Papers by Juan Gómez-esteban
Expert Opinion on Pharmacotherapy, Jun 13, 2018
Background: PD0013 was a 6-month non-interventional study in clinical-practice comparing effectiv... more Background: PD0013 was a 6-month non-interventional study in clinical-practice comparing effectiveness and tolerability of rotigotine+levodopa in younger (<70years) vs. older (≥70years) Parkinson's disease (PD) patients. Methods: Patients previously received levodopa for ≥6-months as monotherapy or in combination with another dopamine-agonist (DA). Primary variable: Unified PD Rating Scale (UPDRS) Part-II change from baseline to end-of-observation-period (EOP). Results: 91 younger/99 older patients started rotigotine; 68 younger/62 older patients completed the study. Most switched from levodopa+another DA. Addition of rotigotine as first DA was more common in older patients (20.2% vs.15.4%). Mean±SD rotigotineexposure: 6.1±3.4mg/24h younger vs. 4.9±2.4mg/24h older. Eleven patients changed levodopa dose during the study. At EOP, improvement in mean UPDRS-II was greater in younger patients (p=0.0289). UPDRS-II responder-rate (≥20% decrease in UPDRS-II score) was higher in younger patients (42.3% vs. 25.9%). Improvement across age-groups was similar on PD Sleep Scale-2 and Clinical Global Impressions-Improvement Scale. Adverse-drug-reactions (ADRs), and discontinuations because of ADRs, were more common among older patients. There were no new safety-signals. Conclusions: Despite low rotigotine doses, when added to levodopa or switched from levodopa+another DA, rotigotine led to greater improvement in UPDRS-II in younger patients (<70years). Assessment of individual patient data revealed clinically-meaningful improvements in UPDRS-II in both age-groups.
Journal of Parkinson's disease, Feb 2, 2021
Background: Safinamide modulates both dopaminergic and glutamatergic systems with positive effect... more Background: Safinamide modulates both dopaminergic and glutamatergic systems with positive effects on motor and nonmotor symptoms of Parkinson's disease (PD). The drug utilization study SYNAPSES was designed to investigate the use of safinamide in routine clinical practice, as recommended by the European Medicines Agency. Objective: To describe the occurrence of adverse events in PD patients treated with safinamide in real-life conditions. Methods: The SYNAPSES trial is an observational, European, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months with analyses performed in the overall population and in patients aged >75 years, with relevant comorbidities and with psychiatric conditions. Results: Of the 1610 patients included, 82.4% were evaluable after 12 months with 25.1% of patients >75 years, 70.8% with relevant comorbidities and 42.4% with psychiatric conditions. During observation 45.8% patients experienced adverse events, 27.7% patients had adverse drug reactions and 9.2% patients had serious adverse events. The adverse events were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroup of patients. Clinically significant improvements were seen in the UPDRS motor score and in the UPDRS total score in ≥40% of patients, according to the criteria developed by Shulman et al.
Journal of stroke and cerebrovascular diseases, Jul 1, 2018
In this case report, we describe a patient who has a persistent left superior vena cava (PLSVC) m... more In this case report, we describe a patient who has a persistent left superior vena cava (PLSVC) manifesting as a transient ischemic attack (TIA) and a remote brain abscess. PLSCV, when draining in the left atrium, is a cause of right to left shunt, and it has been related to brain abscesses and, as reported in a few cases, to ischemic stroke. After admission, our patient experienced 2 new episodes of TIA while being injected with agitated saline contrast through the left arm, producing echocardiographic images of right to left shunt, which gave the clue to the diagnosis.
