Clinical Parkinsonism Related Disorders最新文献

{"title":"Floating door sign does not differentiate Parkinson’s disease from essential tremor","authors":"Valtteri Räty ,&nbsp;Mikael Eklund ,&nbsp;Simo Nuuttila ,&nbsp;Elina Jaakkola ,&nbsp;Elina Mäkinen ,&nbsp;Kirsi Murtomäki ,&nbsp;Tanja Nojonen ,&nbsp;Reeta Levo ,&nbsp;Tuomas Mertsalmi ,&nbsp;Juho Joutsa ,&nbsp;Filip Scheperjans ,&nbsp;Valtteri Kaasinen","doi":"10.1016/j.prdoa.2023.100184","DOIUrl":"10.1016/j.prdoa.2023.100184","url":null,"abstract":"<div><p>Diagnostic usefulness of the floating door sign was tested in 144 PD patients, 41 essential tremor patients and 38 controls. There were no differences in the presence of floating door sign between PD and ET patients. The sign does not seem to be a reliable differential diagnostic tool.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/01/main.PMC9932557.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term results of carbidopa/levodopa enteral suspension across the day in advanced Parkinson’s disease: Post-hoc analyses from a large 54-week trial","authors":"Rajesh Pahwa ,&nbsp;Jason Aldred ,&nbsp;Aristide Merola ,&nbsp;Niodita Gupta ,&nbsp;Emi Terasawa ,&nbsp;Viviana Garcia-Horton ,&nbsp;David R. Steffen ,&nbsp;Prasanna L. Kandukuri ,&nbsp;Yanjun Bao ,&nbsp;Omar Ladhani ,&nbsp;Connie H. Yan ,&nbsp;Vivek Chaudhari ,&nbsp;Stuart H. Isaacson","doi":"10.1016/j.prdoa.2022.100181","DOIUrl":"10.1016/j.prdoa.2022.100181","url":null,"abstract":"<div><h3>Introduction</h3><p>Carbidopa/levodopa enteral suspension (CLES) previously demonstrated reduction in total daily OFF from baseline by over 4 hours in advanced Parkinson’s disease patients across 54 weeks. Evidence on CLES’s long-term effectiveness on patterns of motor-symptom control throughout the day remains limited.</p></div><div><h3>Methods</h3><p>We present post-hoc analyses of a large, open-label study of CLES monotherapy (N = 289). Diary data recorded patients’ motor states at 30-minute intervals over 3 days at baseline and weeks 4, 12, 24, 36, and 54. Adjusted generalized linear mixed models assessed changes from baseline at each timepoint for four outcome measures: time to ON without troublesome dyskinesia (ON-woTD) after waking, motor-symptom control as measured by motor states’ durations throughout the day, number of motor-state transitions, and presence of extreme fluctuations (OFF to ON with TD).</p></div><div><h3>Results</h3><p>Patients demonstrated short-term (wk4) and sustained (wk54) improvement in all outcomes compared to baseline. At weeks 4 and 54, patients were more likely to reach ON-woTD over the course of their day (HR: 1.86 and 2.51, both P &lt; 0.0001). Across 4-hour intervals throughout the day, patients also experienced increases in ON-woTD (wk4: 58–65 min; wk54: 60–78 min; all P &lt; 0.0001) and reductions in OFF (wk4: 50–61 min; wk54: 56–68 min; all P &lt; 0.0001). At weeks 4 and 54, patients’ motor-state transitions were reduced by about half (IRR: 0.53 and 0.49, both P &lt; 0.0001), and fewer patients experienced extreme fluctuations (OR: 0.22 and 0.15, both P &lt; 0.0001).</p></div><div><h3>Conclusion</h3><p>CLES monotherapy was associated with significant long-term reductions in motor-state fluctuations, faster time to ON-woTD upon awakening, and increased symptom control throughout the day.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10842336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased depressive symptoms in Parkinson’s disease during the COVID‐19 pandemic: Preliminary findings from longitudinal analysis of the PHASE study","authors":"Hiroshi Kataoka ,&nbsp;Kenji Obayashi ,&nbsp;Yoshiaki Tai ,&nbsp;Kazuma Sugie ,&nbsp;Keigo Saeki","doi":"10.1016/j.prdoa.2023.100194","DOIUrl":"10.1016/j.prdoa.2023.100194","url":null,"abstract":"<div><h3>Introduction</h3><p>The cumulative number of patients has increased through the four waves of the pandemic in Japan. Many people experienced mental stress due to the fear of infection, and restrictions of leaving the house and leisure activities. No longitudinal study has assessed the fluctuation of neuropsychiatric symptoms during the COVID-19 pandemic using the same scale. We examined changes in non-motor symptoms, and the scores of a Parkinson’s Disease (PD)-specific questionnaire between the early and later periods during the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>We conducted a questionnaire survey during the first wave (from February to April 2020) and the fourth wave of the COVID-19 pandemic (from March to April 2021). We compared the number of symptoms from the two periods.