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Aitken CS, Samotus O, Naidu AS, Jog M, Patel RV. Force Control Issues in Upper and Lower Limbs in Parkinson's Disease and Freezing of Gait. IEEE Trans Neural Syst Rehabil Eng 2024; 32:577-586. [PMID: 38236671 DOI: 10.1109/tnsre.2024.3355429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Parkinson's Disease (PD) has been found to cause force control deficits in upper and lower limbs. About 50% of patients with advanced PD develop a debilitating symptom called freezing of gait (FOG), which has been linked to force control problems in the lower limbs, and some may only have a limited response to the gold standard pharmaceutical therapy, levodopa, resulting in partially levodopa-responsive FOG (PLR-FOG). There has been limited research on investigating upper-limb force control in people with PD with PLR-FOG, and without FOG. In this pilot study, force control was explored using an upper-and-lower-limb haptics-enabled robot in a reaching task while people with PD with and without PLR-FOG were on their levodopa medication. A healthy control group was used for reference, and each cohort completed the task at three different levels of assistance provided by the robot. Similar significant proportional force control deficits were found in the upper and lower limbs in patients with PLR-FOG versus those without FOG. Some aspects of force control were found to be retained, including an ability to increase or decrease force in response to changes in resistance while completing a reaching task. Overall, these results suggest there are force control deficits in both the upper and lower limbs in people with PLR-FOG.
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Witts EC, Mathews MA, Murray AJ. The locus coeruleus directs sensory-motor reflex amplitude across environmental contexts. Curr Biol 2023; 33:4679-4688.e3. [PMID: 37741282 PMCID: PMC10957397 DOI: 10.1016/j.cub.2023.08.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 09/25/2023]
Abstract
Purposeful movement across unpredictable environments requires quick, accurate, and contextually appropriate motor corrections in response to disruptions in balance and posture.1,2,3 These responses must respect both the current position and limitations of the body, as well as the surrounding environment,4,5,6 and involve a combination of segmental reflexes in the spinal cord, vestibulospinal and reticulospinal pathways in the brainstem, and forebrain structures such as the motor cortex.7,8,9,10 These motor plans can be heavily influenced by the animal's surrounding environment, even when that environment has no mechanical influence on the perturbation itself. This environmental influence has been considered as cortical in nature, priming motor responses to a perturbation.8,11 Similarly, postural responses can be influenced by environments that alter threat levels in humans.12,13,14,15,16,17,18 Such studies are generally in agreement with work done in the mouse showing that optogenetic stimulation of the lateral vestibular nucleus (LVN) only results in motor responses when the animal is on a balance beam at height and not when walking on the stable surface of a treadmill.10 In general, this ability to flexibly modify postural responses across terrains and environmental conditions is a critically important component of the balance system.19,20 Here we show that LVN-generated motor corrections can be altered by manipulating the surrounding environment. Furthermore, environmental influence on corrections requires noradrenergic signaling from the locus coeruleus, suggesting a potential link between forebrain structures that convey sensory information about the environment and brainstem circuits that generate motor corrections.
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Affiliation(s)
- Emily C Witts
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, W1T 4JG London, UK.
| | - Miranda A Mathews
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, W1T 4JG London, UK
| | - Andrew J Murray
- Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, W1T 4JG London, UK.
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Onder H, Korkmaz B, Comoglu S. Temporal Investigations of the Changes in Presynaptic Inhibition Associated With Subthalamic Nucleus-Deep-Brain Stimulation. J Clin Neurol 2023; 19:539-546. [PMID: 37488958 PMCID: PMC10622716 DOI: 10.3988/jcn.2022.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE There are controversies regarding the role of presynaptic inhibition (PSI) in the mechanisms underlying the efficacy of deep-brain stimulation (DBS) in Parkinson's disease (PD). We sought to determine the involvement of PSI in DBS-related mechanisms and clinical correlates. METHODS We enrolled PD subjects who had received subthalamic nucleus DBS (STN-DBS) therapy and had been admitted to our clinic between January 2022 and March 2022. The tibial H-reflex was studied bilaterally during the medication-off state, and all tests were repeated 10 and 20 minutes after the simulation was turned off. Simultaneous evaluations based on the Movement-Disorder-Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) were performed in all of the patients. RESULTS Ultimately we enrolled 18 patients aged 58.7±9.3 years (mean±standard deviation, 10 females). Fifty percent of the patients showed a decrease in the MDS-UPDRS-III score of more than 60% during the stimulation-on period. Comparative analyses of the repeated measurements made according to the stimulation status revealed significant differences only in the left H-reflex/M-response amplitude ratio (H/M ratio). However, no difference in the left H/M ratio was found in the subgroup of patients with a prominent clinical response to stimulation (n=9). Analyses of the less-affected side revealed differences in the H-reflex amplitude and H/M ratio. CONCLUSIONS We found evidence of PSI recovery on the less-affected side of our PD subjects associated with STN-DBS. We hypothesize that the involvement of this spinal pathway and its contribution to the mechanisms of DBS differ between individuals based on the severity of the disease and which brainstem regions and descending tracts are involved.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Bektas Korkmaz
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Jin C, Qi S, Yang L, Teng Y, Li C, Yao Y, Ruan X, Wei X. Abnormal functional connectivity density involvement in freezing of gait and its application for subtyping Parkinson's disease. Brain Imaging Behav 2023; 17:375-385. [PMID: 37243751 DOI: 10.1007/s11682-023-00765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/29/2023]
Abstract
The pathophysiological mechanisms at work in Parkinson's disease (PD) patients with freezing of gait (FOG) remain poorly understood. Functional connectivity density (FCD) could provide an unbiased way to analyse connectivity across the brain. In this study, a total of 23 PD patients with FOG (PD FOG + patients), 26 PD patients without FOG (PD FOG- patients), and 22 healthy controls (HCs) were recruited, and their resting-state functional magnetic resonance imaging (rs-fMRI) images were collected. FCD mapping was first performed to identify differences between groups. Pearson correlation analysis was used to explore relationships between FCD values and the severity of FOG. Then, a machine learning model was employed to classify each pair of groups. PD FOG + patients showed significantly increased short-range FCD in the precuneus, cingulate gyrus, and fusiform gyrus and decreased long-range FCD in the frontal gyrus, temporal gyrus, and cingulate gyrus. Short-range FCD values in the middle temporal gyrus and inferior temporal gyrus were positively correlated with FOG questionnaire (FOGQ) scores, and long-range FCD values in the middle frontal gyrus were negatively correlated with FOGQ scores. Using FCD in abnormal regions as input, a support vector machine (SVM) classifier can achieve classification with good performance. The mean accuracy values were 0.895 (PD FOG + vs. HC), 0.966 (PD FOG- vs. HC), and 0.897 (PD FOG + vs. PD FOG-). This study demonstrates that PD FOG + patients showed altered short- and long-range FCD in several brain regions involved in action planning and control, motion processing, emotion, cognition, and object recognition.
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Affiliation(s)
- Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Lei Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yueyang Teng
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Chen Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yudong Yao
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, Hoboken, USA
| | - Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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Chen Y, Wang H, Huang H, Chen Y, Xu Y. Freezing of gait in Chinese patients with multiple system atrophy: prevalence and risk factors. Front Neurosci 2023; 17:1194904. [PMID: 37351425 PMCID: PMC10282176 DOI: 10.3389/fnins.2023.1194904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Objective Freezing of gait (FOG) is common in neurodegenerative forms of atypical parkinsonism, but few studies have examined FOG in multiple system atrophy (MSA). In this study, we examined the prevalence of freezing of gait and its relationship to clinical features in a large cohort of Chinese MSA patients. Methods This exploratory study included 202 Chinese patients with probable MSA. FOG was defined as a score ≥ 1 on item 14 of the Unified Parkinson's Disease Rating Scale. Patients with or without FOG were compared in terms of the Unified MSA Rating Scale (UMSARS) as well as cognitive and neuropsychiatric assessments. Results The frequency of FOG was 48.0, 52.1, and 38.7% in MSA, MSA with predominant parkinsonism (MSA-P), and MSA with predominant cerebellar ataxia (MSA-C), respectively. FOG was associated with worse subscores on parts I, II and IV of the UMSARS as well as worse total UMSARS score; greater likelihood of speech difficulties, falls, gait impairment and balance disorder; more severe symptoms of anxiety and depression; and lower activities of daily living. The binary logistic regression model indicated that higher total UMSARS scores were associated with FOG in MSA, MSA-P, and MSA-C patients. Conclusion Freezing of gait may be common among Chinese MSA patients, FOG may correlate with severe motor symptoms, anxiety, depression and activities of daily living. Total UMSARS score may be an independent risk factor for FOG.
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Affiliation(s)
- Yalan Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zhu S, Wu Z, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Gait Analysis with Wearables Is a Potential Progression Marker in Parkinson's Disease. Brain Sci 2022; 12:1213. [PMID: 36138949 PMCID: PMC9497215 DOI: 10.3390/brainsci12091213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Gait disturbance is a prototypical feature of Parkinson's disease (PD), and the quantification of gait using wearable sensors is promising. This study aimed to identify gait impairment in the early and progressive stages of PD according to the Hoehn and Yahr (H-Y) scale. A total of 138 PD patients and 56 healthy controls (HCs) were included in our research. We collected gait parameters using the JiBuEn gait-analysis system. For spatiotemporal gait parameters and kinematic gait parameters, we observed significant differences in stride length (SL), gait velocity, the variability of SL, heel strike angle, and the range of motion (ROM) of the ankle, knee, and hip joints between HCs and PD patients in H-Y Ⅰ-Ⅱ. The changes worsened with the progression of PD. The differences in the asymmetry index of the SL and ROM of the hip were found between HCs and patients in H-Y Ⅳ. Additionally, these gait parameters were significantly associated with Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39. This study demonstrated that gait impairment occurs in the early stage of PD and deteriorates with the progression of the disease. The gait parameters mentioned above may help to detect PD earlier and assess the progression of PD.