Pain, Dec 1, 2014
A sound strategy for improving the clinical efficacy of opioids involves exploiting positive inte... more A sound strategy for improving the clinical efficacy of opioids involves exploiting positive interactions with drugs directed at other targets in pain pathways. The current study investigated the role of dopamine receptor D2 (D2R) in modulation of spinal dorsal horn excitability to noxious input, and interactions therein with μ-opioid receptor (MOR) in an animal model of neuropathic pain induced by spinal nerve ligation (SNL). C-fiber-evoked field potentials in the spinal dorsal horn were depressed concentration dependently by spinal superfusion with the D2R agonist quinpirole both in nerve-injured and sham-operated (control) rats. However, quinpirole-induced depression was significant at 10 μmol/L after SNL but only at 100 μmol/L in control rats. This quinpirole effect was completely abolished by MOR antagonist CTOP at subclinical concentration (1 μmol/L) in nerve-injured rats, but was unaltered in sham-operated rats. Nine days after SNL, D2R was upregulated to both presynaptic and postsynaptic locations in dorsal horn neurons, as revealed by double confocal immunofluorescence stainings for synaptophysin and PSD-95. In addition, D2R/MOR co-localization was increased after SNL. Co-administration of 1 μmol/L quinpirole, insufficient per se to alter evoked potentials, dramatically enhanced inhibition of evoked potentials by MOR agonist DAMGO, reducing the IC50 value of DAMGO by 2 orders of magnitude. The present data provide evidence of profound functional and subcellular changes in D2R-mediated modulation of noxious input after nerve injury, including positive interactions with spinal MOR. These results suggest D2R co-stimulation as a potential avenue to improve MOR analgesia in sustained pain states involving peripheral nerve injury.
Frontiers in Neurology, 2013
Orthostatic hypotension (OH) is a common and disabling symptom affecting Parkinson's disease (PD)... more Orthostatic hypotension (OH) is a common and disabling symptom affecting Parkinson's disease (PD) patients. We present the effect of the different therapies commonly used to manage PD on this clinical manifestation. For this purpose, we describe the relationship between OH and the current treatments employed in PD, such as L-DOPA, dopaminergic agonists, and continuous dopaminergic stimulation therapies. Additionally, we review the therapeutic measures that could be used to ameliorate OH. There are different approaches to deal with this manifestation, including pharmacological and nonpharmacological treatments, although none of them is specifically aimed for treating OH in PD.
Frontiers in psychology, May 27, 2024
Introduction: Olfactory dysfunction (OD) is frequent after SARS-CoV-2 infection. The aim of this ... more Introduction: Olfactory dysfunction (OD) is frequent after SARS-CoV-2 infection. The aim of this study was to examine if long-term OD is common in post-COVID condition, and the relationship between olfaction, cognition, neuropsychiatric symptoms, and disease duration in these patients. Methods: This study included 121 participants with post-COVID condition and 51 healthy controls (HC). A comprehensive neuropsychological and neuropsychiatric assessment was conducted, encompassing various domains, including general cognition, processing speed, verbal fluency, attention, verbal memory, visual memory, visuoconstructive ability, visuospatial ability, abstraction, executive functions, anxious-depressive symptoms, general health perception, fatigue level, sleep quality, and olfaction. Statistical analyses were carried out to understand the relationship of OD with cognition, and its role as moderator variable. Results: In total, 25% of the post-covid patients had a reduced smell capacity, while only 9.3% of HC presented OD. Post-COVID patients had statistically significantly worse cognitive performance and clinical status than HC. Verbal fluency (AUC = 0.85, p < 0.001), and attention (AUC = 0.82, p < 0.001) were the variables that best discriminate between groups. OD seemed to be a moderator between fatigue and cognition, and between disease duration and attention (β = −0.04; p = 0.014). Discussion: The study highlights marked cognitive and neuropsychiatric sequelae in individuals post-COVID relative to HC. Olfactory impairment exhibits correlations with both cognitive performance and general health. Olfaction emerges as a potential prognostic marker owing to its moderating influence on disease severity indicators.
Parkinsonism & Related Disorders, Dec 1, 2016
Objective Internet gaming disorder (IGD) is a type of behavioral addiction characterized by abnor... more Objective Internet gaming disorder (IGD) is a type of behavioral addiction characterized by abnormal executive control, leading to loss of control over excessive gaming. Attention deficit and hyperactivity disorder (ADHD) is one of the most common comorbid disorders in IGD, involving delayed development of the executive control system, which could predispose individuals to gaming addiction. We investigated the influence of childhood ADHD on neural network features of IGD. Methods Resting-state functional magnetic resonance imaging analysis was performed on 44 young, male IGD subjects with and without childhood ADHD and 19 age-matched, healthy male controls. Posterior cingulate cortex (PCC)-seeded connectivity was evaluated to assess abnormalities in default mode network (DMN) connectivity, which is associated with deficits in executive control. Results IGD subjects without childhood ADHD showed expanded functional connectivity (FC) between DMN-related regions (PCC, medial prefrontal cortex, thalamus) compared with controls. These subjects also exhibited expanded FC between the PCC and brain regions implicated in salience processing (anterior insula, orbitofrontal cortex) compared with IGD subjects with childhood ADHD. IGD subjects with childhood ADHD showed expanded FC between the PCC and cerebellum (crus II), a region involved in executive control. The strength of connectivity between the PCC and cerebellum (crus II) was positively correlated with self-reporting scales reflecting impulsiveness. Conclusion Individuals with IGD showed altered PCC-based FC, the characteristics of which might be dependent upon history of childhood ADHD. Our findings suggest that altered neural networks for executive control in ADHD would be a predisposition for developing IGD. Disclosure of interest The authors have not supplied their declaration of competing interest.
