1. M. M. Dumitru¹∙², V.Chirita¹∙², R.Chirita¹∙²
Characteristics of early onset dementia in a hospital setting from Romania
M. M. Dumitru¹∙², V.Chirita¹∙², R.Chirita¹∙²
“Socola” Psychiatric Hospital, Iasi, Romania
“Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Introduction
Figure 1. Percentage distribution of PDSS items in PD patients
Dementia represents a true flagellum of the contemporary society, this pathology reducing life expectancy and quality of life dramatically for the elderly(1). It is probably the most important of the degenerative diseases due to its frequent occurrence and devastating nature. Diagnosis of early onset dementia (EOD), defined as the onset of dementia before the age of 65 years, is frequently missed in these younger patients, as it can be caused by a great number of etiologies and presents with a variety of symptoms.
Objective
The main objective of this study was to describe the frequency, clinical characteristics and etiology of EOD and to compare with late onset dementia (LOD), and the
second objective  was to compare EOD with LOD.
Materials and Methods
The study we included all patients with dementia defined according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(2), referred to the “Socola” Psychiatric Hospital between In the EOD group were included patients age less than 65 years, and the older patients were included in the late-onset dementia (LOD) group. Was assessed  cognitive functioning with the Mini Mental State Examination (MMSE). Dementia was diagnosed and classified according to common criteria: frontotemporal lobar degeneration (FTD),13 alcohol-related dementia (ARD), 14 and Parkinson’s disease (PD) dementia (defined by diagnosis of PD associated with dementia syndrome with insidious onset and slow progression). 15 The EOD and LOD groups were compared in terms of demographic features and the causes and severity of dementia. The categorical variables were compared with x² test and continuous variables, with t-test. A P value of less than 0.05 was
considered significant. Analyses were performed using SPSS statistical software
We have not found significant differences in disease related characteristics between patients who complains about sleep problems and those who did not. We observed that only mental health problems, fatigue and RLS were factors associated with PDSS score.
Table 2. Factors associated with total PDSS score
Variable
Block one
Beta
p-value
Block two
Block three
Age (years)
0.14
0.13
0.08
0.02
0.15
Gender
-0.05
0.64
-0.06
0.62
0.27
Disease duration (years)
-0.13
-0.86
0.26
UPDRS part III
-0.17
0.6
Mental health
0.38
<0.001
Fatigue
-0.19
0.03
Restless legs syndrome
-0.36
Results
350 patients (190 women) were included and 81 were classified as EOD. The sex ratio was 1.18, but women were frequent in LOD (p=0.03). Patients with EOD were more frequently (p=0.003), they had a higher education than LOD, but a lower educational level than the general population. The MMSE did not differ between EOD and LOD. The most frequent causes of EOD were Alzheimer’s disease (28.4%) and vascular disease (19.8%). Alcohol-related dementia (16.1%), frontotemporal dementia (9.9%) and traumatic brain injury (6.2%) were significantly more frequent (p<0.005) in EOD group than in LOD group.
References
1. Comella CL. Sleep disturbances and excessive daytime sleepiness in Parkinson disease: an overview. J Neural Transm Suppl. 2006;70:349–355.
2.Trenkwalder C, Sleep dysfunction in Parkinson’s disease. Clinical Neuroscience. 1998; 5(2):
3.Chaudhuri KR, Schapira AHV, Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol 2009; 8:464–474.
4.Claassen DO, Josephs KA, Ahlskog JE, Silber MH, Tippmann-Peikert M, Boeve BF, REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 2010; 75:494–499.
Conclusions
These current findings call for increased awareness of sleep problems in patients with Parkinson’s disease, especially focusing on the association with mental health problems, fatigue and RLS. Physicians should be aware of these issues so that sleep problems can be appropriately recognized and treated, and so the quality of life of patients with Parkinson's disease will be enhanced.  
Correspondence to: Maria Magdalena Dumitru, “Socola” Psychiatric Hospital, Road Bucium, No.36, Iasi, Romania,
No potential conflict of interest

2. Sleep disturbances in Parkinson's disease
M. M. Dumitru¹∙², V.Chirita¹∙², R.Chirita¹∙²
“Socola” Psychiatric Hospital, Iasi, Romania
“Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
Introduction
Results
For patients with Parkinson’s disease (PD), sleep problems are the most prominent non- motor symptoms.(1) While the exact prevalence of sleep disturbances in PD patients are unknown, sleep complaints have been reported in 60% to 90% of patients.(2) Sleep problems can be multifactorial and may present at any stage during the course of disease. (3,4)
44 consecutive patients with Parkinson’s disease (41% females) were included in a study of non-motor symptoms, including sleep disturbances. The mean age was 67.8 years (range 35–74); the mean Hoehn and Yahr stage was 2.4 (SD 0.8), and the mean UPDRS part III was 22.6 (SD 11.5). The mean MMSE was 25 (range 23-28), the mean mental health SF-36 score was 70.1 (SD 17.7), and the mean total fatigue score was 16 (SD 6.0). Sleep disturbances were common among patients with Parkinson’s disease. While only 23% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between Parkinson’s disease severity and any of the sleep items in the PDSS.
Figure 1. Percentage distribution of PDSS items in PD patients
Objective
The main objective of this study was to examine the prevalence of sleep disturbances in patients with Parkinson’s disease in a hospital setting from Romania, and their associated risk factors.
Materials and Methods
The study was conducted in Clinical Hospital of Recovery, Iasi. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS).Staging of the disease was in accordance with Hoehn and Yahr Staging and Unified Parkinson’s Disease Rating Scale (UPDRS). Also was assessed  cognitive functioning with the Mini Mental State Examination (MMSE), mental health by the mental health subscale of the Short Form 36, fatigue by the Fatigue Questionnaire, and restless legs syndrome in a clinical interview.
Conclusions
These current findings call for increased awareness of sleep problems in patients with Parkinson’s disease, especially focusing on the association with mental health problems, fatigue and RLS. Physicians should be aware of these issues so that sleep problems can be appropriately recognized and treated, and so the quality of life of patients with Parkinson's disease will be enhanced.  
We have not found significant differences in disease related characteristics between patients who complains about sleep problems and those who did not. We observed that only mental health problems, fatigue and RLS were factors associated with PDSS score.
Table 2. Factors associated with total PDSS score
References
1. Comella CL. Sleep disturbances and excessive daytime sleepiness in Parkinson disease: an overview. J Neural Transm Suppl. 2006;70:349–355.
2.Trenkwalder C, Sleep dysfunction in Parkinson’s disease. Clinical Neuroscience. 1998; 5(2):
3.Chaudhuri KR, Schapira AHV, Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol 2009; 8:464–474.
4.Claassen DO, Josephs KA, Ahlskog JE, Silber MH, Tippmann-Peikert M, Boeve BF, REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 2010; 75:494–499.
Variable
Block one
Beta
p-value
Block two
Block three
Age (years)
0.14
0.13
0.08
0.02
0.15
Gender
-0.05
0.64
-0.06
0.62
0.27
Disease duration (years)
-0.13
-0.86
0.26
UPDRS part III
-0.17
0.6
Mental health
0.38
<0.001
Fatigue
-0.19
0.03
Restless legs syndrome
-0.36
No potential conflict of interest
Correspondence to: Maria Magdalena Dumitru, “Socola” Psychiatric Hospital, Road Bucium, No.36, Iasi, Romania