Movement disorders : official journal of the Movement Disorder Society
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Randomized Controlled Trial Multicenter Study Clinical Trial
Rivastigmine versus placebo in hyperhomocysteinemic Parkinson's disease dementia patients.
The effects of rivastigmine versus placebo in Parkinson's disease dementia (PDD) patients with elevated or normal/low plasma homocysteine were determined. In this prospective analysis of a 24-week, randomly assigned, placebo-controlled study of rivastigmine in PDD, subpopulations comprised patients with plasma homocysteine >or=14 micromol/L (elevated) or <14 micromol/L (normal/low). Coprimary outcomes were the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Alzheimer Disease Cooperative Society-Clinical Global Impression of Change (ADCS-CGIC). ⋯ Rivastigmine- and placebo-treated hyperhomocysteinemic patients (16.5% and 14.6%) discontinued the study because of AEs. Patients with normal/low homocysteine showed no treatment differences on primary or secondary outcomes (1.4 on the ADAS-cog and 0.1 on ADCS-CGIC, both P = ns); 16.7% and 10.3% rivastigmine- and placebo-treated patients discontinued because of AEs. Elevated homocysteine was associated with greater rivastigmine treatment differences than normal/low homocysteine.
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The objective of this study was to evaluate psychological features in severely affected patients with complex regional pain syndrome type I- (CRPS-I) related dystonia. Personality traits, psychopathology, dissociative experiences, the number of traumatic experiences, and quality of life were studied in 46 patients. Findings were compared with two historical psychiatric control groups [54 patients with conversion disorder (CD) and 50 patients with affective disorders (AD)] and normative population data. ⋯ Rates of early traumatic experiences were comparable with the CD and AD patients, and the level of somatoform dissociation was comparable to the CD patients, but was elevated in comparison to the AD patients. Early traumatic experiences were reported in 87% of the CRPS-I patients and were found to be moderately related to somatoform dissociative experiences, indicating that early traumatic experiences might be a predisposing, although not a necessary factor for the development of CRPS-I-related dystonia. Although the psychological profile of the patients with CRPS-I-related dystonia shows some elevations, there does not seem to be a unique disturbed psychological profile on a group level.