</p></div><div><h3>Results</h3><p>Compared with the first wave, the Geriatric Depression Scale score was significantly higher in the fourth wave of the pandemic (median score of GDS: 4.00 vs. 5.50, p = 0.022). Consistently, the scores of symptoms on MDS-UPDRS part 1 in the fourth wave were significantly higher in hygiene (p = 0.033), handwriting (p = 0.033), performing hobbies and other activities (p = 0.035), and turning in bed (p = 0.046) than in the first wave.</p></div><div><h3>Conclusions</h3><p>Our observation over a year between the early and later phases of the COVID-19 pandemic showed an increase in the severity of depression in patients with PD.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10030263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9269250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stable low prevalence of Huntington’s disease in Finland","authors":"Jussi O.T. Sipilä ,&nbsp;Kari Majamaa","doi":"10.1016/j.prdoa.2023.100198","DOIUrl":"10.1016/j.prdoa.2023.100198","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/e2/main.PMC10154769.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9423535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dopamine agonist monotherapy utilization in patients with Parkinson’s disease","authors":"Monica Frazer ,&nbsp;Steve Arcona ,&nbsp;Lisa Le ,&nbsp;Rahul Sasane","doi":"10.1016/j.prdoa.2022.100173","DOIUrl":"10.1016/j.prdoa.2022.100173","url":null,"abstract":"<div><h3>Objectives</h3><p>To characterize patients with Parkinson’s disease (PD) who initiated dopamine agonist (DA) monotherapy, describe medication utilization and provider types, and estimate medication adherence and discontinuation rates.</p></div><div><h3>Methods</h3><p>Retrospective study identified patients with PD in the Optum Research Database and included those with ≥1 claim for DA or levodopa between 09/01/2012 and 12/31/2018, ≥2 PD diagnoses, commercial or Medicare Advantage Part D (MAPD) insurance, ≥40 years old, and continuous medical and pharmacy coverage ≥12 months before and after index date. A subset of patients receiving DA monotherapy was selected for this analysis. Variables were analyzed descriptively. Adherence was measured with medication possession ratio (MPR) and proportion of days covered (PDC); defined as ≥0.80.</p></div><div><h3>Results</h3><p>Patients (N = 642) had mean (SD) age of 70.2 (9.9) years, 70.6 % had MAPD coverage, and 61.7 % were male. Neurologists prescribed 64.6 % of DA monotherapy, and 56.9 % of patients had ≥2 PD diagnoses before or on the index date. Index therapy was discontinued by 44.1 % of patients, and 55.9 % persisted for 12 months without change. Mean (SD) time to discontinuation was 102 (79) days. Mean (SD) MPR for patients (n = 562) with ≥2 fills was 0.84 (0.2); 70.3 % were MPR adherent. Mean (SD) PDC for all 642 patients was 0.66 (0.3); 50.5 % were PDC adherent.</p></div><div><h3>Conclusion</h3><p>Adherence and continuation of therapy were suboptimal, which could translate into poor patient outcomes. Future studies could provide insights on the impact of low adherence and persistence with DA monotherapy.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/a3/main.PMC9842678.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10554479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nausea as a non-motor fluctuation in Parkinson’s disease","authors":"Emily Weisbach ,&nbsp;Joseph Friedman ,&nbsp;Umer Akbar","doi":"10.1016/j.prdoa.2022.100178","DOIUrl":"10.1016/j.prdoa.2022.100178","url":null,"abstract":"","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9804130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10477054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of developing motor complications with Levodopa immediate versus dual release upon treatment initiation in Parkinson’s disease","authors":"Christian Ineichen,&nbsp;Heide Baumann-Vogel,&nbsp;Matthias Sitzler,&nbsp;Christian R. Baumann","doi":"10.1016/j.prdoa.2023.100209","DOIUrl":"https://doi.org/10.1016/j.prdoa.2023.100209","url":null,"abstract":"<div><h3>Introduction</h3><p>Motor complications (MCs) compromise therapy in many patients suffering from Parkinson’s Disease. By achieving more physiologic stimulation of dopamine-receptors, the continuous dopamine stimulation hypothesis suggests that longer-acting levodopa formulations may improve outcome. The aim of this study was to compare the duration until onset of MCs and motor disease progression in patients during their treatment initiation with either an immediate (IR) or a combined rapid- and sustained-release (i.e. dual-release; DR) levodopa formulation.