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Divandari N, Bird ML, Vakili M, Jaberzadeh S. The association between dynamic balance and executive function: Which dynamic balance test has the strongest association with executive function? A systematic review and meta-analysis. Curr Neurol Neurosci Rep 2024; 24:151-161. [PMID: 38730213 PMCID: PMC11143012 DOI: 10.1007/s11910-024-01340-3] [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: 04/02/2024] [Indexed: 05/12/2024]
Abstract
AIM The aging global population poses increasing challenges related to falls and dementia. Early identification of cognitive decline, particularly before noticeable symptoms manifest, is crucial for effective intervention. This review aims to determine the dynamic balance test most closely associated with executive function, potentially serving as a biomarker for cognitive decline. RECENT FINDINGS Based on recent reviews, inhibitory control, a component of executive function, holds significance in influencing balance performance. Studies suggest that the strength of the correlation between cognition and balance tends to be domain-specific and task-specific. Despite these findings, inconclusive evidence remains regarding the connection between executive function and various dynamic balance assessments. Our review identifies a significant association between all dynamic balance tests and executive function, albeit with varying strengths. Notably, a medium effect size is observed for the Timed Up and Go and Functional Reach Test, a small effect size for balance scales, and a strong effect size for postural sway. This review underscores a clear relationship between dynamic balance task performance and executive function. Dynamic posturography holds potential as a clinical biomarker for early detection of cognitive decline, with a note of caution due to observed heterogeneity and limited studies.
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Affiliation(s)
- Nahid Divandari
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia.
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Newnham Tasmania, 7248, Australia
| | | | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia
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Du YH, Ma J, Hu JY, Zhu L, Wang LY, Yang RY, Liang LC, Jiang M, Cai M, Pu J. Effects of dual-task training on gait and motor ability in patients with Parkinson's disease: A systematic review and meta-analysis. Clin Rehabil 2022; 37:942-953. [PMID: 36537108 DOI: 10.1177/02692155221146085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Parkinson's disease is one of the most common neurodegenerative diseases in the world, which seriously damages motor and balance ability. Dual-task training is discussed as an appropriate intervention. The aim of this review was to synthesize the existing research findings on the efficacy of dual-task training for people with Parkinson's disease. DATA RESOURCES A systematic search on PubMed, CENTRAL, Embase, Web of Science, and PEDro, randomized-controlled trials (RCTs) of dual-task training for individuals with Parkinson's disease. METHODS Articles published until 1 November 2022 were included. Our search identified 7 RCTs with a total of 406 subjects. Review Manager 5.4 software was used for bias evaluation and to process the results of the outcome measures collected from the investigations. RESULTS Dual-task training was associated with significant improvement in most motor and balance outcomes including gait velocity (standard mean difference (SMD) = 0.62; 95% CI, 0.37-0.87; I2 = 31%; P = 0.21), cadence (SMD = 0.29; 95% CI, 0.05-0.53; I2 = 0%; P = 0.71), timed-up-and-go test (mean difference (MD) = -2.38; 95% CI, -3.93 to -0.84; I2 = 32%; P = 0.22) and mini-balance evaluation systems test (MD = 2.04; 95% CI, 1.05-3.03; I2 = 0%; P = 0.92). CONCLUSION Evidence from meta-analyses suggests that dual-task training may improve motor and balance abilities in Parkinson's disease patients. Future research should focus on finding the most appropriate dual-task treatment model for patients with different degrees, in order to further improve the rehabilitation treatment of Parkinson's disease.
