Daytime Alertness in Parkinson's Disease: Potentially Dose-Dependent, Divergent Effects by Drug Class
Identifieur interne : 001157 ( Main/Exploration ); précédent : 001156; suivant : 001158Daytime Alertness in Parkinson's Disease: Potentially Dose-Dependent, Divergent Effects by Drug Class
Auteurs : Donald L. Bliwise [États-Unis] ; Lynn Marie Trotti [États-Unis] ; Anthony G. Wilson [États-Unis] ; Sophia A. Greer [États-Unis] ; Cathy Wood-Siverio [États-Unis] ; Jorge J. Juncos [États-Unis] ; Stewart A. Factor [États-Unis] ; Alan Freeman [États-Unis] ; David B. Rye [États-Unis]Source :
- Movement disorders [ 0885-3185 ] ; 2012.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Adult, Aged, Analysis of Variance, Antiparkinson Agents (adverse effects), Antiparkinson Agents (therapeutic use), Attention (drug effects), Dopamine Agonists (adverse effects), Dopamine Agonists (therapeutic use), Dose-Response Relationship, Drug, Female, Humans, Levodopa (adverse effects), Levodopa (therapeutic use), Male, Middle Aged, Nervous system diseases, Neuropsychological Tests, Parkinson Disease (drug therapy), Parkinson Disease (psychology), Parkinson disease, Polysomnography, Sleep, Treatment, Wakefulness, Wakefulness (drug effects).
- MESH :
- chemical , adverse effects : Antiparkinson Agents, Dopamine Agonists, Levodopa.
- chemical , therapeutic use : Antiparkinson Agents, Dopamine Agonists, Levodopa.
- drug effects : Attention, Wakefulness.
- drug therapy : Parkinson Disease.
- psychology : Parkinson Disease.
- Adult, Aged, Analysis of Variance, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Polysomnography.
Abstract
Many patients with idiopathic Parkinson's disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of antiparkinsonian medications, the disease itself, or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson's patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness. Patients (n = 63) underwent a 48-hour laboratory-based study incorporating 2 consecutive nights of overnight polysomnography and 2 days of Maintenance of Wakefulness Testing. We examined correlates of individual differences in alertness, including demographics, clinical features, nocturnal sleep variables, and class and dosage of anti-Parkinson's medications. Results indicated that, first, relative to unmediated patients, all classes of dopaminergic medications were associated with reduced daytime alertness, and this effect was not mediated by disease duration or disease severity. Second, the results showed that increasing dosages of dopamine agonists were associated with less daytime alertness, whereas higher levels of levodopa were associated with higher levels of alertness. Variables unrelated to the Maintenance of Wakefulness Test defined daytime alertness including age, sex, years with diagnosis, motor impairment score, and most nocturnal sleep variables. Deficits in objectively assessed daytime alertness in Parkinson's disease appear to be a function of both the disease and the medications and their doses used. The apparent divergent dose-dependent effects of drug class in Parkinson's disease are anticipated by basic science studies of the sleep/wake cycle under different pharmacological agents.
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Bliwise</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Program in Sleep Medicine, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Trotti, Lynn Marie" sort="Trotti, Lynn Marie" uniqKey="Trotti L" first="Lynn Marie" last="Trotti">Lynn Marie Trotti</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Program in Sleep Medicine, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Wilson, Anthony G" sort="Wilson, Anthony G" uniqKey="Wilson A" first="Anthony G." last="Wilson">Anthony G. Wilson</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Program in Sleep Medicine, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Greer, Sophia A" sort="Greer, Sophia A" uniqKey="Greer S" first="Sophia A." last="Greer">Sophia A. Greer</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Program in Sleep Medicine, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Wood Siverio, Cathy" sort="Wood Siverio, Cathy" uniqKey="Wood Siverio C" first="Cathy" last="Wood-Siverio">Cathy Wood-Siverio</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Juncos, Jorge J" sort="Juncos, Jorge J" uniqKey="Juncos J" first="Jorge J." last="Juncos">Jorge J. Juncos</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Factor, Stewart A" sort="Factor, Stewart A" uniqKey="Factor S" first="Stewart A." last="Factor">Stewart A. Factor</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Freeman, Alan" sort="Freeman, Alan" uniqKey="Freeman A" first="Alan" last="Freeman">Alan Freeman</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Rye, David B" sort="Rye, David B" uniqKey="Rye D" first="David B." last="Rye">David B. Rye</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Program in Sleep Medicine, Emory University School of Medicine</s1><s2>Atlanta, Georgia</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Analysis of Variance</term><term>Antiparkinson Agents (adverse effects)</term><term>Antiparkinson