Clinical Neurology and Neurosurgery, May 1, 2010
The presence of asymmetry in symptoms and clinical signs favours the diagnosis of Parkinson&a... more The presence of asymmetry in symptoms and clinical signs favours the diagnosis of Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (PD). The aim of this study is to analyse this symptom asymmetry as a function of different variables and compare it with other parkinsonisms. 201 Patients with PD were studied. The sample was supplemented with 29 patients diagnosed with MSA-P (according to the criteria established by the American Academy of Neurology) and 17 with PSP (according to the criteria established by the NINDS-SPSP International Workshop). The symmetry was evaluated, based on items 20-23, 25 and 26 of the Unified Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease Rating Scale, by subtracting the motor score for the left side from that for the right side. Those patients with a difference of one point or more were designated as being asymmetric. Around 16.4% of patients presented symmetrical clinical symptoms. There were no differences between those patients with or without family history of the disease. Those patients with symmetric symptoms were found to have longer symptomatic disease duration (10.8 vs. 7.9 years), a worse mental state (UPDRS I: 3.9 vs. 3.2), a higher incidence of complications (UPDRS IV: 4.5 vs. 3.2) and had their activities of daily living (ADL) affected to a greater degree (UPDRS II: 13.0 vs. 11.0). Around 48.3% of the MSA-P patients and 52.9% of the PSP patients showed symmetric symptoms. The degree of symmetry is not useful in differentiating between sporadic and familial PD. However, the observation of highly symmetrical symptoms in a patient with short evolution time indicates that an atypical parkinsonism should be suspected.
Revista De Neurologia, 2011
Gonzalez-Soltero et al [1] y Herrero-Velazquez et al [2] han presentado, recientemente, nuevos ca... more Gonzalez-Soltero et al [1] y Herrero-Velazquez et al [2] han presentado, recientemente, nuevos casos de encefalitis con anticuerpos antiNMDA-R en dos mujeres, en las que no se asocio a tumor ovarico ni en ninguna otra localizacion. El seguimiento hasta un ano despues fue negativo, sin que apareciera ninguna neoplasia ginecologica. Con este motivo queremos aportar nuestra experiencia en un caso similar, en el que el seguimiento si ha demostrado la aparicion de un teratoma de ovario. El caso ya fue publicado [3]; en resumen, se trata de una adolescente de 14 anos de edad con un cuadro agudo de trastornos del comportamiento, alucinaciones, movimientos anormales y tormenta disautonomica. En el liquido cefalorraquideo habia una ligera pleocitosis. La SPECT-HMPAO detecto focos multiples de hiperperfusion corticales y en los ganglios basales. La respuesta a la inmunoterapia fue espectacular y la paciente se recupero completamente. Fue estudiada mediante ecografia abdominopelvica, tomografia computarizada (TC) de cuerpo entero, resonancia magnetica (RM) ovarica y tomografia por emision de positrones (PET), sin detectarse ninguna tumoracion. Los marcadores tumorales fueron negativos. Tras el alta, se le realizo un seguimiento en las consultas externas de neurologia y ginecologia, sin apreciarse ninguna anomalia. Al cabo de un ano, la paciente acudio espontaneamente a urgencias por presentar molestias abdominales durante la menstruacion y haberse palpado ella misma un bulto abdominal. La TC detecto una masa de 6 cm en el ovario derecho que fue extirpada, con el diagnostico histopatologico de teratoma maduro (quiste dermoide). Hemos considerado la posibilidad de que el tumor estuviera presente en el momento del diagnostico de la encefalitis y no se detectara en las exploraciones practicadas (falso negativo). Sin embargo, se han revisado esas exploraciones iniciales de la paciente y no se ha encontrado ningun indicio de que hubiera un error de deteccion del tumor. Por la edad de la paciente, no se practico ecografia transvaginal, que se considera el metodo de eleccion para el diagnostico del teratoma ovarico, pero creemos que la combinacion de ecografia abdominal, TC, RM y PET deberia haber detectado el tumor si estuviera presente. Aportamos esta experiencia para resaltar la importancia del seguimiento prolongado de pacientes con sindromes de encefalitis antiNMDA-R, por la posibilidad de aparicion del tumor en ausencia de recidiva del sindrome neurologico.
