Background: Once-daily treatment formulation is associated with better adherence in comparison to more complex medication regimens. The study aimed to detect the extent of adherence to pharmacotherapy in Parkinson disease (PD) patients who take a minimum of three daily doses of drugs, and to identify factors associated with lower levels of adherence. Methods: The cohort was selected from non-demented PD patients. The 8-Item Morisky Medication Adherence Scale (MMAS-8), 8-Item Parkinson's Disease Questionnaire (PDQ-8), Geriatric Depression Scale (GDS), Non-Motor Symptom Assessment Scale (NMSS), 9-Item Wearing-off Questionnaire (WOQ-9), MDS-UPDRS III (motor examination), and IV (motor complications) scales were used in this study. Results: From a total of 124 subjects, 33.9% reported a high level of adherence, 29.8% reported a medium level of adherence, and 36.3% reported a low level of adherence to their pharmacotherapy. The level of non-adherence correlated with gender, longer disease duration, higher scores of PDQ-8, NMSS, WOQ-9, and MDS-UPDRS IV. Detailed analysis of NMSS demonstrated a correlation between the level of adherence and domains sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, and urinary symptoms. Independent risk factors for non-adherence were excessive daytime sleepiness, anhedonia, and forgetfulness. Conclusion: Non-adherence to more complicated medication regimens is frequent in PD patients and is associated with gender, longer PD duration, poorer quality of life, frequency and severity of non-motor symptoms, and more severe motor and non-motor fluctuations. Non-adherence was predicted by non-motor symptoms including fatigue, mood disturbances, and subjective cognitive complaints.

Non-adherence to pharmacotherapy in Parkinson's disease (PD) is associated with worsen clinical state and poor quality of life (QoL). Majority of PD patients takes three daily doses of dopaminergic drugs in minimum. Therefore, it is very important to know predictors of low level of adherence to pharmacotherapy to PD drugs.

Sleep disturbances are one of the most common non-motor symptoms in patient with Parkinson's disease (PD) with community-based studies reporting prevalence data of 60%. Differences in symptoms between men and women have been reported. Aim: In the present study, we assessed whether there are gender differences in clinical presentation of PD and prevalence of sleep disturbances in individuals diagnosed in the Slovak Republic. Material and method: Questionnaires were distributed to participating neurologists and patients in outpatient practices across the Slovak Republic. Sociodemographic variables - gender, age, age at onset, disease severity according to Hoehn and Yahr stage, phenotype of the dominating symptom of Parkinson's disease and type of medication - were collected. The Slovak language version of the PDSS was used in a questionnaire to test sleep disturbances. Results: Data from 1,067 outpatients with PD were collected. Comparative analyses showed males and females not to be significantly different on the majority of the demographic and medical characteristics collected. Males had a slightly higher proportion of individuals with Hoehn and Yahr score 4 and, among those taking levodopa medication as monotherapy, males took significantly higher levodopa dose than females (p <0.01). A significant difference in the distribution of PDSS subscores between males and females was observed on item 7 (distressing hallucinations at night) - score for males 8.22, for females 8.48, p <0.05. Similar result was observed on item 8 (getting up to pass urine) - score for males 5.90, for females 6.53, p <0.01.

Pantothenate kinase-associated neurodegeneration is a rare autosomal-recessive hereditary disorder that is characterized by accumulation of brain iron. PKAN has a diverse phenotypic expression with childhood or adult onset. It manifests typically with speech disturbances and combinations of motor symptoms such as dystonia, parkinsonism, corticospinal tract and//or retinopathy. This disorder is also associated with neurobehavioural changes. We present a case of a 25-year-old man with a speech defect and anxiety that proceeded to progressive tremor and clumsiness of the left upper extremity. Physical examination revealed signs of extrapyramidal dysfunction and corticospinal tract involvement. T2-weighted brain MRI images disclosed focal changes in the globus pallidus typical of PKAN in ("eye of the tiger sign"). Molecular genetic analysis confirmed the homozygous mutation in the gene for pantothenate-kinase 2 (PANK2). Detailed clinical examination associated with cranial imaging techniques results in appropriate genetic analysis.

Introduction: The objective of this study was to determine the prevalence of LRRK2 gene mutations in Slovak PD patients. Patients and methods: 126 PD patients (78 men, 48 women) were included in the study. The average age of this population was 57 years. Twenty-four patients (19.1%) reported a positive family history of parkinsonism; Hoehn-Yahr stage was between 1 and 5 (mean 2.6). There were 19 patients with early-onset parkinsonism (beginning before the age of 45) in the group. All subjects were screened for selected exons in the LRRK2 gene by means of dHPLC analysis. Exons 31, 35, 41 and 48 we examined. Results: From a total of 126 samples, one exonic and four intronic polymorphisms in the exon 48 and one intronic polymorphism in exon 35 of the LRRK2 gene were detected. No common pathogenic mutations were found. Conclusion: The study indicates that the most common mutations in the LRRK2 gene do not play an important role in the aetiology of Parkinson's disease in central Europe. This has also been shown by previous studies. It must be emphasized that the overall sample size is relatively small, particularly for the familial PD cases.