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Affiliation(s)
- Yi-Hong Du
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ma
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Yun Hu
- Central Lab, 596680Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Lei Zhu
- College of Sport Sciences, 56650Qufu Normal University, Qufu, Shandong Province, China
| | - Li-Yan Wang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ruo-Yu Yang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lei-Chao Liang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Men Jiang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Cai
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sun H, Zhao F, Liu Y, Ma T, Jin H, Quan K, Leng B, Zhao J, Yuan X, Li Z, Li F, Kwok LY, Zhang S, Sun Z, Zhang J, Zhang H. Probiotics synergized with conventional regimen in managing Parkinson's disease. NPJ Parkinsons Dis 2022; 8:62. [PMID: 35610236 PMCID: PMC9130297 DOI: 10.1038/s41531-022-00327-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is mainly managed by pharmacological therapy (e.g., Benserazide and dopamine agonists). However, prolonged use of these drugs would gradually diminish their dopaminergic effect. Gut dysbiosis was observed in some patients with PD, suggesting close association between the gut microbiome and PD. Probiotics modulate the host's gut microbiota beneficially. A 3-month randomized, double-blind, placebo-controlled clinical trial was conducted to investigate the beneficial effect of probiotic co-administration in patients with PD. Eighty-two PD patients were recruited and randomly divided into probiotic [n = 48; Bifidobacterium animalis subsp. lactis Probio-M8 (Probio-M8), Benserazide, dopamine agonists] and placebo (n = 34; placebo, Benserazide, dopamine agonists) groups. Finally, 45 and 29 patients from Probio-M8 and placebo groups provided complete fecal and serum samples for further omics analysis, respectively. The results showed that Probio-M8 co-administration conferred added benefits by improving sleep quality, alleviating anxiety, and gastrointestinal symptoms. Metagenomic analysis showed that, after the intervention, there were significantly more species-level genome bins (SGBs) of Bifidobacterium animalis, Ruminococcaceae, and Lachnospira, while less Lactobacillus fermentum and Klebsiella oxytoca in Probio-M8 group (P < 0.05). Interestingly, Lactobacillus fermentum correlated positively with the scores of UPDRS-III, HAMA, HAMD-17, and negatively with MMSE. Klebsiella oxytoca correlated negatively with feces hardness. Moreover, co-administering Probio-M8 increased SGBs involved in tryptophan degradation, gamma-aminobutyric acid, short-chain fatty acids, and secondary bile acid biosynthesis, as well as serum acetic acid and dopamine levels (P < 0.05). Taken together, Probio-M8 synergized with the conventional regimen and strengthened the clinical efficacy in managing PD, accompanied by modifications of the host's gut microbiome, gut microbial metabolic potential, and serum metabolites.
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Affiliation(s)
- Hairong Sun
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Feiyan Zhao
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Yuanyuan Liu
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Teng Ma
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Hao Jin
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Keyu Quan
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Bing Leng
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Junwu Zhao
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Xiaoling Yuan
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 264200, China
| | - Zhenguang Li
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Fang Li
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Lai-Yu Kwok
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Shukun Zhang
- Department of Pathology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China
| | - Zhihong Sun
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China
| | - Jinbiao Zhang
- Department of neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China.
| | - Heping Zhang
- Inner Mongolia Key Laboratory of Dairy Biotechnology and Engineering; Key Laboratory of Dairy Products Processing, Ministry of Agriculture and Rural Affairs; Key Laboratory of Dairy Biotechnology and Engineering, Ministry of Education, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia, 010018, China.
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Touchscreen-based finger tapping: Repeatability and configuration effects on tapping performance. PLoS One 2021; 16:e0260783. [PMID: 34874977 PMCID: PMC8651103 DOI: 10.1371/journal.pone.0260783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease that affects almost 2% of the population above the age of 65. To better quantify the effects of new medications, fast and objective methods are needed. Touchscreen-based tapping tasks are simple yet effective tools for quantifying drug effects on PD-related motor symptoms, especially bradykinesia. However, there is no consensus on the optimal task set-up. The present study compares four tapping tasks in 14 healthy participants. In alternate finger tapping (AFT), tapping occurred with the index and middle finger with 2.5 cm between targets, whereas in alternate side tapping (AST) the index finger with 20 cm between targets was used. Both configurations were tested with or without the presence of a visual cue. Moreover, for each tapping task, within- and between-day repeatability and (potential) sensitivity of the calculated parameters were assessed. Visual cueing reduced tapping speed and rhythm, and improved accuracy. This effect was most pronounced for AST. On average, AST had a lower tapping speed with impaired accuracy and improved rhythm compared to AFT. Of all parameters, the total number of taps and mean spatial error had the highest repeatability and sensitivity. The findings suggest against the use of visual cueing because it is crucial that parameters can vary freely to accurately capture medication effects. The choice for AFT or AST depends on the research question, as these tasks assess different aspects of movement. These results encourage further validation of non-cued AFT and AST in PD patients.