Neurology, Apr 5, 2016
Objective: To compare the neuropsychological profile in carriers of E46K mutation of alpha-synucl... more Objective: To compare the neuropsychological profile in carriers of E46K mutation of alpha-synuclein gene (E46K-SNCA) with healthy controls (HC), idiopathic Parkinson’s disease (iPD) and dementia with Lewy bodies (DLB). Background: E46K-SNCA is a rare, highly-penetrant and clinically aggressive genetic model of pure Lewy body disease, with early and severe cognitive deficits. Methods: We evaluated cross-sectionally 63 participants including n=7 E46K-SNCA [4 symptomatic (motor parkinsonism; mean disease duration (dd): 9.1 years) and 3 asymptomatic], n=28 iPD (dd: 5.3 years), n=2 DLB (dd: 6.6 years) and n=26 HC, matched by sex, age and education. We assessed premorbid intelligence, attention, processing speed, verbal fluency, verbal and visual learning and memory, theory-of-mind (ToM), executive functioning, and higher order visual (visuospatial, visuoperceptive, visuoconstructive) skills. Mann-Whitney U Test was used to assess differences between groups. Results: Compared with HC, symptomatic E46K-SNCA showed a statistically significant lower performance in verbal fluency and verbal memory, ToM and specially processing speed and higher order visual skills. Although we did not observe significant differences between HC and asymptomatic E46K-SNCA, a tendency for poorer performance in visual memory and in both semantic and phonetic verbal fluency was found in the latter. Compared with iPD, symptomatic E46K-SNCA demonstrated significantly lower performance in processing speed, verbal fluency, learning and memory, ToM, and executive functioning. Here again, higher order visual skills were especially more affected in symptomatic E46K-SNCA. Cognitive performance was also poorer in DLB than in iPD for most cognitive domains. Interestingly, DLB cognitive profile was similar to that of symptomatic E46K-SNCA carriers, especially for verbal memory and higher order visual skills. Conclusions: Neuropsychological deterioration in E46K-SNCA is more severe and affects more cognitive domains than in iPD. Moreover, the similarities between E46K-SNCA and DLB may support the existence of a cognitive phenotype specific for alpha-synucleinopathies driven by higher order visuospatial abnormalities. Disclosure: Dr. Lucas-Jimenez has nothing to disclose. Dr. Del Pino has nothing to disclose. Dr. Acera has nothing to disclose. Dr. Gabilondo has nothing to disclose. Dr. Gomez-Esteban has nothing to disclose. Dr. Tijero has nothing to disclose. Dr. Diez-Cirarda has nothing to disclose. Dr. Pena has nothing to disclose. Dr. Ibarretxe-Bilbao has nothing to disclose. Dr. Ojeda has nothing to disclose.