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Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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Lv L, Zhang H, Tan X, Long Z, Qin L, Bai R, Xiao Q, Wu Z, Hu S, Tan C, Liao H, Yan W, Tang B, Ren F, Wang C. Associated factors and abnormal dorsal raphe nucleus connectivity patterns of freezing of gait in Parkinson's disease. J Neurol 2022; 269:6452-6466. [PMID: 35933494 DOI: 10.1007/s00415-022-11294-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), and its exact pathophysiological mechanism is still poorly understood. The control of gait is a complex process that may be influenced by emotions modulated by serotonergic networks. Therefore, this study aimed to determine factors associated with FOG in PD patients and to evaluate the importance of the dorsal raphe nucleus (DRN; central node in the serotoninergic system) in FOG pathophysiology. METHODS We combined cross-sectional survey data from 453 PD patients. According to the Freezing of Gait Questionnaire (FOGQ), patients were divided into two groups: the "PD with frozen gait (PD-FOG)" and "PD without frozen gait (PD-nFOG)" groups. Demographic characteristics, clinical features, and motor and nonmotor symptoms (NMS) assessments of PD patients were recorded. Univariate statistical analysis was performed between the two groups, and then regression analysis was performed on related factors. We also acquired resting-state functional MRI (rs-fMRI) data from 20 PD-FOG, 21 PD-nFOG, and 22 healthy controls (HCs) who were randomly chosen. We defined seeds in the DRN to evaluate functional connectivity (FC) patterns. RESULTS The overall frequency of FOG was 11.9% patients in the PD-FOG group were older, had a longer disease duration, had a higher levodopa equivalent daily dose, had more severe motor symptoms and worse quality of life, had a higher proportion of dyskinesia, wearing-off and postural instability/gait difficulty (PIGD) clinical phenotype, and experienced more depression and impaired sleep function than those in the PD-nFOG group. Logistic regression analysis showed that H&Ystage ≥ 3, UPDRS-III scores, PIGD clinical phenotype and excessive daytime sleepiness were associated with FOG. In addition, there was significantly lower FC between the DRN and some cortical structures, including the supplementary motor area (SMA), left superior frontal gyrus (SFG), and left median cingulated cortex (MCC) in PD-FOG patients than HCs and PD-nFOG patients. CONCLUSIONS These results demonstrate that the severity of PD and PIGD clinical phenotype are associated factors for freezing and that DRN dysfunction may play a key role in PD-related NMS and FOG. An abnormal cortical and brainstem networks may contribute to the mechanisms underlying FOG.
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Affiliation(s)
- Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Xuling Tan
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhe Long
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Rongrong Bai
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qile Xiao
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ziwei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shenglan Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haiyan Liao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weiqian Yan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Ren
- Department of Geriatric Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China.
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Closing the loop for patients with Parkinson disease: where are we? Nat Rev Neurol 2022; 18:497-507. [PMID: 35681103 DOI: 10.1038/s41582-022-00674-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Although levodopa remains the most efficacious symptomatic therapy for Parkinson disease (PD), management of levodopa treatment during the advanced stages of the disease is extremely challenging. This difficulty is a result of levodopa's short half-life, a progressive narrowing of the therapeutic window, and major inter-patient and intra-patient variations in the dose-response relationship. Therefore, a suitable alternative to repeated oral administration of levodopa is being sought. Recent research efforts have focused on the development of novel levodopa delivery strategies and wearable physical sensors that track symptoms and disease progression. However, the need for methods to monitor the levels of levodopa present in the body in real time has been overlooked. Advances in chemical sensor technology mean that the development of wearable and mobile biosensors for continuous or frequent levodopa measurements is now possible. Such levodopa monitoring could help to deliver personalized and timely medication dosing to alleviate treatment-related fluctuations in the symptoms of PD. Therefore, with the aim of optimizing therapeutic management of PD and improving the quality of life of patients, we share our vision of a future closed-loop autonomous wearable 'sense-and-act' system. This system consists of a network of physical and chemical sensors coupled with a levodopa delivery device and is guided by effective big data fusion algorithms and machine learning methods.
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Amboni M, Ricciardi C, Cuoco S, Donisi L, Volzone A, Ricciardelli G, Pellecchia MT, Santangelo G, Cesarelli M, Barone P. Mild Cognitive Impairment Subtypes Are Associated With Peculiar Gait Patterns in Parkinson's Disease. Front Aging Neurosci 2022; 14:781480. [PMID: 35299943 PMCID: PMC8923162 DOI: 10.3389/fnagi.2022.781480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Mild cognitive impairment (MCI) is frequent in Parkinson's disease (PD) and represents a risk factor for the development of dementia associated with PD (PDD). Since PDD has been associated with disability, caregiver burden, and an increase in health-related costs, early detection of MCI associated with PD (PD-MCI) and its biomarkers is crucial. Objective Given that gait is considered a surrogate marker for cognitive decline in PD, the aim of this study was to compare gait patterns in PD-MCI subtypes in order to verify the existence of an association between specific gait features and particular MCI subtypes. Methods A total of 67 patients with PD were consecutively enrolled and assessed by an extensive clinical and cognitive examination. Based on the neuropsychological examination, patients were diagnosed as patients with MCI (PD-MCI) and without MCI (no-PD-MCI) and categorized in MCI subtypes. All patients were evaluated using a motion capture system of a BTS Bioengineering equipped with six IR digital cameras. Gait of the patients was assessed in the ON-state under three different tasks (a single task and two dual tasks). Statistical analysis included the t-test, the Kruskal-Wallis test with post hoc analysis, and the exploratory correlation analysis. Results Gait pattern was poorer in PD-MCI vs. no-PD-MCI in all tasks. Among PD-MCI subtypes, multiple-domain PD-MCI and amnestic PD-MCI were coupled with worse gait patterns, notably in the dual task. Conclusion Both the magnitude of cognitive impairment and the presence of memory dysfunction are associated with increased measures of dynamic unbalance, especially in dual-task conditions, likely mirroring the progressive involvement of posterior cortical networks.
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Affiliation(s)
- Marianna Amboni
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
- Istituto di Diagnosi e Cura (IDC) Hermitage-Capodimonte, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Leandro Donisi
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Volzone
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Gianluca Ricciardelli
- Department of Medicine, Azienda Ospedaliera Universitaria OO. RR. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Telese Terme, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
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Xiang K, Liu Y, Sun L. Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery. Front Aging Neurosci 2022; 13:728799. [PMID: 35185512 PMCID: PMC8847709 DOI: 10.3389/fnagi.2021.728799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
The motoric cognitive risk (MCR) syndrome is a pre-dementia condition, marked by the enhanced risk for Alzheimer's disease (AD) and vascular dementia, together with falls, disability, and abnormal movements. The research studies revealed the distinct neurological and non-neurological clinical gait irregularities during dementia and accelerated functional decline, such as postural and balance impairments, memory loss, cognitive failure, and metabolic dysfunctions. The disabling characteristics of MCR comprise altered afferent sensory and efferent motor responses, together with disrupted visual, vestibular, and proprioceptive components. The pathological basis of MCR relates with the frontal lacunar infarcts, white matter hyperintensity (WMH), gray matter atrophy in the pre-motor and pre-frontal cortex, abnormal cholinergic functioning, inflammatory responses, and genetic factors. Further, cerebrovascular lesions and cardiovascular disorders exacerbate the disease pathology. The diagnosis of MCR is carried out through neuropsychological tests, biomarker assays, imaging studies, questionnaire-based evaluation, and motor function tests, including walking speed, dual-task gait tests, and ambulation ability. Recovery from MCR may include cognitive, physical, and social activities, exercise, diet, nutritional supplements, symptomatic drug treatment, and lifestyle habits that restrict the disease progression. Psychotherapeutic counseling, anti-depressants, and vitamins may support motor and cognitive improvement, primarily through the restorative pathways. However, an in-depth understanding of the association of immobility, dementia, and cognitive stress with MCR requires additional clinical and pre-clinical studies. They may have a significant contribution in reducing MCR syndrome and the risk for dementia. Overall, the current review informs the vital connection between gait performance and cognition in MCR and highlights the usefulness of future research in the discernment and treatment of dementiating illness.
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Characteristics of wearing-off and motor symptoms improved by safinamide adjunct therapy in patients with Parkinson's disease: A post hoc analysis of a Japanese phase 2/3 study. J Neurol Sci 2021; 434:120083. [PMID: 35007919 DOI: 10.1016/j.jns.2021.120083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) experience various motor and non-motor symptoms. We conducted a post hoc analysis of a Japanese phase 2/3 study of safinamide (50 or 100 mg/day) in patients with Parkinson's disease and wearing-off to evaluate response according to background factors. Safinamide efficacy against major motor symptoms was also assessed. METHODS Multiple regression analyses in safinamide-treated patients (50 or 100 mg/day) assessed changes in daily ON-time without troublesome dyskinesia (hereafter referred to as ON-time) according to baseline clinical variables. Subgroup analyses by baseline Unified Parkinson's Disease Rating Scale (UPDRS) part III score were also conducted. We evaluated cardinal motor symptoms using the UPDRS. RESULTS In the multiple regression analysis, changes in ON-time were related to baseline non-motor symptoms (UPDRS part I score) and ON-time in the 50-mg group, but no relationships with non-motor symptoms were observed in the 100-mg group. Additionally, in the subgroup analysis of patients with more severe motor symptoms (UPDRS part III score > 20), a significant improvement in ON-time was observed only with 100 mg/day (p = 0.01). At both doses, safinamide significantly improved cardinal motor symptom scores (bradykinesia, rigidity, tremor, axial symptoms, and gait disturbances). CONCLUSIONS The observed response profile to the 50-mg/day dose may be related to baseline non-motor symptoms, but this was not true for the 100-mg/day dose. Both safinamide doses improved major motor symptoms in levodopa-treated patients with PD.