Objective: Impulse control disorders (ICDs) such as pathological gambling, compulsive shopping, compulsive eating, and hypersexuality are a matter of growing interest, especially in patients with Parkinson disease who are on dopamine replacement therapy. It was recently reported that ICDs are associated with other disorders also treated with dopaminergic drugs (dopamine agonists) such as restless legs syndrome, multiple system atrophy, progressive supranuclear palsy, and fibromyalgia. The aim of this study was to determine the prevalence of ICDs in patients with pituitary adenomas who take dopamine agonists (DAs).Methods: Twenty consecutive patients with pituitary adenomas (mostly prolactinomas) taking DAs were assessed. All participated in a structured interview focused on ICDs, which was conducted by a physician.Results: Two (10%) of 20 subjects had a condition diagnosed as ICD. The first patient is a 35-year-old man with giant macroprolactinoma who was alternately treated with different types of DAs (cabergoline, bromocriptine, and quinagolide). He developed compulsive eating and pathological gambling. The second patient is a 53-year-old man with macroprolactinoma who suffered from severe hypersexuality after cabergoline was begun.Conclusions: This study demonstrates the importance of systematic screening for ICDs in patients taking dopaminergic medication regardless of their primary condition.

Parkinson's disease is the most common neurodegenerative disorder, with serious socio-economic consequences. At present the disorder appears incurable, but well-timed diagnostics and appropriate therapy can improve the quality of life for those who suffer from it. Recent research appears to support a hypothesis that oxidative damage and mitochondrial dysfunction may play a primary role in the pathogenesis of PD. Further investigation of the mechanisms implicated in the complex process of neurodegeneration may result in the possibility of identifying individuals at risk and presymptomatic patients, and also determining proper therapeutic targets and subsequent neuroprotective treatments.

Introduction: Behavioral disturbances associated with Parkinson's disease include impulse control disorders, punding and dopamine dysregulation syndrome. Despite rising interest in this specific area, behavioral disturbances still remain under-diagnosed. The aim of our study was to verify the effectiveness of a specific questionnaire-based interview in detection of behavioral disturbances in parkinsonian patients. Subjects and methods: By means of a specific 8-item questionnaire, we interviewed 80 patients (63 with Parkinson's disease and 17 with prolactinoma). In Parkinson's disease patients we also recorded disease phenotype, duration and dopaminergic treatment, as well as any history of anxiety, depression, obsessive-compulsive disorder or panic disorder. Cognitive function state was assessed by means of MMSE and PANDA questionnaires. Results: None of prolactinoma patients exhibited behavioral disturbances. Twenty (31.75%) of 63 patients with Parkinson's disease had a history of some form of behavioral disturbances. Seven of them had more than one behavioral abnormality. All the behavioral disturbances started after initiation of dopaminergic treatment. Patients with behavioral disturbances were younger (61.3 versus 63.3 years; p < 0.05), with longer duration of Parkinson's disease (11.0 versus 6.5 years; p < 0.02), and were on higher doses of dopaminergic medication. Furthermore, the group with behavioral disturbances had higher subscores for depression in the PANDA questionnaire (3.8 versus 3.2; p < 0.02). Conclusion: Our study demonstrates that a specific questionnaire-based interview can significantly facilitate the detection of behavioral disturbances in patients with Parkinson's disease. The prevalence of these behaviors is undoubtedly higher than may be anticipated in routine clinical examination.

BACKGROUND:The 8-hydroxy-2 deoxyguanosine (8-OHdG) is a product of nucleoside oxidation of DNA and a reliable marker of oxidative stress markers. Increased levels of oxidative stress have been reported in the cerebrospinal fluid (CSF) of patients with various neurodegenerative disorders.OBJECTIVE:In search of a biochemical indicator of Parkinson's disease (PD), we analyzed the levels 8-OHdG in the CSF of 99 patients, using ELISA to assess the differences between various neurodegenerative disorders.RESULTS:Statistically significant higher CSF levels (p = 0.022) of 8-OHdG in non-demented PD patients as compared to the control group were observed. No differences between CSF 8-OHdG levels and age at the time of lumbar puncture, presence or severity of dementia, or gender were found.CONCLUSIONS:8-OHdG levels could be potentially useful in the neurochemically supported diagnosis of PD.

Aim of study: The study was aimed to detect and characterize patients with restless legs syndrome (RLS) using questionnaire. Subjects and Methods: Study sample included 555 persons who were recruited in a waiting-room of a neurological outpatient clinic. Participants firstly filled a brief questionnaire aimed to collect demographic data and than responded to four specific questions, i.e., essential criteria for RLS according to the International Restless Legs Syndrome Study Group. If respondent answered positively all four questions, he/she was classified as probable RLS-sufferer. Consecutively, he/she completed a second part of the questionnaire, applied by health care professional. This part was oriented to confirmation and particular RLS description. If respondent did not respond positively all four diagnostic questions, he/she was classified as negative in relation to RLS. Results: Criteria for clinical diagnosis of RLS were fulfilled altogether by 23.4% of respondents (men 18.1%, women 26.5%). Thirty five per cent of RLS-sufferers referred daily occurrence of RLS symptoms. RLS begun in average age of 45.7 +/- 16.1 years, and it persisted 8.6 +/- 8.2 years. Sleep disorders caused by RLS were referred in 58% of RLS-sufferers. Familial occurrence of RLS was reported by 41.9% of patients. RLS-sufferers were greater health care consumers in parameters: 1. number of medicaments, and 2. number of visits of physician in last three months. Conclusion: Detection of patients with RLS by means of simple questionnaire, e.g. during waiting for clinical assessment or treatment, is very effective approach applicable in a broad medical practice.