patients used less tremor suppressing medications 36 months following surgery (p = 0.02). The decision to discontinue primidone after surgery resulted in a non-significant long-term improvement in tremor motor score (23 points versus 15 points, p = 0.19), and did not significantly influence the physical and mental composite quality of life scores (p = 0.81, 0.23, respectively).
    Conclusions: Bilateral deep brain stimulation effectively eliminated the need for tremor suppressing medications, while unilateral stimulation was not as effective in reducing medication usage. Clinicians and patients should be aware that discontinuation of primidone after surgery may worsen tremor in unilateral deep brain stimulation cases, but discontinuation will not likely impact quality of life.
    MeSH term(s) Aged ; Anticonvulsants/therapeutic use ; Combined Modality Therapy ; Deep Brain Stimulation/methods ; Essential Tremor/therapy ; Female ; Humans ; Male ; Primidone/therapeutic use ; Treatment Outcome
    Chemical Substances Anticonvulsants ; Primidone (13AFD7670Q)
    Language English
    Publishing date 2013-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1311489-x
    ISSN 1873-5126 ; 1353-8020
    ISSN (online) 1873-5126
    ISSN 1353-8020
    DOI 10.1016/j.parkreldis.2012.09.002
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  10. Article ; Online: Worsening essential tremor following deep brain stimulation: disease progression versus tolerance.

    Favilla, Christopher G / Ullman, David / Wagle Shukla, Aparna / Foote, Kelly D / Jacobson, Charles E / Okun, Michael S

    Brain : a journal of neurology

    2012  Volume 135, Issue Pt 5, Page(s) 1455–1462

    Abstract: A major concern regarding ventralis intermedius nucleus deep brain stimulation for essential tremor has been the loss of surgical efficacy over time in a minority of patients. Some experts have ascribed the worsening tremor to tolerance, while other ... ...

    Abstract A major concern regarding ventralis intermedius nucleus deep brain stimulation for essential tremor has been the loss of surgical efficacy over time in a minority of patients. Some experts have ascribed the worsening tremor to tolerance, while other evidence has suggested that disease progression may play a role. Suboptimal lead placement has also been reported to be a factor in worsening tremor following deep-brain stimulation; however, most authors consider this phenomenon to manifest within a few months of the actual surgery. We aimed to dissect the tolerance versus disease progression issue by analysing preoperative versus long-term post-surgical Fahn-Tolosa-Marin Tremor Rating Scale scores both on and off stimulation among 28 patients who underwent ventralis intermedius nucleus deep brain stimulation and 21 age-matched controls. Of the 28 patients in the treatment arm of the cohort, seven (25%) demonstrated evidence of tremor progression, and had a 34% increase in the tremor score off stimulation at the 36 month follow-up compared with a 32% increase among controls (P = 0.67). In one of the seven patients there was evidence of suboptimal lead placement given the lateral position of the lead, and the motor side effects during threshold testing. This patient demonstrated a loss of stimulation benefit between 24 and 36 months, which may have been more indicative of tolerance. The other six subjects (86%) maintained stimulation benefit throughout the follow-up period, despite worsening tremor off stimulation (at a comparable rate to that of controls), making disease progression the most likely explanation. The data suggest that deep brain stimulation tolerance may be over-reported in the literature, and that a tolerance versus disease progression work-up should include: examining the trend in off stimulation scores, accounting for image based lead locations, and during programming sessions checking for thresholds which may elicit clinical benefits and side effects.
    MeSH term(s) Aged ; Aged, 80 and over ; Case-Control Studies ; Cohort Studies ; Databases, Factual/statistics & numerical data ; Deep Brain Stimulation/adverse effects ; Disease Progression ; Electrodes, Implanted ; Essential Tremor/therapy ; Female ; Functional Laterality ; Humans ; Intralaminar Thalamic Nuclei/physiology ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Statistics, Nonparametric ; Treatment Outcome
    Language English
    Publishing date 2012-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80072-7
    ISSN 1460-2156 ; 0006-8950
    ISSN (online) 1460-2156
    ISSN 0006-8950
    DOI 10.1093/brain/aws026
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