Agents (therapeutic use)</term><term>Attention (drug effects)</term><term>Dopamine Agonists (adverse effects)</term><term>Dopamine Agonists (therapeutic use)</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Humans</term><term>Levodopa (adverse effects)</term><term>Levodopa (therapeutic use)</term><term>Male</term><term>Middle Aged</term><term>Nervous system diseases</term><term>Neuropsychological Tests</term><term>Parkinson Disease (drug therapy)</term><term>Parkinson Disease (psychology)</term><term>Parkinson disease</term><term>Polysomnography</term><term>Sleep</term><term>Treatment</term><term>Wakefulness</term><term>Wakefulness (drug effects)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiparkinson Agents</term><term>Dopamine Agonists</term><term>Levodopa</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term><term>Dopamine Agonists</term><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Attention</term><term>Wakefulness</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Analysis of Variance</term><term>Dose-Response Relationship, Drug</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Neuropsychological Tests</term><term>Polysomnography</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Sommeil</term><term>Veille</term><term>Traitement</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Many patients with idiopathic Parkinson's disease experience difficulties maintaining daytime alertness. Controversy exists regarding whether this reflects effects of antiparkinsonian medications, the disease itself, or other factors such as nocturnal sleep disturbances. In this study we examined the phenomenon by evaluating medicated and unmedicated Parkinson's patients with objective polysomnographic measurements of nocturnal sleep and daytime alertness. Patients (n = 63) underwent a 48-hour laboratory-based study incorporating 2 consecutive nights of overnight polysomnography and 2 days of Maintenance of Wakefulness Testing. We examined correlates of individual differences in alertness, including demographics, clinical features, nocturnal sleep variables, and class and dosage of anti-Parkinson's medications. Results indicated that, first, relative to unmediated patients, all classes of dopaminergic medications were associated with reduced daytime alertness, and this effect was not mediated by disease duration or disease severity. Second, the results showed that increasing dosages of dopamine agonists were associated with less daytime alertness, whereas higher levels of levodopa were associated with higher levels of alertness. Variables unrelated to the Maintenance of Wakefulness Test defined daytime alertness including age, sex, years with diagnosis, motor impairment score, and most nocturnal sleep variables. Deficits in objectively assessed daytime alertness in Parkinson's disease appear to be a function of both the disease and the medications and their doses used. The apparent divergent dose-dependent effects of drug class in Parkinson's disease are anticipated by basic science studies of the sleep/wake cycle under different pharmacological agents.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Géorgie (États-Unis)</li></region></list><tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Bliwise, Donald L" sort="Bliwise, Donald L" uniqKey="Bliwise D" first="Donald L." last="Bliwise">Donald L. Bliwise</name></region><name sortKey="Bliwise, Donald L" sort="Bliwise, Donald L" uniqKey="Bliwise D" first="Donald L." last="Bliwise">Donald L. Bliwise</name><name sortKey="Factor, Stewart A" sort="Factor, Stewart A" uniqKey="Factor S" first="Stewart A." last="Factor">Stewart A. Factor</name><name sortKey="Freeman, Alan" sort="Freeman, Alan" uniqKey="Freeman A" first="Alan" last="Freeman">Alan Freeman</name><name sortKey="Greer, Sophia A" sort="Greer, Sophia A" uniqKey="Greer S" first="Sophia A." last="Greer">Sophia A. Greer</name><name sortKey="Greer, Sophia A" sort="Greer, Sophia A" uniqKey="Greer S" first="Sophia A." last="Greer">Sophia A. Greer</name><name sortKey="Juncos, Jorge J" sort="Juncos, Jorge J" uniqKey="Juncos J" first="Jorge J." last="Juncos">Jorge J. Juncos</name><name sortKey="Rye, David B" sort="Rye, David B" uniqKey="Rye D" first="David B." last="Rye">David B. Rye</name><name sortKey="Rye, David B" sort="Rye, David B" uniqKey="Rye D" first="David B." last="Rye">David B. Rye</name><name sortKey="Trotti, Lynn Marie" sort="Trotti, Lynn Marie" uniqKey="Trotti L" first="Lynn Marie" last="Trotti">Lynn Marie Trotti</name><name sortKey="Trotti, Lynn Marie" sort="Trotti, Lynn Marie" uniqKey="Trotti L" first="Lynn Marie" last="Trotti">Lynn Marie Trotti</name><name sortKey="Wilson, Anthony G" sort="Wilson, Anthony G" uniqKey="Wilson A" first="Anthony G." last="Wilson">Anthony G. Wilson</name><name sortKey="Wilson, Anthony G" sort="Wilson, Anthony G" uniqKey="Wilson A" first="Anthony G." last="Wilson">Anthony G. Wilson</name><name sortKey="Wood Siverio, Cathy" sort="Wood Siverio, Cathy" uniqKey="Wood Siverio C" first="Cathy" last="Wood-Siverio">Cathy Wood-Siverio</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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