</p></div><div><h3>Methods</h3><p>Using a sample of 69 patients, we applied time-varying survival regression analyses and linear mixed effect models to analyze the data. The latter involved preprocessing of the data to temporally align the response and predictors, including analyzing the extent of visit irregularity and potential predictors of visit intensity.</p></div><div><h3>Results</h3><p>This retrospective study suggests that levodopa-benserazide DR is not superior to levodopa-benserazide IR in affecting duration until MCs and disease progression. Conversely, using DR levodopa-benserazide, similar disease progression was achieved with lower and more constant doses.</p></div><div><h3>Conclusions</h3><p>The effects of DR levodopa-benserazide might not be strong enough to delay onset of MCs. The development of more powerful levodopa formulations remains a pressing clinical need.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49817556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term effects of cognitive training in Parkinson’s disease: A randomized, controlled trial","authors":"Tim D. van Balkom ,&nbsp;Odile A. van den Heuvel ,&nbsp;Henk W. Berendse ,&nbsp;Ysbrand D. van der Werf ,&nbsp;Rob H. Hagen ,&nbsp;Tanja Berk ,&nbsp;Chris Vriend","doi":"10.1016/j.prdoa.2023.100204","DOIUrl":"https://doi.org/10.1016/j.prdoa.2023.100204","url":null,"abstract":"<div><h3>Background</h3><p>Computerized cognitive training may be promising to improve cognitive impairment in Parkinson’s disease and has even been suggested to delay cognitive decline. However, evidence to date is limited. The aim of this study was to assess the durability of eight-week cognitive training effects at up to two years follow-up.</p></div><div><h3>Methods</h3><p>One hundred and thirty-six (1<!--> <!-->3<!--> <!-->6) individuals with Parkinson’s disease, subjective cognitive complaints but without severe cognitive impairment (Montreal Cognitive Assessment ≥ 22) participated in this double-blind RCT. Participants underwent an eight-week home-based intervention of either adaptive, computerized cognitive training with <em>BrainGymmer</em> (n = 68) or an active control (n = 68). They underwent extensive neuropsychological assessment, psychiatric questionnaires and motor symptom assessment at baseline and one and two years after the intervention. We used mixed-model analyses to assess changes in cognitive function at follow-up and performed Fisher’s exact tests to assess conversion of cognitive status.</p></div><div><h3>Results</h3><p>There were no group differences on any neuropsychological assessment outcome at one- and two-year follow-up. Groups were equally likely to show conversion of cognitive status at follow-up. A considerable amount of assessments was missed (1y: n = 27; 2y: n = 33), most notably due to COVID-19 regulations.</p></div><div><h3>Conclusions</h3><p>Eight-week cognitive training did not affect long-term cognitive function in Parkinson’s disease. Future studies may focus on one cognitive subgroup to enhance reliability of study results. Intervention improvements are needed to work towards effective, lasting treatment options.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49858629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial hardship is associated with employment challenges and reduced quality of life in early Parkinson’s disease","authors":"Miriam R. Rafferty ,&nbsp;Sydney Achler ,&nbsp;Han Su ,&nbsp;Masha Kocherginsky ,&nbsp;Danny Bega ,&nbsp;Allen W. Heinemann ,&nbsp;Kurt Johnson","doi":"10.1016/j.prdoa.2023.100225","DOIUrl":"https://doi.org/10.1016/j.prdoa.2023.100225","url":null,"abstract":"<div><h3>Introduction</h3><p>Motor and nonmotor Parkinson’s disease (PD) symptoms can negatively influence employment, which may contribute to financial hardship. This article explores the association between financial hardship, employment challenges, and quality of life in people with early PD.