Parkinsonism & Related Disorders, Jun 1, 2022
Movement Disorders Clinical Practice, Nov 1, 2018
A 65-year-old man presented with a 3-month history of gait disturbance, generalized chorea, and p... more A 65-year-old man presented with a 3-month history of gait disturbance, generalized chorea, and painful intermittent cervical dystonia. He also reported sleep disruption, mood changes, and irritability. He had a medical history of hypertension and polymyalgia rheumatica. There was no family history. Neurological examination evidenced moderate generalized chorea, dystonia of the neck, mild unsteady gait, and subtle dysarthria. There were no signs of parkinsonism or limitation of eye movements. Also, no Kayser-Fleischer ring, xanthomas, or signs of neuropathy were observed. A neuropsychiatric assessment evidenced emotional lability with no neurocognitive impairment. A blood test showed normal iron profile, cholestanol, phytanic acid levels, vitamin E, copper, ceruloplasmin, creatine kinase, chitotriosidase activity, hypercoagulability, systemic autoimmunity assays, and peripheral blood smear examination. HIV and bacterial serologies were negative. Genetic testing excluded both Huntington's disease and the main Huntington's disease-like spinocerebellar ataxia 17. A brain MRI showed paramagnetic deposits in the basal ganglia, substantia nigra, and red nucleus (Fig. ). A normal CT of the brain (Fig. ) ruled out calcification. A video-polysomnography showed fragmented sleep, motor restlessness, vocalizations, the absence of REM-sleep, and an apnea-hypopnea index of 57 (severe sleep apnea). Symptomatic treatment with tetrabenazine, quetiapine, trazodone, and CPAP was started. Nine months later, the patient's clinical state was suddenly impaired by an exacerbation with bulbar dysfunction (severe dysarthria, dysphagia, and aspiration pneumonia) and severe gait
Parkinsonism & Related Disorders, 2016
OBJECTIVE: To examine the relationship between blood pressure and symptoms in a cohort of Parkins... more OBJECTIVE: To examine the relationship between blood pressure and symptoms in a cohort of Parkinson disease (PD) patients with the goal of identifying a hemodynamic target to guide treatment. BACKGROUND: Orthostatic hypotension (OH) is frequent in patients with PD and can occur with or without symptoms. Pharmacological treatments are effective but often exacerbate supine hypertension. Guidelines exist for the diagnosis but not for the treatment of OH. METHODS: We measured blood pressure supine and upright (tilt or active standing) and identified the presence or absence of symptomatic OH by using a validated patient reported outcome questionnaire in 210 patients with PD. We evaluated the usefulness of the 20/10 and 30/15 mmHg diagnostic criteria (systolic/diastolic) to identify symptomatic OH. RESULTS: Fifty percent of the PD patient cohort met criteria for the 20/10 fall and 30[percnt] for the 30/15 blood pressure fall. Among the patients who met either OH criteria, the percentage of those with symptoms was small (33[percnt] of those with 20/10 and 44[percnt] of those with 30/15 mmHg; 16[percnt] and 13[percnt], respectively overall). Symptomatic OH was associated with an upright mean blood pressure below 75 mmHg. A mean standing blood pressure <75 mmHg had a sensitivity of 97[percnt] and a specificity of 98[percnt] for detecting symptomatic OH. CONCLUSIONS: Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing blood pressure below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension. Disclosure: Dr. Palma has received personal compensation for activities with Lundbeck Research USA, Inc. as a consultant. Dr. Martinez has nothing to disclose. Dr. Norcliffe-Kaufmann has nothing to disclose. Dr. Gomez-Esteban has nothing to disclose. Dr. Tijero Merino has nothing to disclose. Dr. Berganzo Corrales has nothing to disclose. Dr. Kaufmann has received personal compensation from Chelsea Therapeutics as a scientific advisory board member. Dr. Kaufmann has received personal compensation in an editorial capacity for Clinical Autonomic Research. Dr. Kaufmann has received research s
Journal of the Neurological Sciences, Oct 1, 2014
ABSTRACT •Compulsive eating was not related to dopaminergic replacement therapy.•Other impulse co... more ABSTRACT •Compulsive eating was not related to dopaminergic replacement therapy.•Other impulse control disorders showed clear relation to dopamine agonist therapy.•Punding was associated with higher dose of both dopamine agonists and L-dopa.•Rotigotine might cause less ICRBDs than other dopamine agonists.
