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Statistically and clinically significant cognitive declines are observed in a small subset of individuals with Parkinson's Disease (PD) following treatment with Deep Brain Stimulation (DBS).We examine the association between multi-domain cognitive decline (MCD) and demographic and baseline clinical variables and the incidence of serious adverse events (SAE) arising within a six-month interval following DBS for PD.Study participants with PD who displayed MCD at 6-month follow-up evaluation after DBS (n = 18) were contrasted with individuals with PD from the same study who did not show cognitive decline after DBS (n = 146). Logistic regression analyses were employed to assess relationship between predictors, including age (70 years old), pre-DBS cognitive screening test performance, SAE, and MCD. MCD+ and MCD-groups were also compared on other baseline clinical and demographic variables.MCD showed modest association with older age and lower baseline neurocognitive screening performance, whereas the groups did not differ on most other baseline clinical and demographic variables. SAEs during the study interval were the most robust predictor of MCD in the DBS group. A variety of SAEs were documented in study participants experiencing MCD after DBS surgery, including, but not limited to, infections and small intracranial hemorrhages.Older age and lower baseline cognition measured prior to treatment are associated with MCD measured at six-months after DBS. SAE occurring following DBS surgery are also predictive of MCD. These predictors may reflect aspects of "frailty" in advanced PD. Risk factors for SAE warrant careful consideration in clinical trials.

Recent estimates indicate that the lower Amazon River outgasses significant amounts of carbon dioxide (CO2) that was not previously accounted for the global inland water carbon budget. Detailed evaluation of seasonal variability and controlling mechanisms behind the CO2 fluxes in this large and complex area remains incomplete. Previous observations throughout the Amazon basin showed that higher CO2 fluxes (FCO2) and partial pressure of CO2 (pCO2) occur during high water and higher wind intensity seasons. The influence of wind and water speed, depth of water column, as well as respiration of allochthonous and autochthonous organic matter, are frequently assigned as the main control variables. Here, we assess the influence of a set of biogeochemical and hydrodynamic parameters on the seasonal variation of FCO2 and pCO2 near the Amazon River mouth. FCO2, pCO2 and biogeochemical and hydrologic analyses were carried out from 2010 to 2016 during four different hydrological periods per year (N = 25) in the North Channel of the Amazon River mouth. FCO2 and pCO2 were used as independent variables and analyzed against 33 biogeochemical, hydrodynamic and meteorological parameters along the hydrological seasons. The highest FCO2 and pCO2 was obtained at high discharge season (11.28 ± 7.82 μmol m−2 s−1 and (4575 ± 429 μatm, respectively) when most of these parameters tend to be higher. Among the 33 parameters analyzed, the significant correlations with FCO2 and pCO2 (p < 0.05) observed were for water and air temperatures, dissolved oxygen, dissolved organic carbon, nitrate, dissolved inorganic nitrogen and pH. These variables could be considered suitable predictors for estimating pCO2 and FCO2 in the Amazon River mouth area. For a better estimation and understanding of carbon budgets in tropical rivers it is still required to verify and to quantify more deeply the relationship among CO2 evasion and others hydrodynamic, meteorological and biogeochemical variables.

Here we present direct measurements of the biological breakdown of 13C-labeled substrates to CO2 at seven locations along the lower Amazon River, from Obidos to the mouth. Dark incubation experiments were performed at high and low water periods using vanillin, a lignin phenol derived from vascular plants, and at the high water period using four different 13C-labeled plant litter leachates. Leachates derived from oak wood were degraded most slowly with vanillin monomers, macrophyte leaves, macrophyte stems, and whole grass leachates being converted to CO2 1.2, 1.3, 1.7, and 2.3 times faster, respectively, at the upstream boundary, Obidos. Relative to Obidos, the sum degradation rate of all four leachates was 3.3 and 2.6 times faster in the algae-rich Tapajos and Xingu Rivers, respectively. Likewise, the leachates were broken down 3.2 times more quickly at Obidos when algal biomass from the Tapajos River was simultaneously added. Leachate reactivity similarly increased from Obidos to the mouth with leachates breaking down 1.7 times more quickly at Almeirim (midway to the mouth) and 2.8 times more quickly across the river mouth. There was no discernible correlation between in situ nutrient levels and remineralization rates, suggesting that priming effects were an important factor controlling reactivity along the continuum. Further, continuous measurements of CO2, O2, and conductivity along the confluence of the Tapajos and Amazon Rivers and the Xingu and Jaraucu Rivers revealed in situ evidence for enhanced O2 drawdown and CO2 production along the mixing zone of these confluences.