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Jiang L, Chen W, Guo Q, Yang C, Gu J, Xian W, Liu Y, Zheng Y, Ye J, Xu S, Hu Y, Wu L, Chen J, Qian H, Fu X, Liu J, Chen L. Eight-year follow-up outcome of subthalamic deep brain stimulation for Parkinson's disease: Maintenance of therapeutic efficacy with a relatively low levodopa dosage and stimulation intensity. CNS Neurosci Ther 2021; 27:1366-1373. [PMID: 34350691 PMCID: PMC8504521 DOI: 10.1111/cns.13713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS This follow-up study aimed to examine the 8-year efficacy and safety of subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with Parkinson's disease (PD) in southern China. METHODS The follow-up data of 10 patients with PD undergoing STN-DBS were analyzed. Motor symptoms were assessed before and 1, 3, 5, and 8 years after the surgery with stimulation-on in both off-medication (off-med) and on-medication (on-med) status using the Unified Parkinson's disease Rating Scale Part III. The quality of life was assessed using the 39-item Parkinson's Disease Questionnaire. The sleep, cognition, and emotion were evaluated using a series of nonmotor scales. Levodopa equivalent daily dose (LEDD) and stimulation parameters were recorded at each follow-up. RESULTS The motor symptoms were improved by 50.9%, 37.7%, 36.7%, and 37.3% in 1, 3, 5, and 8 years, respectively, in the off-med / stimulation-on status compared with the baseline. The quality of life improved by 39.7% and 56.1% in 1 and 3 years, respectively, but declined to the preoperative level thereafter. The sleep, cognition, and emotion were mostly unchanged. LEDD reduced from 708.1 ± 172.5 mg to 330 ± 207.8 mg in 8 years. The stimulation parameters, including amplitude, pulse width, and frequency, were 2.77 ± 0.49 V, 71.3 ± 12.8 μs, and 121.5 ± 21 Hz, respectively, in 8 years. CONCLUSION Long-term therapeutic efficacy of STN-DBS could be achieved even with relatively low stimulation intensity and medication dosage for PD patients in southern China. Motor improvement and medication reduction were maintained through the 8-year follow-up, but improvement in quality of life lasted for only 3 years. No definite changes was found in nonmotor symptoms after STN-DBS.
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Affiliation(s)
- Lulu Jiang
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanru Chen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiyu Guo
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chao Yang
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenbiao Xian
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanmei Liu
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yifan Zheng
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Ye
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaohua Xu
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Hu
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Wu
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Chen
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Qian
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Fu
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinlong Liu
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ling Chen
- Department of Neurology, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Analysis of Gait for Disease Stage in Patients with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020720. [PMID: 33467634 PMCID: PMC7830506 DOI: 10.3390/ijerph18020720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
Understanding the motor patterns underlying the movement of individuals with Parkinson's disease (PD) is fundamental to the effective targeting of non-pharmacological therapies. This study aimed to analyze the gait pattern in relation to the evolutionary stages I-II and III-IV according to the Hoehn and Yahr (H&Y) scale in individuals affected by PD. The study was conducted with the participation of 37 PD patients with a mean age of 70.09 ± 9.53 years, and of whom 48.64% were women. The inclusion criteria were (1) to be diagnosed with PD; (2) to be in an evolutionary stage of the disease between I and IV: and (3) to be able to walk independently and without any assistance. Kinematic and spatial-temporal parameters of the gait were analyzed. The results showed differences in speed of movement, cadence, stride length, support duration, swing duration, step width, walking cycle duration, and double support time between the stages analyzed. These results confirmed the differences in PD gait pattern between stages I-II and III-IV. Different behaviors of the same variable were recorded depending on whether the right or left side was affected by PD.
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Saeedi Y, Ghadimi M, Rohani M, Emamikhah M, Shahidi G, Moghaddasi M, Habibi SAH. Impact of anticholinergic drugs withdrawal on motor function in patients with Parkinson's disease. Clin Neurol Neurosurg 2021; 202:106480. [PMID: 33503509 DOI: 10.1016/j.clineuro.2021.106480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Physicians have prescribed anticholinergic agents as monotherapy or adjuvant therapy in patients with Parkinson's disease for decades. However, these medications can cause many adverse effects including gait freezing and falling. Herein we assessed the effects of anticholinergic medications on motor function, freezing of gait and falling in a group of patients with PD. PATIENTS AND METHODS This prospective study evaluated the effect of gradual discontinuation of anticholinergics on motor function in 131 outpatients with Parkinson's disease. We assessed patients' motor function at baseline six and twelve months later using the UPDRS-III. We also evaluated freezing of gait and falling in patients using UPDRS-II part 14 and 13 respectively. The anticholinergics were tapered and gradually discontinued and additional levodopa doses were added as patients needed. RESULTS 131patients successfully discontinued their anticholinergic medications. Stopping anticholinergics significantly improved the motor symptoms in PD patients as reflected in the change between the mean (±SD) UPDRS-III score of 36.85(±11.5) at the baseline to 32.51(±11.4) and 31.43 (±11.3) after six and twelve months (P < 0.001). The mean (±SD) scores of freezing of gait (FOG)significantly changed from 1.34(±1) to 1.17(±1) and 0.6(±0.7) and for falling down from 0.62(±0.8) to 0.5 (±0.8) and 0.29(±0.5) respectively (p-value of <0.001). CONCLUSION Our finding demonstrated an improvement in motor function and FOG and falling incidences in PD patients, after discontinuation of anticholinergic drugs. As motor complications adversely affect the quality of life in PD patients, clinicians must be careful with the unnecessary use of anticholinergic drugs in their treatment strategies.
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Affiliation(s)
- Yasaman Saeedi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghadimi
- Department of Radiology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran; Skull Base Research Center, Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Emamikhah
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghaddasi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hassan Habibi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.
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K channel blockage with 3,4-diaminopyridine potentiates the effect of L-DOPA on dopamine release in striatal slices prepared from 6-OHDA pre-treated rats. Exp Brain Res 2020; 238:2539-2548. [PMID: 32870323 DOI: 10.1007/s00221-020-05912-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022]
Abstract
Although L-DOPA revolutionized in the treatment of Parkinson's disease, most patients developed motor complications after several years of treatment. Adjunctive therapy to L-DOPA with drugs related to dopaminergic signaling may reduce its dose without decreasing the therapeutic efficiency and thus ameliorates its adverse effects. It has been shown that 3,4-diaminopyridine (3,4-DAP), a K channel blocker, increased dopamine release from striatal slices by increasing neuronal firing in striatal dopaminergic terminals. The current study investigates whether 3,4-DAP may enhance L-DOPA-induced dopamine (DA) release from striatal slices by increasing neuronal firing in striatal dopaminergic terminals. The effects of L-DOPA and 3,4-DAP on spontaneous DA and DOPAC release were tested in vitro, on acute rat striatal slices prepared from non-treated and 6-hydroxydopamine-pre-treated rats. DA and DOPAC levels were determined by HPLC methods. When 3,4-diaminopyridine was combined with L-DOPA, the observed effect was considerably greater than the increases induced by L-DOPA or 3,4-DAP alone in normoxic and neurodegenerative conditions produced by FeSO4 and 6-hydroxydopamine. Furthermore, L-DOPA plus 3,4-DAP also ameliorated DOPAC levels in neurodegenerative conditions. These data indicate that 3,4 DAP plus L-DOPA activates striatal dopaminergic terminals by increasing the DA release and, thus, could be considered as a promising finding in treatment of acute and chronic injury in dopaminergic neurons.
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Funao H, Isogai N, Ishii K. The potential efficacy of serotonin noradrenaline reuptake inhibitor duloxetine in dropped head syndrome: A case report and review of the literature. Heliyon 2020; 6:e04774. [PMID: 32885085 PMCID: PMC7452494 DOI: 10.1016/j.heliyon.2020.e04774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
A 78 year-old female presented with dropped head syndrome (DHS). Three months before her initial visit to our hospital, the patient noticed a pronounced flexion of her head and neck with subsequent deterioration of symptoms, which included neck pain, difficulty with forward gaze, and gait disturbance. Cervical radiographs demonstrated scoliotic and kyphotic changes, and her symptom deteriorated over time, especially in the standing position. Duloxetine was administered for her low back pain because nonsteroidal anti-inflammatory drugs deemed ineffective. The patient demonstrated marked improvements in both radiographic and clinical appearances after 4 months. Her neck pain decreased from 8 to 2 out of 10 in the Numeric Rating Scale, and her symptoms such as difficulty with forward gaze and gait disturbance had also resolved. Duloxetine is a serotonin noradrenaline reuptake inhibitor that is usually used for chronic musculoskeletal pain, neuropathic pain, or depression. In this report, we present another potential application of duloxetine in the treatment of DHS. The following possibilities were considered for the improved outcomes: (1) pain relief may have helped the patient feel comfortable enough to move her neck, and (2) we suppose that serotonin and noradrenaline reuptake may contribute to the improvement of DHS, because there might be a potential disequilibrium of neurotransmitters such as serotonin, dopamine and noradrenaline in DHS patients. Although further investigation is needed to clarify the mechanism, duloxetine should be considered as one of the optional treatments for DHS.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Japan.,Spine and Spinal Cord Center, IUHW Mita Hospital, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Japan.,Spine and Spinal Cord Center, IUHW Mita Hospital, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Japan.,Spine and Spinal Cord Center, IUHW Mita Hospital, Japan
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17
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Guo S, Li J, Zhang Y, Li Y, Zhuang P. Optimal target localisation and eight-year outcome for subthalamic stimulation in patients with Parkinson's disease. Br J Neurosurg 2020; 35:151-156. [PMID: 32532160 DOI: 10.1080/02688697.2020.1775786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a useful therapy to improve motor functions and reduce dependence on medication in patients with Parkinson's disease (PD). The purpose of the study is to assess the long-term clinical outcomes of STN-DBS and to determine the optimal placement of electrodes that for the most positive outcomes. METHODS A consecutive series of 42 PD patients were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) before and after STN-DBS lead implantation. Postoperatively, patients were evaluated during both the medication 'ON' period (medication suppressed symptoms) and the medication 'OFF' period (when medication failed to suppress symptoms), and the results were compared to the baseline values prior to surgery. Follow-up assessments, focusing on motor functions, were performed 1, 3, 5, and 8 years after the initial implantation surgery. The locations of electrodes were measured and compared against the clinical outcomes. RESULTS STN-DBS remarkably improved the UPDRS-II, -III, and -IV dyskinesia and motor fluctuation scores in the OFF-medication condition when compared to baseline values. In addition, the dose of levodopa needed to elicit an effect declined sharply in the OFF-medication condition. Over time, the axial signs progressively worsened even with continuous stimulation and a levodopa response. The location of electrodes correlated with the most beneficial outcomes was the dorsal STN margin. CONCLUSIONS Our results confirm that overall, stimulation-induced motor improvement is still evident after 8 years. However, the primary best outcome declines with the progressive loss of favourable axial signs.