</p></div><div><h3>Methods</h3><p>We measured financial hardship with a validated summary item (5-point scale, lower score - less hardship) and the Comprehensive Score for Financial Toxicity (0–44, lower score worse toxicity) in a cohort of 60 employed individuals with early PD (&lt;5 years). We used Spearman’s Correlations and nonparametric tests to identify associations between financial hardship, demographic characteristics, PD-related factors, employment factors, and quality of life (Neuro-QOL computer adapted measures).</p></div><div><h3>Results</h3><p>The sample was mostly white (93 %) and male (65 %). The plurality were highly-educated with graduate degrees (42 %). Of the 60 participants, 23 (38 %) reported <em>a little bit</em> and 14 (23 %) reported <em>somewhat or more</em> hardship. Comprehensive financial toxicity (22.0 ± 8.7) was correlated moderately (<em>ρ</em> = −0.56) with the single-item summary score. High financial hardship was associated with reduced confidence in job retention (<em>ρ</em> = −0.43, p = 0.001) and reduced perceived workplace success (<em>ρ</em> = −0.352, p = 0.006). Financial hardship was also associated with poorer quality of life in five Neuro-QOL domains: lower extremity function, satisfaction with social roles and activities, depression, anxiety, and stigma (p &lt; 0.05).</p></div><div><h3>Conclusion</h3><p>Financial hardship was common and was associated with employment challenges and poor quality of life. Further work should explore the effects of medical and psychosocial interventions to alleviate financial and employment challenges in individuals with early PD.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112523000439/pdfft?md5=91b33c56e9e963260161d4f65bc47a41&pid=1-s2.0-S2590112523000439-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91957236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Istradefylline effects on tremor dominance (TD) and postural instability and gait difficulty (PIGD)","authors":"Yasar Torres-Yaghi ,&nbsp;Nobutaka Hattori ,&nbsp;Olivier Rascol ,&nbsp;Yu Nakajima ,&nbsp;Shelby M. King ,&nbsp;Akihisa Mori ,&nbsp;Fernando Pagan","doi":"10.1016/j.prdoa.2023.100224","DOIUrl":"https://doi.org/10.1016/j.prdoa.2023.100224","url":null,"abstract":"<div><h3>Background</h3><p>In patients with Parkinson’s Disease (PD), two distinct motor subtypes, tremor dominant (TD) and postural instability and gait difficulty (PIGD), can be differentiated using Unified Parkinson’s Disease Rating Scale (UPDRS) sub-scores. This <em>post hoc</em> analysis of pooled data from eight pivotal studies examined the effect of treatment with istradefylline, a selective adenosine A_2A receptor antagonist, on these subtypes.</p></div><div><h3>Methods</h3><p>In eight randomized, placebo-controlled phase 2b/3 trials, patients on levodopa with carbidopa/benserazide experiencing motor complications received istradefylline (20 or 40 mg/day) or placebo for 12 or 16 weeks. TD subtype was defined by the UPDRS II/III items kinetic and postural tremor in right/left hand and (resting) tremor in the face, lips, chin, hands, or feet; PIGD items were freezing, walking, posture, gait, and postural instability. The ratio of mean scores from TD:PIGD items determined subtype (TD [TD:PIGD ratio ≥ 1.5], PIGD [TD:PIGD ratio ≤ 1.0], mixed-type [ratio 1–1.5]).</p></div><div><h3>Results</h3><p>In total, 2719 patients were included (PIGD, n = 2165; TD, n = 118; mixed-type, n = 188; not evaluable, n = 248). Among TD subtype patients, the least-squares mean change from baseline versus placebo in UPDRS II/III TD-related total score was significant at 20 mg/day istradefylline (−2.21; 95 % CI, −4.05 to −0.36; p = 0.02). For PIGD subtype patients, there was a significant difference from placebo in UPDRS II/III PIGD-related total score at 40 mg/day istradefylline (−0.25; −0.43 to −0.06; p = 0.01).</p></div><div><h3>Conclusions</h3><p>The data from this analysis of UPDRS-based motor subtypes suggest that istradefylline can improve motor disability in PD patients with motor fluctuations regardless of PD subtype. Future research should characterize the effects of istradefylline on tremor.</p></div>","PeriodicalId":33691,"journal":{"name":"Clinical Parkinsonism Related Disorders","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590112523000427/pdfft?md5=1b5486691ea6e1ca0cf0af0c693d21d5&pid=1-s2.0-S2590112523000427-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91957238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}