A large fraction of the organic carbon derived from land that is transported through inland waters is decomposed along river systems and emitted to the atmosphere as carbon dioxide (CO2). The Amazon River outgasses nearly as much CO2 as the rainforest sequesters on an annual basis, representing ~25% of global CO2 emissions from inland waters. However, current estimates of CO2 outgassing from the Amazon basin are based on a conservative upscaling of measurements made in the central Amazon, meaning both basin and global scale budgets are likely underestimated. The lower Amazon River, from Óbidos to the river mouth, represents ~13% of the total drainage basin area, and is not included in current basin-scale estimates. Here, we assessed the concentration and evasion rate of CO2 along the lower Amazon River corridor and its major tributaries, the Tapajós and Xingu Rivers. Evasive CO2 fluxes were directly measured using floating chambers and gas transfer coefficients (k600) were calculated for different hydrological seasons. Temporal variations in pCO2 and CO2 emissions were similar to previous observations throughout the Amazon (e.g., peak concentrations at high water) and CO2 outgassing was lower in the clearwater tributaries compared to the mainstem. However, k600-values were higher than previously reported upstream likely due to the generally windier conditions, turbulence caused by tidal forces, and an amplification of these factors in the wider channels with a longer fetch. We estimate that the lower Amazon River mainstem emits 20 Tg C year−1 within our study boundaries, or as much as 48 Tg C year−1 if the entire spatial extent to the geographical mouth is considered. Emissions from the Xingu and Tapajós lower tributaries contribute an additional 2.3 Tg C year−1. Including these values with updated basin scale estimates and estimates of CO2 outgassing from small streams we estimate that the Amazon running waters outgasses as much as 0.95 Pg C year−1, increasing the global emissions from inland waters by 15% for a total of 2.45 Pg C year−1. These results highlight the lower reaches of large rivers as a missing gap in basin-scale and global carbon budgets. In the case of the Amazon River, the previously unstudied tidally-influenced reaches contribute to 5% of CO2 emissions from the entire basin.

The Amazon River outgasses nearly an equivalent amount of CO2 as the rainforest sequesters on an annual basis due to microbial decomposition of terrigenous and aquatic organic matter. Most research performed in the Amazon has been focused on unraveling the mechanisms driving CO2 production since the recognition of a persistent state of CO2 supersaturation. However, although the river system is clearly net heterotrophic, the interplay between primary production and respiration is an essential aspect to understanding the overall metabolism of the ecosystem and potential transfer of energy up trophic levels. For example, an efficient ecosystem is capable of both decomposing high amounts of organic matter at lower trophic levels, driving CO2 emissions, and accumulating energy/biomass in higher trophic levels, stimulating fisheries production. Early studies found minimal evidence for primary production in the Amazon River mainstem and it has since been assumed that photosynthesis is strongly limited by low light penetration attributed to the high sediment load. Here, we test this assumption by measuring the stable isotopic composition of O2 (δ18O-O2) and O2 saturation levels in the lower Amazon River from Obidos to the river mouth and its major tributaries, the Xingu and Tapajos rivers, during high and low water periods. An oxygen mass balance model was developed to estimate the input of photosynthetic oxygen in the discrete reach from Obidos to Almeirim, midway to the river mouth. Based on the oxygen mass balance we estimate that primary production occurred at a rate of 0.39 ± 0.24 g O m3 d-1 at high water and 1.02 ± 0.55 g O m3 d-1 at low water. This translates to 41 ± 24% of the rate of O2 drawdown via respiration during high water and 67 ± 33% during low water. These primary production rates are 2-7 times higher than past estimates for the Amazon River mainstem. It is possible that at high water much of this productivity signal is the result of legacy advection from floodplains, whereas limited floodplain connectivity during low water implies that most of this signal is the result of in situ primary production in the Amazon River mainstem.

Background Deep brain stimulation (DBS) improves motor symptoms in Parkinson9s disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods Neuropsychological functioning was assessed in patients with Parkinson9s disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL. Trial registration number NCT00056563 and NCT01076452.