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Affiliation(s)
- Song Guo
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Jianyu Li
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yuqing Zhang
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yongjie Li
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Ping Zhuang
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
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Hirata K, Hattori T, Kina S, Chen Q, Ohara M, Yokota T. Striatal Dopamine Denervation Impairs Gait Automaticity in Drug‐Naïve Parkinson's Disease Patients. Mov Disord 2020; 35:1037-1045. [DOI: 10.1002/mds.28024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kosei Hirata
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Satoko Kina
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Masahiro Ohara
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
| | - Takanori Yokota
- Department of Neurology and Neurological ScienceGraduate School of Medical and Dental Sciences and Center for Brain Integration Research, Tokyo Medical and Dental University Tokyo Japan
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Ferrazzoli D, Ortelli P, Cucca A, Bakdounes L, Canesi M, Volpe D. Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease. Neurodegener Dis Manag 2020; 10:41-55. [PMID: 32039653 DOI: 10.2217/nmt-2019-0025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.
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Affiliation(s)
- Davide Ferrazzoli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Paola Ortelli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY 10017, USA
| | - Leila Bakdounes
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| | - Margherita Canesi
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
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20
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Ortelli P, Ferrazzoli D, Cian V, Zarucchi M, Palamara G, Giobbia A, Frazzitta G, Maestri R, Canesi M. How Cognition and Motivation "Freeze" the Motor Behavior in Parkinson's Disease. Front Neurosci 2019; 13:1302. [PMID: 31866812 PMCID: PMC6909398 DOI: 10.3389/fnins.2019.01302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/20/2019] [Indexed: 01/30/2023] Open
Abstract
Objective Freezing of gait (FoG) is a debilitating problem in patients with PD. The multifactorial pathogenesis of FoG remains poorly understood. We aimed to find which factors are most strongly associated with the occurrence of FoG. Methods Three hundred five PD patients were enrolled and subdivided according to the presence (FoG +, n = 128) or absence (FoG-, n = 177) of FoG. Several clinical, functional, and neuropsychological data were collected and compared between groups. The association between the probability of presence of FoG and possible explanatory variables was assessed by logistic regression analysis. Results FoG + patients were younger at the diagnosis (p = 0.04), and their mean daily dose of dopaminergic drugs (p < 0.0001) was higher in comparison with FoG- patients. FoG + patients get worse in Frontal Assessment Battery (p = 0.005), had higher scores in Apathy Evaluation Scale (p = 0.03), and were much more impaired on Wisconsin Card Sorting Test (WCST) (p = 0.018), Trail Making Test A (p = 0.0013), and Ray Auditory Verbal Learning Test (p = 0.012). Levodopa equivalent dose, age (direct), age at disease onset (inverse), and WCST were significant predictors of FoG (p = 0.01, p = 0.0025, p = 0.0016, and p = 0.029, respectively). Conclusion FoG + patients show more deficits in executive functions and in motivation. The main explanatory variables of FoG occurrence are levodopa equivalent dose, age, age at disease onset, and WCST. These data suggest that a specific involvement of frontal cortical circuits in PD is responsible for certain cognitive–behavioral alterations related to the occurrence of FoG.
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Affiliation(s)
- Paola Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
| | - Davide Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
| | - Veronica Cian
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy.,School of Specialization in Neuropsychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marianna Zarucchi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
| | - Grazia Palamara
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
| | - Alessandro Giobbia
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
| | | | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri IRCCS SpA SB, Pavia, Italy
| | - Margherita Canesi
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Como, Italy
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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Mei S, Li J, Middlebrooks EH, Almeida L, Hu W, Zhang Y, Ramirez-Zamora A, Chan P. New Onset On-Medication Freezing of Gait After STN-DBS in Parkinson's Disease. Front Neurol 2019; 10:659. [PMID: 31275238 PMCID: PMC6593871 DOI: 10.3389/fneur.2019.00659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
Freezing of gait (FoG) is commonly observed in advanced Parkinson's disease (PD) and it is associated with reduced mobility, recurrent falls, injuries, and loss of independence. This phenomenon typically occurs as the effect of dopaminergic medications wears off (“off” FoG) but on rare occasions, it can also be observed during peak medication effect (“on” FoG). In this report, we present the case of a 65-year-old female with a 13-year history of akinetic-rigid idiopathic PD who developed recurrent episodes of “on” FoG after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). She underwent STN-DBS for management of motor fluctuations, which resulted in a marked improvement in her motor symptoms. Within the next 6 months and after several programming sessions, the patient reported “on” FoG occurring regularly 1 h after taking levodopa and lasting a few hours. Accordingly, a repeated levodopa challenge showed that FoG resolved with either levodopa administration or STN stimulation alone, but the combination of both therapies induced recurrence of FoG in our patient. Subsequent management was complex requiring adjustments in levodopa dose and formulation along with advanced DBS programming.
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Affiliation(s)
- Shanshan Mei
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiping Li
- Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Leonardo Almeida
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Wei Hu
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Yuqing Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
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23
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Filonova GE, Nikolaevskaya EN, Kansuzyan AV, Krylova IV, Egorov MP, Jouikov VV, Syroeshkin MA. Antioxidant Properties of Adrenaline in the Presence of Ge-132. European J Org Chem 2019. [DOI: 10.1002/ejoc.201900331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Galina E. Filonova
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
- I.M. Sechenov First Moscow State Medical University; Bolshaya Pirogovskaya 2 119435 Moscow Russian Federation
| | - Elena N. Nikolaevskaya
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
| | - Artem V. Kansuzyan
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
- UMR CNRS 6226 ISCR; University of Rennes 1; 35042 Rennes France
| | - Irina V. Krylova
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
| | - Mikhail P. Egorov
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
| | | | - Mikhail A. Syroeshkin
- N.D. Zelinsky Institute of Organic Chemistry; Russian Academy of Sciences; Leninsky Prospect, 47 119991 Moscow Russian Federation
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24
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Iijima M, Orimo S, Terashi H, Suzuki M, Hayashi A, Shimura H, Mitoma H, Kitagawa K, Okuma Y. Efficacy of istradefylline for gait disorders with freezing of gait in Parkinson's disease: A single-arm, open-label, prospective, multicenter study. Expert Opin Pharmacother 2019; 20:1405-1411. [PMID: 31039621 DOI: 10.1080/14656566.2019.1614167] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Gait disorders are common in Parkinson's disease patients who respond poorly to dopaminergic treatment. Blockade of adenosine A2A receptors is expected to improve gait disorders. Istradefylline is a first-in-class selective adenosine A2A receptor antagonist with benefits for motor complications associated with Parkinson's disease. Research design and methods: This multicenter, open-label, single-group, prospective interventional study evaluated changes in total gait-related scores of the Part II/III Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Freezing of Gait Questionnaire (FOG-Q) in 31 Parkinson's disease patients treated with istradefylline. Gait analysis by portable gait rhythmogram was performed. Results: MDS-UPDRS Part III gait-related total scores significantly decreased at Weeks 4-12 from baseline with significant improvements in gait, freezing of gait, and postural stability. Significant decreases in MDS-UPDRS Part II total scores and individual item scores at Week 12 indicated improved daily living activities. At Week 12, there were significant improvements in FOG-Q, new FOG-Q, and overall movement per 48 h measured by portable gait rhythmogram. Adverse events occurred in 7/31 patients. Conclusions: Istradefylline improved gait disorders in Parkinson's disease patients complicated with freezing of gait, improving their quality of life. No unexpected adverse drug reactions were identified. Trial registration: UMIN-CTR (UMIN000020288).
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Affiliation(s)
- Mutsumi Iijima
- a Department of Neurology , Tokyo Women's Medical University , Tokyo , Japan
| | - Satoshi Orimo
- b Department of Neurology , Kanto Central Hospital , Tokyo , Japan
| | - Hiroo Terashi
- c Department of Neurology , Tokyo Medical University , Tokyo , Japan
| | - Masahiko Suzuki
- d Department of Neurology , Katsushika Medical Center, The Jikei University School of Medicine , Tokyo , Japan
| | - Akito Hayashi
- e Department of Rehabilitation , Juntendo University Urayasu Hospital , Urayasu , Japan
| | - Hideki Shimura
- f Department of Neurology , Juntendo University Urayasu Hospital , Urayasu , Japan
| | - Hiroshi Mitoma
- g Department of Medical Education , Tokyo Medical University , Tokyo , Japan
| | - Kazuo Kitagawa
- a Department of Neurology , Tokyo Women's Medical University , Tokyo , Japan
| | - Yasuyuki Okuma
- h Department of Neurology , Juntendo University Shizuoka Hospital , Izunokuni , Japan
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25
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Sawada M, Wada-Isoe K, Hanajima R, Nakashima K. Clinical features of freezing of gait in Parkinson's disease patients. Brain Behav 2019; 9:e01244. [PMID: 30851088 PMCID: PMC6456785 DOI: 10.1002/brb3.1244] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To clarify the clinical features of freezing of gait (FOG) in Parkinson's disease (PD) patients by classification into two groups: Clinically observed FOG (CFOG) and self-reported FOG (SFOG). METHODS Two hundred twenty-nine PD patients were medically examined in an examination room as well as subjected to a New Freezing of Gait Questionnaire (NFOG-Q) and analysis of nonmotor symptoms including sleep, cognition, depression, and fatigue. RESULTS The prevalence of CFOG was 17.9%, while 53.7% of the patients without CFOG reported the presence of FOG via the NFOG-Q. Univariate analysis revealed that CFOG was associated with longer disease duration, motor dysfunction, sleepiness, fatigue, and cognitive dysfunction. These symptoms, excluding akinesia, apathy, rapid eye movement (REM) sleep Behavior Disorder, and cognitive dysfunction, were also associated with SFOG. Multivariate analysis revealed that long PD duration, postural instability, and gait difficulty (PIGD), along with fatigue, were independent factors for SFOG. CONCLUSIONS SFOG and CFOG have many common clinical features. Although the clinical relevance of SFOG remains unclear, careful attention should be paid to related features in clinical practice.