Frontiers in Neuroscience, Jul 12, 2021
Background: Retinal microvascular alterations have been previously described in Parkinson's disea... more Background: Retinal microvascular alterations have been previously described in Parkinson's disease (PD) patients using optical coherence tomography angiography (OCT-A). However, an extensive description of retinal vascular morphological features, their association with PD-related clinical variables and their potential use as diagnostic biomarkers has not been explored. We performed a cross-sectional study including 49 PD patients (87 eyes) and 40 controls (73 eyes). Retinal microvasculature was evaluated with Spectralis OCT-A and cognitive status with Montreal Cognitive Assessment. Unified PD Rating Scale and disease duration were recorded in patients. We extracted microvascular parameters from superficial and deep vascular plexuses of the macula, including the area and circularity of foveal avascular zone (FAZ), skeleton density, perfusion density, vessel perimeter index, vessel mean diameter, fractal dimension (FD) and lacunarity using Python and MATLAB. We compared the microvascular parameters between groups and explored their association with thickness of macular layers and clinical outcomes. Data were analyzed with General Estimating Equations (GEE) and adjusted for age, sex, and hypertension. Logistic regression GEE models were fitted to predict diagnosis of PD versus controls from microvascular, demographic, and clinical data. The discrimination ability of models was tested with receiver operating characteristic curves. Results: FAZ area was significantly smaller in patients compared to controls in superficial and deep plexuses, whereas perfusion density, skeleton density, FD and lacunarity of capillaries were increased in the foveal zone of PD. In the parafovea, microvascular parameters of superficial plexus were associated with ganglion cellinner plexiform layer thickness, but this was mainly driven by PD with mild cognitive impairment. No such associations were observed in controls. FAZ area was negatively associated with cognition in PD (non-adjusted models). Foveal lacunarity, combined with demographic and clinical confounding factors, yielded an outstanding diagnostic accuracy for discriminating PD patients from controls.
Movement Disorders, May 28, 2019
A BS TRACT: Background: Retinal optical coherence tomography findings in Lewy body diseases and t... more A BS TRACT: Background: Retinal optical coherence tomography findings in Lewy body diseases and their implications for visual outcomes remain controversial. We investigated whether region-specific thickness analysis of retinal layers could improve the detection of macular atrophy and unravel its association with visual disability in Parkinson's disease. Methods: Patients with idiopathic Parkinson's disease (n = 63), dementia with Lewy bodies (n = 8), and E46K mutation carriers in the α-synuclein gene (E46K-SNCA) (n = 4) and 34 controls underwent Spectralis optical coherence tomography macular scans and a comprehensive battery of visual function and cognition tests. We computed mean retinal layer thicknesses of both eyes within 1-, 2-, 3-, and 6-mm diameter macular discs and in concentric parafoveal (1-to 2-mm, 2-to 3-mm, 1-to 3-mm) and perifoveal (3-to 6-mm) rings. Group differences in imaging parameters and their relationship with visual outcomes were analyzed. A multivariate logistic model was developed to predict visual impairment from optical coherence tomography measurements in Parkinson's disease, and cutoff values were determined with receiver operating characteristic analysis. Results: When compared with controls, patients with dementia with Lewy bodies had significant thinning of the ganglion cell-inner plexiform layer complex within the central 3-mm disc mainly because of differences in 1-to 3-mm parafoveal thickness. This parameter was strongly correlated in patients, but not in controls, with low contrast visual acuity and visual cognition outcomes (P < .05, False Discovery Rate), achieving 88% of accuracy in predicting visual impairment in Parkinson's disease. Conclusion: Our findings support that parafoveal thinning of ganglion cell-inner plexiform complex is a sensitive and clinically relevant imaging biomarker for Lewy body diseases, specifically for Parkinson's disease.
Neurología, Nov 1, 2016
The aim of the present study is to analyse the influence that motor and non- motor symptoms have ... more The aim of the present study is to analyse the influence that motor and non- motor symptoms have on the quality of life (QoL) of patients with Parkinson's disease (PD), and to study the relationship between the two types of symptoms. This cross-sectional study included 103 patients with PD (55 men and 48 women). Quality of life was measured on the PDQ-39 scale. The UPDRS scale (I-IV) was also used, and different items were grouped to analyse the presence of tremor, rigidity, bradykinesia, and axial symptoms. The non-motor symptoms scale (NMSS) was administered to assess nonmotor symptoms. We performed correlation analyses between different scales to analyse the influence of motor and non-motor symptoms on QoL. Results: Correlations were observed between the PDQ-39 summary index (PDQ39 SI) and the NMSS (correlation coefficient [cc], 0.56; P < .001), UPDRS III (cc, 0.44; P < .001) and UPDRS IV (cc, 0.37; P < .001) scores. The strongest correlation was between cognitive symptoms and mood. The analysis pointed to a direct relationship between the NMSS score and axial symptoms (cc, 0.384; P < .01), bradykinesia (cc, 0.299; P < .01), and to a lesser extent, rigidity (cc, 0.194; P < .05). No relationship was observed between presence of tremor and the NMSS score.
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Papers by Juan Gómez-esteban