The Dashboard Vitals of Parkinson’s: Not to Be Missed Yet an Unmet Need
1. Commentary
- Specific attention and query about oral health, gum, and gingivitis and an examination by a dentist in all cases. Infection with porphyromonas gingivalis, a Gram-negative anaerobic bacterium, can cause chronic periodontitis and possibly systemic inflammation, together with gingipains, and may have an overall effect on worsening of the Parkinsonian state and even pathogenesis [33]. A recent study suggested that high serum C-reactive protein (CRP) level may be a good indicator of periodontitis and should trigger a referral to a dentist and needs to feature in the dashboard [34].
- Delayed oral drug absorption as well as clinical phenomena of “delayed on” or “no on” or even dyskinesias-related erratic absorption may relate to delayed gastric emptying and “gastric blocks”. Helicobacter pylori (H Pylori) infection, a Gram-negative bacteria, in the stomach is common in PD and several case-control studies report that prevalence of H Pylori infection is five-times higher in older PD patients, specifically those over 80 years of age, and up to three-times higher in PD patients compared to healthy individuals [35].
- Eradication of H Pylori infection using combined antibiotic therapies can improve bioavailability and pharmacokinetics of levodopa and drug bioavailability by increasing its absorption by 21 to 54%, despite one single-centre negative study. The latter study, however, did not address blood levels of levodopa and instead focused on quality of life and motor scores [36]. Any patient with delayed time to ‘ON’ after oral levodopa absorption, as well as upper gastrointestinal symptoms of heartburn, bloating, and reflux, must have H Pylori infection tested and, if positive, be treated [37].
- Severe constipation may arise from chronic dehydration and impacted faeces. This also interferes with oral drug absorption and a simple abdominal X-ray may show dilated bowel loops and impacted faeces [38,39]. Treatment with regular laxatives and even an enema may then be warranted, as part of the vitals, in relevant cases.
2. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Chaudhuri, K.R.; Titova, N.; Qamar, M.A.; Murășan, I.; Falup-Pecurariu, C. The Dashboard Vitals of Parkinson’s: Not to Be Missed Yet an Unmet Need. J. Pers. Med. 2022, 12, 1994. https://doi.org/10.3390/jpm12121994
Chaudhuri KR, Titova N, Qamar MA, Murășan I, Falup-Pecurariu C. The Dashboard Vitals of Parkinson’s: Not to Be Missed Yet an Unmet Need. Journal of Personalized Medicine. 2022; 12(12):1994. https://doi.org/10.3390/jpm12121994
Chicago/Turabian StyleChaudhuri, Kallol Ray, Nataliya Titova, Mubasher A. Qamar, Iulia Murășan, and Cristian Falup-Pecurariu. 2022. "The Dashboard Vitals of Parkinson’s: Not to Be Missed Yet an Unmet Need" Journal of Personalized Medicine 12, no. 12: 1994. https://doi.org/10.3390/jpm12121994