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Affiliation(s)
- Makoto Sawada
- Division of Rehabilitation, National Hospital Organization Tottori Medical Center, Tottori, Japan.,Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kenji Wada-Isoe
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kenji Nakashima
- National Hospital Organization Matsue Medical Center, Matue, Japan
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26
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Banks SJ, Bayram E, Shan G, LaBelle DR, Bluett B. Non-motor predictors of freezing of gait in Parkinson's disease. Gait Posture 2019; 68:311-316. [PMID: 30553992 PMCID: PMC6773271 DOI: 10.1016/j.gaitpost.2018.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/25/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The etiology of freezing of gait in Parkinson's disease (PD) is yet to be clarified. Non-motor risk factors including cognitive impairment, sleep disturbance and mood disorders have been shown in freezing of gait. RESEARCH QUESTION We aimed to determine the predictive value of non-motor features in freezing of gait development. METHODS Data were obtained from the Parkinson's Progression Markers Initiative. Fifty PD patients with self-reported freezing of gait, and 50 PD patients without freezing of gait at the fourth year visit were included. Groups were matched for Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III scores. Several cognitive and non-cognitive tests were used for non-motor features at baseline and over time. Executive function, visuospatial function, processing speed, learning and memory tests were used for cognition. Non-cognitive tests included sleepiness, REM sleep behavior disorder, depression and anxiety scales. RESULTS Patients with freezing of gait had higher scores on sleepiness, REM sleep behavior disorder, depression and anxiety scales. However, predictor model analysis revealed that baseline processing speed, learning and sleepiness scores were predictive of self-reported freezing of gait development over time. SIGNIFICANCE Our findings suggest that specific cognitive deficits and sleep disorders are predictive of future freezing of gait. These features may be helpful in identifying underlying networks in freezing of gait and should be further investigated with neuroimaging studies.
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Affiliation(s)
- Sarah J Banks
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Ece Bayram
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
| | - Guogen Shan
- Epidemiology and Biostatistics Program, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Denise R LaBelle
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
| | - Brent Bluett
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA; Department of Neurology and Neurological Sciences, Stanford University, USA.
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27
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Parmentier É, De Pasqua V, D'Ostilio K, Depierreux F, Garraux G, Maertens de Noordhout A. Correlation between deep brain stimulation effects on freezing of gait and audio-spinal reflex. Clin Neurophysiol 2018; 129:2083-2088. [PMID: 30077869 DOI: 10.1016/j.clinph.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A network of cortical, subcortical and brainstem structures might be involved in freezing of gait (FOG). Subthalamic nucleus (STN) deep brain stimulation (DBS) could modulate this network. The audio-spinal reflex (ASR), reduced in PD, but increased by treatment, can be used to further investigate that locomotor network. The aim of this study is to find whether a correlation exists between ASR and FOG in PD patients under DBS. METHODS In 14 PD patients with STN DBS and previous FOG, ASR was recorded, with DBS switched on and off. We also assessed FOG Questionnaire (FOGQ) and Unified Parkinson's Disease Rating Scale (UPDRS) Part III. RESULTS Switching "on" DBS increased ASR amplitude (+ 33.2% with DBS ON, p = 0.048). We also found a significant inverse correlation between FOGQ and modulation of ASR by DBS (r = -0.59, r2 = 0.35, p < 0.05). CONCLUSIONS This study shows that the incremental effect of DBS on ASR is greater in PD patients with less severe FOG. SIGNIFICANCE This study shows a link between electrophysiological and clinical data about gait control. It might contribute to better understand why some DBS patients report heavy FOG and others do not. ASR might be used to evaluate or maybe predict the effect of stimulation parameters changes on FOG.
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Affiliation(s)
- Éric Parmentier
- Neurology Department, Centre Hospitalier Universitaire, Liège, Belgium; Cyclotron Research Centre, University of Liège, Belgium.
| | - Victor De Pasqua
- Neurology Department, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Kévin D'Ostilio
- Neurology Department, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Frédérique Depierreux
- Neurology Department, Centre Hospitalier Universitaire, Liège, Belgium; Cyclotron Research Centre, University of Liège, Belgium
| | - Gaëtan Garraux
- Neurology Department, Centre Hospitalier Universitaire, Liège, Belgium; Cyclotron Research Centre, University of Liège, Belgium
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28
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Perugini A, Ditterich J, Shaikh AG, Knowlton BJ, Basso MA. Paradoxical Decision-Making: A Framework for Understanding Cognition in Parkinson's Disease. Trends Neurosci 2018; 41:512-525. [PMID: 29747856 PMCID: PMC6124671 DOI: 10.1016/j.tins.2018.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022]
Abstract
People with Parkinson's disease (PD) show impaired decision-making when sensory and memory information must be combined. This recently identified impairment results from an inability to accumulate the proper amount of information needed to make a decision and appears to be independent of dopamine tone and reinforcement learning mechanisms. Although considerable work focuses on PD and decisions involving risk and reward, in this Opinion article we propose that the emerging findings in perceptual decision-making highlight the multisystem nature of PD, and that unraveling the neuronal circuits underlying perceptual decision-making impairment may help in understanding other cognitive impairments in people with PD. We also discuss how a decision-making framework may be extended to gain insights into mechanisms of motor impairments in PD.
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Affiliation(s)
- Alessandra Perugini
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences, Department of Neurobiology, Semel Institute for Neuroscience and Human Behavior, Brain Research Institute, The David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jochen Ditterich
- Center for Neuroscience and Department of Neurobiology, Physiology, and Behavior, University of California, Davis, CA, USA
| | - Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Barbara J Knowlton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michele A Basso
- Fuster Laboratory of Cognitive Neuroscience, Department of Psychiatry and Biobehavioral Sciences, Department of Neurobiology, Semel Institute for Neuroscience and Human Behavior, Brain Research Institute, The David Geffen School of Medicine, Los Angeles, CA 90095, USA.
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29
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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30
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Faggiani E, Naudet F, Janssen ML, Temel Y, Benazzouz A. Serotonergic neurons mediate the anxiolytic effect of l -DOPA: Neuronal correlates in the amygdala. Neurobiol Dis 2018; 110:20-28. [DOI: 10.1016/j.nbd.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
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Suppa A, Kita A, Leodori G, Zampogna A, Nicolini E, Lorenzi P, Rao R, Irrera F. l-DOPA and Freezing of Gait in Parkinson's Disease: Objective Assessment through a Wearable Wireless System. Front Neurol 2017; 8:406. [PMID: 28855889 PMCID: PMC5557738 DOI: 10.3389/fneur.2017.00406] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/28/2017] [Indexed: 01/21/2023] Open
Abstract
Freezing of gait (FOG) is a leading cause of falls and fractures in Parkinson’s disease (PD). The episodic and rather unpredictable occurrence of FOG, coupled with the variable response to l-DOPA of this gait disorder, makes the objective evaluation of FOG severity a major clinical challenge in the therapeutic management of patients with PD. The aim of this study was to examine and compare gait, clinically and objectively, in patients with PD, with and without FOG, by means of a new wearable system. We also assessed the effect of l-DOPA on FOG severity and specific spatiotemporal gait parameters in patients with and without FOG. To this purpose, we recruited 28 patients with FOG, 16 patients without FOG, and 16 healthy subjects. In all participants, gait was evaluated clinically by video recordings and objectively by means of the wearable wireless system, during a modified 3-m Timed Up and Go (TUG) test. All patients performed the modified TUG test under and not under dopaminergic therapy (ON and OFF therapy). By comparing instrumental data with the clinical identification of FOG based on offline video-recordings, we also assessed the performance of the wearable system to detect FOG automatically in terms of sensitivity, specificity, positive and negative predictive values, and finally accuracy. TUG duration was longer in patients than in controls, and the amount of gait abnormalities was prominent in patients with FOG compared with those without FOG. l-DOPA improved gait significantly in patients with PD and particularly in patients with FOG mainly by reducing FOG duration and increasing specific spatiotemporal gait parameters. Finally, the overall wireless system performance in automatic FOG detection was characterized by excellent sensitivity (93.41%), specificity (98.51%), positive predictive value (89.55%), negative predictive value (97.31%), and finally accuracy (98.51%). Our study overall provides new information on the beneficial effect of l-DOPA on FOG severity and specific spatiotemporal gait parameters as objectively measured by a wearable sensory system. The algorithm here reported potentially opens to objective long-time sensing of FOG episodes in patients with PD.
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Affiliation(s)
- Antonio Suppa
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed Institute, Pozzilli, Italy
| | - Ardian Kita
- Department of Information Engineering, Electronics and Telecommunication, Sapienza University of Rome, Rome, Italy
| | - Giorgio Leodori
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Alessandro Zampogna
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ettore Nicolini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Paolo Lorenzi
- Department of Information Engineering, Electronics and Telecommunication, Sapienza University of Rome, Rome, Italy
| | - Rosario Rao
- Department of Information Engineering, Electronics and Telecommunication, Sapienza University of Rome, Rome, Italy
| | - Fernanda Irrera
- Department of Information Engineering, Electronics and Telecommunication, Sapienza University of Rome, Rome, Italy
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Tien LT, Lee YJ, Pang Y, Lu S, Lee JW, Tseng CH, Bhatt AJ, Savich RD, Fan LW. Neuroprotective Effects of Intranasal IGF-1 against Neonatal Lipopolysaccharide-Induced Neurobehavioral Deficits and Neuronal Inflammation in the Substantia Nigra and Locus Coeruleus of Juvenile Rats. Dev Neurosci 2017; 39:443-459. [PMID: 28787734 PMCID: PMC5799046 DOI: 10.1159/000477898] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/30/2017] [Indexed: 01/29/2023] Open
Abstract
Neonatal lipopolysaccharide (LPS) exposure-induced brain inflammation resulted in motor dysfunction and brain dopaminergic neuronal injury, and increased the risks of neurodegenerative disorders in adult rats. Our previous studies showed that intranasal administration of insulin-like growth factor-1 (IGF-1) protects against LPS-induced white matter injury in the developing rat brain. To further examine whether IGF-1 protects against LPS-induced brain neuronal injury and neurobehavioral dysfunction, recombinant human IGF-1 (rhIGF-1) at a dose of 50 µg/pup was administered intranasally 1 h following intracerebral injection of LPS (1 mg/kg) in postnatal day 5 (P5) Sprague-Dawley rat pups. Neurobehavioral tests were carried out from P7 to P21, and brain neuronal injury was examined at P21. Our results showed that LPS exposure resulted in disturbances of motor behaviors in juvenile rats. Moreover, LPS exposure caused injury to central catecholaminergic neurons, as indicated by a reduction of tyrosine hydroxylase (TH) immunoreactivity in the substantia nigra (SN), ventral tegmental area (VTA) and olfactory bulb (OB), and brain noradrenergic neurons, as indicated by a reduction of TH immunoreactivity in the locus coeruleus (LC) of the P21 rat brain. The LPS-induced reduction of TH+ cells was observed at a greater degree in the SN and LC of the P21 rat brain. Intranasal rhIGF-1 treatment attenuated LPS-induced central catecholaminergic neuronal injury and motor behavioral disturbances, including locomotion, beam walking test and gait analysis. Intranasal rhIGF-1 administration also attenuated LPS-induced elevation of IL-1β levels and numbers of activated microglia, and cyclooxygenase-2+ cells, which were double labeled with TH+ cells in the SN, VTA, OB and LC of the P21 rat brain. These results suggest that IGF-1 may provide protection against neonatal LPS exposure-induced central catecholaminergic neuronal injury and motor behavioral disturbances, and that the protective effects are associated with the inhibition of microglia activation and the reduction of neuronal oxidative stress by the suppression of the neuronal cyclooxygenase-2 expression.
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Affiliation(s)
- Lu-Tai Tien
- School of Medicine, Fu Jen Catholic University, Xinzhuang Dist, New Taipei City 24205, Taiwan
| | - Yih-Jing Lee
- School of Medicine, Fu Jen Catholic University, Xinzhuang Dist, New Taipei City 24205, Taiwan
| | - Yi Pang
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Silu Lu
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jonathan W Lee
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Chih-Hsueh Tseng
- School of Medicine, Fu Jen Catholic University, Xinzhuang Dist, New Taipei City 24205, Taiwan
| | - Abhay J Bhatt
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Renate D Savich
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Lir-Wan Fan
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Su XL, Luo XG, Lv H, Wang J, Ren Y, He ZY. Factors predicting the instant effect of motor function after subthalamic nucleus deep brain stimulation in Parkinson's disease. Transl Neurodegener 2017; 6:14. [PMID: 28580139 PMCID: PMC5452406 DOI: 10.1186/s40035-017-0084-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson’s disease (PD), the predictive effect of levodopa responsiveness on surgical outcomes was confirmed by some studies, however there were different conclusions about that through long- and short-term follow-ups. We aimed to investigate the factors which influence the predictive value of levodopa responsiveness, and discover more predictive factors of surgical outcomes. Methods Twenty-three PD patients underwent bilateral STN-DBS and completed our follow-up. Clinical evaluations were performed 1 week before and 3 months after surgery. Results STN-DBS significantly improved motor function of PD patients after 3 months; preoperative levodopa responsiveness and disease subtype predicted the effect of DBS on motor function; gender, disease duration and duration of motor fluctuations modified the predictive effect of levodopa responsiveness on motor improvement; the duration of motor fluctuations and severity of preoperative motor symptoms modified the predictive effect of disease subtype on motor improvement. Conclusions The intensity of levodopa responsiveness served as a predictor of motor improvement more accurately in female patients, patients with shorter disease duration or shorter motor fluctuations; PD patients with dominant axial symptoms benefit less from STN-DBS compared to those with limb-predominant symptoms, especially in their later disease stage.
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Affiliation(s)
- Xin-Ling Su
- Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Xiao-Guang Luo
- Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Hong Lv
- Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Jun Wang
- Department of Neurosurgery, First Affiliated Hospital, China Medical University, China Medical University, Shenyang, China
| | - Yan Ren
- Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Zhi-Yi He
- Department of Neurology, First Affiliated Hospital, China Medical University, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 China
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Dalfampridine in Parkinson's disease related gait dysfunction: A randomized double blind trial. J Neurol Sci 2017; 379:7-11. [PMID: 28716283 DOI: 10.1016/j.jns.2017.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/20/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Disease-related gait dysfunction causes extensive disability for persons with Parkinson's disease (PD), with no effective therapies currently available. The potassium channel blocker dalfampridine has been used in multiple neurological conditions and improves walking in persons with multiple sclerosis. OBJECTIVES We aimed to evaluate the effect of dalfampridine extended release (D-ER) 10mg tablets twice daily on different domains of walking in participants with PD. METHODS Twenty-two participants with PD and gait dysfunction were randomized to receive D-ER 10mg twice daily or placebo for 4weeks in a crossover design with a 2-week washout period. The primary outcomes were change in the gait velocity and stride length. RESULTS At 4weeks, gait velocity was not significantly different between D-ER (0.89m/s±0.33) and placebo (0.93m/s±0.27) conditions. The stride length was also similar between conditions: 0.96m±0.38 for D-ER versus 1.06m±0.33 for placebo. D-ER was generally well tolerated with the most frequent side effects being dizziness, nausea and balance problems. CONCLUSIONS D-ER is well tolerated in PD patients, however it did not show significant benefit for gait impairment.
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Corallo F, De Cola MC, Lo Buono V, Di Lorenzo G, Bramanti P, Marino S. Observational study of quality of life of Parkinson's patients and their caregivers. Psychogeriatrics 2017; 17:97-102. [PMID: 27338524 DOI: 10.1111/psyg.12196] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/12/2016] [Accepted: 01/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a degenerative disorder that leads to a decrease in cognitive performance and affects patients' quality of life (QoL). The purpose of this study was to investigate the QoL of PD patients and their caregivers in relation to each patient's cognitive impairment. METHODS A total of 60 subjects with idiopathic PD were recruited; all had a primary caregiver. Patients' cognitive abilities were evaluated by the Mini-Mental State Examination, the Activities of Daily Living Scale, and the Instrumental Activities of Daily Living Scale. The 39-item Parkinson's Disease Questionnaire and the 36-item Short Form Health Survey were used to assess the QoL of patients and caregivers, respectively. RESULTS The Mini-Mental State Examination was a significant predictor of most of the QoL subscales, including mobility, stigma, social support, cognition, and physical discomfort. The Activities of Daily Living Scale and the Instrumental Activities of Daily Living Scale were significant predictors of mobility, activities of daily living, and cognition. Patients' clinical conditions also significantly affected all of the 36-item Short Form Health Survey subscales; predicted physical functioning, bodily pain, vitality, and social role functioning on the Activities of Daily Living Scale; and predicted physical functioning, physical role functioning, and emotional role functioning on the Mini-Mental State Examination. CONCLUSIONS Our results confirm a relationship between PD patients QoL and the perceived burden of their caregivers. Indeed, patients' cognitive impairment strictly correlated to lower QoL scores in both patients and caregivers and is a strong predictor of caregiver stress and burden. These results emphasize the importance of implementing early interventions to prevent or ameliorate caregivers' burnout.
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Affiliation(s)
| | | | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.,Department of Biomedical Sciences and Dental Sciences and Morphological Imaging, University of Messina, Messina, Italy
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Kale OE, Awodele O, Ogundare TF, Ekor M. Amlodipine, an L-type calcium channel blocker, protects against chlorpromazine-induced neurobehavioural deficits in mice. Fundam Clin Pharmacol 2017; 31:329-339. [PMID: 28103649 DOI: 10.1111/fcp.12267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 12/12/2022]
Abstract
This study investigated the modulatory and chemopreventive benefit of amlodipine (AML), a dihydropyridine calcium channel antagonist, against neurobehavioural abnormalities (NAs) associated with chlorpromazine (CPZ) toxicity in mice. Adult mice were divided into five groups of six animals/group. Group 1 (control) was administered saline (10 mL/kg i.p.). Group 2 received CPZ (2 mg/kg i.p.). Groups 3 and 4 received bromocriptine (BMC, 2.5 mg/kg s.c.) and AML (1 mg/kg s.c.), respectively, while group 5 received their combination. Groups 3-5 later received CPZ 30 min after initial treatments. Animals were subjected to neurobehavioural tests and euthanized 18 h later. CPZ-induced NAs were characterized by significant increase (P < 0.001) in cataleptic behaviour and lowered (P < 0.05) spontaneous activity reaction time in mice. There were also significant (P < 0.001) increases in malondialdehyde levels and decreased locomotion plus learning and memory parameters (P < 0.05-0.001). AML pretreatment alone did not alleviate CPZ-induced motor deficits in the mice. While pretreatment with BMC alone attenuated CPZ-associated catalepsy, its combination with AML further protected mice against NAs. Furthermore, BMC pretreatment did not affect CPZ-induced increase in malondialdehyde level, but AML or BMC+AML significantly (P < 0.05) decreased malondialdehyde in the CPZ-treated rats. Reduced glutathione levels and activities of superoxide dismutase and catalase remained elevated in all treatment groups. In conclusion, data from this study suggest possible chemopreventive benefit of AML alone or in combination with BMC against CPZ-associated neurobehavioural deficits. The ameliorative effect of AML may be related to its antioxidant and/or calcium channel blocking property.
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Affiliation(s)
- Oluwafemi E Kale
- Department of Pharmacology, Benjamin Carson (Snr.) School of Medicine, Babcock University, Ilisan-Remo, Ogun State, 21244 Ikeja, Nigeria.,Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, P.M.B 12003 Idi-Araba, Lagos, Nigeria
| | - Olufunsho Awodele
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, P.M.B 12003 Idi-Araba, Lagos, Nigeria
| | - Temitope F Ogundare
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, P.M.B 12003 Idi-Araba, Lagos, Nigeria
| | - Martins Ekor
- Department of Pharmacology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Lenfeldt N, Holmlund H, Larsson A, Birgander R, Forsgren L. Frontal white matter injuries predestine gait difficulties in Parkinson's disease. Acta Neurol Scand 2016; 134:210-8. [PMID: 27465659 DOI: 10.1111/ane.12532] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study applies diffusion tensor imaging (DTI) to determine differences in neuronal integrity between motor phenotypes in Parkinson's disease. MATERIAL AND METHODS One hundred and twenty-two patients (47 females, mean age = 70.3 years) were included at baseline. Forty patients were tremor dominant (TD), 64 had postural imbalance and gait difficulty (PIGD), and 18 patients were indeterminate. The DTI was repeated after one, three and 5 years, including reassessment of phenotype. DTI was quantified using fractional anisotropy (FA), and mean, radial and axial diffusion. Targeted white matter involved six regions of interests (ROIs) in prefrontal cortex (PFC), the entrance to the external capsule (EEC) and lateral to the horn of the anterior ventricle (LVAH). Grey matter involved the basal ganglia. Data were analysed using mixed linear models with P < 0.05 (Bonferroni corrected) as significance threshold. RESULTS PIGD and Indeterminate had reduced FA and axial diffusion in PFC, EEC and LVAH compared to Tremor dominant (P < 0.05). Basal ganglia showed no differences. Post hoc analysis showed that FA correlated negatively, and mean and radial diffusion positively, to PIGD symptoms in EEC, LVAH and four ROIs in PFC (P < 0.05). Tremor symptoms showed no correlations. Patients converting to PIGD and Indeterminate had lower FA, and higher mean and radial diffusion, at baseline in EEC, LVAH and four areas in PFC compared to non-converting patients (P < 0.05). CONCLUSION Degeneration in frontal white matter is connected to PIGD symptoms in Parkinson's disease and if present at an early stage, the risk for conversion to the PIGD phenotype increases.
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Affiliation(s)
- N. Lenfeldt
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - H. Holmlund
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - A. Larsson
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - L. Forsgren
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
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Rahimi F, Roberts AC, Jog M. Patterns and predictors of freezing of gait improvement following rasagiline therapy: A pilot study. Clin Neurol Neurosurg 2016; 150:117-124. [PMID: 27618783 DOI: 10.1016/j.clineuro.2016.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Freezing of gait (FoG) is a challenging clinical symptom in Parkinson's disease with variable improvements in FoG with rasagiline. In this prospective, uncontrolled, pre-/post- treatment pilot study, we explore the clinical variables that contribute to this variability and those that predict improvement. PATIENTS AND METHODS Frequency and duration of FoG, along with other standardized scales, were evaluated in 18 optimally medicated PD participants with intractable FoG, prior to and after completion of a 90-day course of 1mg daily rasagiline. Gait tasks were video-recorded and analyzed by two independent reviewers. After evaluating the simple main effect, hierarchical cluster analysis was used to identify subgroups for treatment responsiveness. Bidirectional elimination stepwise regression analysis was conducted to identify which clinical variables predicted reduction in frequency of FoG events post-treatment. RESULTS There were no overall pre-/post- treatment improvements, a result driven by a heterogeneous response to treatment. Three subgroups were identified: improved (n=6) with a 136% and 162% reduction in FoG count and duration; worsened (n=5) with 154% and 141% increase in FoG count and duration; and no change (n=3). The final predictive model had good explanatory power (adjusted-R2=0.9898, p<0.01), explaining 99% of the variance between the improved and worsened groups. In this model, lower UPDRS gait scores, higher LEDD dose, lower anxiety scores, lower FOG-Q scores, and higher UPDRS scores for lower extremity rigidity and rise from chair, predicted FoG-related rasagiline benefit. CONCLUSION Using both objective and subjective measures for FoG, the current pilot study identified a set of clinical variables that may elucidate the heterogeneous FoG-responsiveness following rasagiline treatment and aid in predicting improvement.
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Affiliation(s)
- Fariborz Rahimi
- Department of Electrical Engineering, Bonab University, Bonab, Iran.
| | - Angela C Roberts
- Northwestern University, Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, 2240 Campus Drive, Evanston, Illinois, United States
| | - Mandar Jog
- Department of Clinical Neurosciences, London Health Sciences Centre, London, Ontario, Canada
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Jiang LL, Liu JL, Fu XL, Xian WB, Gu J, Liu YM, Ye J, Chen J, Qian H, Xu SH, Pei Z, Chen L. Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A 5-year Follow-up Study in China. Chin Med J (Engl) 2016; 128:2433-8. [PMID: 26365958 PMCID: PMC4725566 DOI: 10.4103/0366-6999.164925] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Subthalamic nucleus deep brain stimulation (STN DBS) is effective against advanced Parkinson's disease (PD), allowing dramatic improvement of Parkinsonism, in addition to a significant reduction in medication. Here we aimed to investigate the long-term effect of STN DBS in Chinese PD patients, which has not been thoroughly studied in China. Methods: Ten PD patients were assessed before DBS and followed up 1, 3, and 5 years later using Unified Parkinson's Disease Rating Scale Part III (UPDRS III), Parkinson's Disease Questionnatire-39, Parkinson's Disease Sleep Scale-Chinese Version, Mini-mental State Examination, Montreal Cognitive Assessment, Hamilton Anxiety Scale and Hamilton Depression Scale. Stimulation parameters and drug dosages were recorded at each follow-up. Data were analyzed using the ANOVA for repeated measures. Results: In the “off” state (off medication), DBS improved UPDRS III scores by 35.87% in 5 years, compared with preoperative baseline (P < 0.001). In the “on” state (on medication), motor scores at 5 years were similar to the results of preoperative levodopa challenge test. The quality of life is improved by 58.18% (P < 0.001) from baseline to 3 years and gradually declined afterward. Sleep, cognition, and emotion were mostly unchanged. Levodopa equivalent daily dose was reduced from 660.4 ± 210.1 mg at baseline to 310.6 ± 158.4 mg at 5 years (by 52.96%, P < 0.001). The average pulse width, frequency and amplitude at 5 years were 75.0 ± 18.21 μs, 138.5 ± 19.34 Hz, and 2.68 ± 0.43 V, respectively. Conclusions: STN DBS is an effective intervention for PD, although associated with a slightly diminished efficacy after 5 years. Compared with other studies, patients in our study required lower voltage and medication for satisfactory symptom control.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ling Chen
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department, National Key Discipline, Guangzhou, Guangdong 510080, China
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Organogermanium compound, Ge-132, forms complexes with adrenaline, ATP and other physiological cis-diol compounds. Future Med Chem 2016; 7:1233-46. [PMID: 26144262 DOI: 10.4155/fmc.15.62] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In mammals, adrenaline and ATP are life-essential vicinal diol and cis-diol functional groups. Here, we show that interactions between a safe organogermanium compound and these cis-diol compounds have the potential to regulate physiological functions. In addition, we represent a possible new druggable target for controlling the action of cis-diol compounds. RESULTS We analyzed a single crystal structure of organogermanium 3-(trihydroxygermyl)propanoic acid (THGPA), a hydrolysate of safe Ge-132, in complex with catecholamine (adrenaline and noradrenaline), and evaluated the affinity between several cis-diol compounds and THGPA by NMR. An in vitro study using normal human epidermal keratinocytes was performed to investigate the inhibition of cis-diol compound-stimulated receptors by THGPA. At high concentration, THGPA inhibited the calcium influx caused by adrenaline and ATP. CONCLUSION This study demonstrates that THGPA can modify cis-diol-mediated cell-to-cell signaling.
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Tekin I, Carkaci-Salli N, Lewis MM, Mailman RB, Huang X, Vrana KE. The V81M variant of tyrosine hydroxylase is associated with more severe freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2015; 23:86-90. [PMID: 26732803 DOI: 10.1016/j.parkreldis.2015.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/10/2015] [Accepted: 12/20/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Many of the symptoms and signs of Parkinson's disease (PD) arise from the death of midbrain dopamine neurons that utilize tyrosine hydroxylase (TH) as the rate-limiting enzyme in catecholamine biosynthesis. METHODS We investigated whether the presence of a common TH polymorphism affects the clinical outcomes in 101 PD subjects. We further examined the effect of this polymorphism on the purified recombinant enzyme. RESULTS PD subjects homozygous for the common V81M polymorphism, have higher overall freezing of gait scores after controlling for disease duration, although this polymorphism does not associate with the occurrence of PD or FOG. In vitro functional assays on pure recombinant wild type TH and V81M TH revealed that the Km of the mutant enzyme for tyrosine was twice that of the wild-type. This polymorphism, however, did not change the stability of the enzyme, nor did it affect the Vmax or Km for the co-substrate BH4. CONCLUSION The data suggest that presence of a homozygous V81M polymorphism is associated with more severe FOG, possibly due to lower catecholamine synthetic capacity. Further studies are warranted to investigate the role of subtle changes in catecholamine availability in the development of FOG.
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Affiliation(s)
- Izel Tekin
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nurgul Carkaci-Salli
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Richard B Mailman
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Department of Neurology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA; Departments of Radiology and Neurosurgery, Milton S. Hershey Medical Center, and Kinesiology, Pennsylvania State University, Hershey, PA, USA
| | - Kent E Vrana
- Department of Pharmacology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Sterling NW, Cusumano JP, Shaham N, Piazza SJ, Liu G, Kong L, Du G, Lewis MM, Huang X. Dopaminergic modulation of arm swing during gait among Parkinson's disease patients. JOURNAL OF PARKINSONS DISEASE 2015; 5:141-50. [PMID: 25502948 DOI: 10.3233/jpd-140447] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduced arm swing amplitude, symmetry, and coordination during gait have been reported in Parkinson's disease (PD), but the relationship between dopaminergic depletion and these upper limb gait changes remains unclear. OBJECTIVE We aimed to investigate the effects of dopaminergic drugs on arm swing velocity, symmetry, and coordination in PD. METHODS Forearm angular velocity was recorded in 16 PD and 17 control subjects (Controls) during free walking trials. Angular velocity amplitude of each arm, arm swing asymmetry, and maximum cross-correlation were compared between control and PD groups, and between OFF- and ON-medication states among PD subjects. RESULTS Compared to Controls, PD subjects in the OFF-medication state exhibited lower angular velocity amplitude of the slower- (p = 0.0018), but not faster- (p = 0.2801) swinging arm. In addition, PD subjects demonstrated increased arm swing asymmetry (p = 0.0046) and lower maximum cross-correlation (p = 0.0026). Following dopaminergic treatment, angular velocity amplitude increased in the slower- (p = 0.0182), but not faster- (p = 0.2312) swinging arm among PD subjects. Furthermore, arm swing asymmetry decreased (p = 0.0386), whereas maximum cross-correlation showed no change (p = 0.7436). Pre-drug angular velocity amplitude of the slower-swinging arm was correlated inversely with the change in arm swing asymmetry (R = -0.73824, p = 0.0011). CONCLUSIONS This study provides quantitative evidence that reduced arm swing and symmetry in PD can be modulated by dopaminergic replacement. The lack of modulations of bilateral arm coordination suggests that additional neurotransmitters may also be involved in arm swing changes in PD. Further studies are warranted to investigate the longitudinal trajectory of arm swing dynamics throughout PD progression.
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Affiliation(s)
- Nicholas W Sterling
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph P Cusumano
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Noam Shaham
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guangwei Du
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Radiology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Neurosurgery, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
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Ou R, Guo X, Wei Q, Cao B, Yang J, Song W, Shao N, Zhao B, Chen X, Shang H. Festination in Chinese patients with Parkinson's disease. Clin Neurol Neurosurg 2015; 139:172-6. [PMID: 26496878 DOI: 10.1016/j.clineuro.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the occurrence and clinical associations of festination in Chinese patients with Parkinson's disease (PD). METHODS A total of 480 PD patients were recruited in this cross-sectional study. Assessments scales included the Unified PD Rating Scale (UPDRS) part III, PD Questionnaire-39 (PDQ-39), Non-Motor Symptoms Scale (NMSS), Mini-Mental State Examination (MMSE), frontal assessment battery (FAB), Montreal Cognitive Assessment (MoCA), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). RESULTS One hundred and forty PD patients (29.2%) reported festination. Festination occurred more frequently in patients with lower limbs as the site of onset and patients with longer disease duration or higher Hoehn and Yahr (H&Y) stage (P<0.05). The mean age, levodopa and entacapone use, incidences of motor complications, falls and freezing of gait, and the scores for the UPDRS part III, NMSS, HAMD and HAMA were higher in patients with festination than those without festination (P<0.05). There were no differences in the scores for the PDQ-39, MMSE, FAB and MoCA between the patients with and without festination. The binary logistic regression model indicated that UPDRS part III, lower limbs as the site of onset, freezing of gait and falls were associated with festination. CONCLUSIONS Festination is a relatively common disabling symptom in Chinese PD patients. Patients with lower limbs as the site of onset and more severe disability were more likely to experience festination. Festination in PD is not related to non-motor symptoms and cognitive dysfunction.
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Affiliation(s)
- Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Xiaoyan Guo
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Na Shao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
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Abstract
Background Human beings rely on multiple systems to maintain their balance as they perform their activities of daily living. These systems may be undermined functionally by both disease and the normal aging process. Balance impairment is associated with increased fall risk. Purpose This paper examines the dynamic formulation of balance as activity and reviews the biological mechanisms for its control. A “minimal-technology” scheme for its clinical evaluation in the ambulatory care setting is proposed. Methods The PubMed, Scopus and CINAHL databases were searched for relevant articles using the following terms in combination with balance: aging, impairment, control mechanisms, clinical assessment. Only articles which describe test procedures, their psychometrics and rely exclusively on equipment found in a regular physician office were reviewed. Results Human bipedal stance and gait are inherently low in stability. Accordingly, an elaborate sensory apparatus comprising visual, vestibular and proprioceptive elements, constantly monitors the position and movement of the body in its environment and sends signals to the central nervous system. The sensory inputs are processed and motor commands are generated. In response to efferent signals, the musculoskeletal system moves the body as is necessary to maintain or regain balance. The combination of senescent decline in organ function and the higher prevalence of diseases of the balance control systems in older adults predisposes this population subset to balance impairment. Older adults with balance impairment are likely to present with “dizziness”. The history should concentrate on the first experience, with an attempt made to categorize it as a Drachman type. Since the symptomatology is often vague, several of the recommended physical tests are provocative maneuvers aimed at reproducing the patient’s complaint. Well-validated questionnaires are available for evaluating the impact of “dizziness” on various domains of patient’s lives, including their fear of falling. Aspects of a good history and physical examination not otherwise addressed to balance function, such as medications review and cognitive assessment, also yield information that contributes to a better understanding of the patient’s complaint. Ordinal scales, which are aggregates of functional performance tests, enable detailed quantitative assessments of balance activity. Conclusion The integrity of balance function is essential for activities of daily living efficacy. Its deterioration with aging and disease places older adults at increased risk of falls and dependency. Balance can be effectively evaluated in the ambulatory care setting, using a combination of scalar questionnaires, dedicated history-taking and physical tests that do not require sophisticated instrumentation.
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Affiliation(s)
- Joseph O Nnodim
- Department of Internal Medicine, University of Michigan Health System, USA
| | - Raymond L Yung
- Department of Internal Medicine, University of Michigan Health System, USA
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Chong RK, Lee KH, Morgan J, Wakade C. Duration of step initiation predicts freezing in Parkinson's disease. Acta Neurol Scand 2015; 132:105-10. [PMID: 25659591 DOI: 10.1111/ane.12361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In some individuals with idiopathic Parkinson's disease (PD), freezing of gait episodes develops as the disease progresses. The neural mechanism underlying freezing in PD is poorly understood. Here, we report a 2-year follow-up on the novel discovery of prolonged step initiation duration as a potential marker of impending freezing. METHODS Non-freezing PD participants in stages 2.5-4 of the Hoehn and Yahr disease severity scale were recruited from an earlier study which determined the effect of semi-virtual cues on walking. Responders were those who completed the first step faster in the presence of the virtual cues while non-responders either did not change or took longer to complete the first step. Both groups of participants were interviewed 2 years later to determine who had developed freezing of gait. RESULTS Participants in the responder group had a 13-fold risk of developing freezing of gait within 2 years following the cueing study (OR=13.3, 95% CI=1.1-167). A cutoff score of -2.6% (i.e., a decrease in the duration of the first step with visual cues by 2.6% relative to no cues) gave a sensitivity and specificity of 100% and 89%, respectively. CONCLUSIONS To the best of our knowledge, this is the first novel discovery of a physical predictor of freezing in PD. The time to complete the first step is a simple test to administer in the clinic or at home and may therefore be easily incorporated into a fall prevention training program for PD before the inception of freezing.
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Affiliation(s)
- R. K. Chong
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
| | - K.-H. Lee
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
| | - J. Morgan
- Department of Neurology; Georgia Regents University; Augusta GA USA
| | - C. Wakade
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
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Picillo M, Dubbioso R, Iodice R, Iavarone A, Pisciotta C, Spina E, Santoro L, Barone P, Amboni M, Manganelli F. Short-latency afferent inhibition in patients with Parkinson’s disease and freezing of gait. J Neural Transm (Vienna) 2015; 122:1533-40. [DOI: 10.1007/s00702-015-1428-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
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48
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Huang SW, Lin JW, Liou TH, Lin HW. Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan. Int J Geriatr Psychiatry 2015; 30:695-701. [PMID: 25351738 DOI: 10.1002/gps.4209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 08/03/2014] [Accepted: 08/12/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND To investigate the incidence and risk of hip fracture among dementia patients METHODS This is a retrospective population-based 7-year cohort study using case-control matched analysis database from Taiwan's Longitudinal Health Insurance Database 2005. Patients were diagnosed with codes or International Classification of Diseases-9-CM codes of dementia, between 1 January 2004 and 31 December 2006. The prevalence and the adjusted odds ratio of hip fracture among dementia patients and the controls were estimated. RESULTS We enrolled 3101 patients with dementia in the dementia cohort and 12,404 (1:4) patients in the control group. Of these, 202 patients experienced hip fractures. The incidence of hip fracture was 1178 per 100,000 person-years in the dementia cohort and 624 per 100,000 person-years in the comparison cohort. The hip fracture hazard ratio during the follow-up period was 1.89 (95% confidence interval [CI] 1.60-2.23, p < 0.001) for dementia patients. After adjusting for the covariates, the hazard ratio of hip fracture was 1.41 (95% CI, 1.19-1.69, p < 0.001) for dementia patients. CONCLUSION People with dementia experience an increased incidence of hip fracture and are at a higher risk of sustaining a hip fracture in the future. Proper and effective hip fracture-prevention strategies are essential for dementia patients.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jia-Wei Lin
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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49
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Sarva H, Deik A, Swan MC, Severt WL. Freezing of gait after a hemorrhagic stroke can respond to venlafaxine and rivastigmine. Neurol Clin Pract 2015; 5:267-269. [DOI: 10.1212/cpj.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Hagino Y, Kasai S, Fujita M, Setogawa S, Yamaura H, Yanagihara D, Hashimoto M, Kobayashi K, Meltzer HY, Ikeda K. Involvement of cholinergic system in hyperactivity in dopamine-deficient mice. Neuropsychopharmacology 2015; 40:1141-50. [PMID: 25367503 PMCID: PMC4367456 DOI: 10.1038/npp.2014.295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/09/2014] [Accepted: 10/12/2014] [Indexed: 12/16/2022]
Abstract
Dopaminergic systems have been known to be involved in the regulation of locomotor activity and development of psychosis. However, the observations that some Parkinson's disease patients can move effectively under appropriate conditions despite low dopamine levels (eg, kinesia paradoxia) and that several psychotic symptoms are typical antipsychotic resistant and atypical antipsychotic sensitive indicate that other systems beyond the dopaminergic system may also affect locomotor activity and psychosis. The present study showed that dopamine-deficient (DD) mice, which had received daily L-DOPA injections, could move effectively and even be hyperactive 72 h after the last L-DOPA injection when dopamine was almost completely depleted. Such hyperactivity was ameliorated by clozapine but not haloperidol or ziprasidone. Among multiple actions of clozapine, muscarinic acetylcholine (ACh) activation markedly reduced locomotor activity in DD mice. Furthermore, the expression of choline acetyltransferase, an ACh synthase, was reduced and extracellular ACh levels were significantly reduced in DD mice. These results suggest that the cholinergic system, in addition to the dopaminergic system, may be involved in motor control, including hyperactivity and psychosis. The present findings provide additional evidence that the cholinergic system may be targeted for the treatment of Parkinson's disease and psychosis.
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Affiliation(s)
- Yoko Hagino
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shinya Kasai
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masayo Fujita
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Susumu Setogawa
- Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Hiroshi Yamaura
- Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Dai Yanagihara
- Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan,Core Research for Evolutional Science and Technology, Japan Science and Technology Corporation, Tokyo, Japan
| | - Makoto Hashimoto
- Parkinson's Disease Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuto Kobayashi
- Department of Molecular Genetics, Institute of Biomedical Sciences, Fukushima Medical University, Fukushima, Japan
| | - Herbert Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan,Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan, Tel: +81 3 6834 2379, Fax: +81 3 6834 2390, E-mail:
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