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Li Y, Zhang L, Wu Y, Zhang J, Liu K. A Longitudinal Randomized Controlled Trial Protocol to Evaluate the Effects of Wuqinxi on Dynamic Functional Connectivity in Parkinson's Disease Patients. Front Hum Neurosci 2021; 15:711703. [PMID: 34566601 PMCID: PMC8461094 DOI: 10.3389/fnhum.2021.711703] [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: 05/19/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a neurodegenerative movement disease that includes non-motor symptoms such as cognitive impairment. Long-term mind-body exercise has been shown to improve cognitive ability in PD patients, but the methods of assessment and intervention were inconsistent across studies. Wuqinxi is a mind-body exercise that is easy to learn, has few physical and cognitive demands, and is recommended for PD patients. Dynamic functional connectivity (DFC) has been associated with cognitive alterations in PD patients, but no studies have yet explored the effects of Wuqinxi on this association. The current protocol is designed to measure the effects of long-term Wuqinxi intervention on cognition in PD patients, and explore the underlying neural mechanisms through DFC. Methods: A long-term single-blind, randomized trial will be conducted. PD patients and age- and gender-matched HC will be recruited; PD patients will be randomly assigned to either Wuqinxi or balance groups, and HC will all receive health education. The Wuqinxi group will receive a 90-min session of Wuqinxi intervention three times a week for 24 weeks, while the balance group will receive balance exercise instruction on the same schedule. Primary outcomes will include assessment of cognitive domains and dynamic temporal characteristics of functional connectivity. Secondary outcomes will include severity of motor symptoms, mobility, balance, and emotional state. Assessments will be conducted at baseline, at the end of 24 weeks of intervention, and 12 weeks after interventions have ended. Discussion: This study will provide evidence to the effects of Wuqinxi exercise on cognitive improvements in PD patients from the perspective of DFC, and will contribute to the understanding of neural mechanisms underlying cognitive enhancement through Wuqinxi practice. Clinical Trial Registration:www.chictr.org.cn, identifier ChiCTR2000038517.
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Affiliation(s)
- Yuting Li
- School of Nursing, Anhui University of Chinese Medicine, Hefei, China.,School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Lanlan Zhang
- School of Leisure Sport and Management, Guangzhou Sport University, Guangzhou, China
| | - Yin Wu
- School of Economics and Management, Shanghai University of Sport, Shanghai, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Ke Liu
- Shanghai Punan Hospital of Pudong New District, Shanghai, China
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A convolutional-recurrent neural network approach to resting-state EEG classification in Parkinson's disease. J Neurosci Methods 2021; 361:109282. [PMID: 34237382 DOI: 10.1016/j.jneumeth.2021.109282] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/12/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is expected to become more common, particularly with an aging population. Diagnosis and monitoring of the disease typically rely on the laborious examination of physical symptoms by medical experts, which is necessarily limited and may not detect the prodromal stages of the disease. NEW METHOD We propose a lightweight (~20 K parameters) deep learning model to classify resting-state EEG recorded from people with PD and healthy controls (HC). The proposed CRNN model consists of convolutional neural networks (CNN) and a recurrent neural network (RNN) with gated recurrent units (GRUs). The 1D CNN layers are designed to extract spatiotemporal features across EEG channels, which are subsequently supplied to the GRUs to discover temporal features pertinent to the classification. RESULTS The CRNN model achieved 99.2% accuracy, 98.9% precision, and 99.4% recall in classifying PD from HC. Interrogating the model, we further demonstrate that the model is sensitive to dopaminergic medication effects and predominantly uses phase information in the EEG signals. COMPARISON WITH EXISTING METHODS The CRNN model achieves superior performance compared to baseline machine learning methods and other recently proposed deep learning model. CONCLUSION The approach proposed in this study adequately extracts spatial and temporal features in multi-channel EEG signals that enable accurate differentiation between PD and HC. The CRNN model has excellent potential for use as an oscillatory biomarker for assisting in the diagnosis and monitoring of people with PD. Future studies to further improve and validate the model's performance in clinical practice are warranted.
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Senior Fitness Test in the assessment of the physical fitness of people with Parkinson's disease. Exp Gerontol 2021; 151:111421. [PMID: 34051286 DOI: 10.1016/j.exger.2021.111421] [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: 02/23/2021] [Revised: 05/02/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) is worth special attention among all the diseases and disorders of the nervous system, since its effects impact the capability of undertaking physical activity. The aim of the study was to analyze the use of the Senior Fitness Test (SFT) in determining the influence of physical rehabilitation on the level of physical fitness, and to assess the correlation between SFT and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) in patients with PD both participating and not participating in physical rehabilitation. The study was conducted in a group of 69 people (age 63.86 ± 5.43 y), with diagnosed idiopathic PD in 2nd stage in the Hoehn and Yahr scale (duration 6.52 ± 5.72 y). To determine the level of mobility of the subjects, the SFT and parts II, III, and IV of the MDS-UPDRS were used. Subjects were divided into participants (A) and non-participants (B) in physical rehabilitation. Correlation coefficients between the MDS-UPDRS and SFT were calculated after the 6-month study period. Participation in the process of physical rehabilitation significantly improved the physical fitness of the exercisers. A strong correlation was observed between the results obtained in the SFT and the assessment obtained on the basis of the MDS-UPDRS scale. It has been found that the SFT is a sensitive diagnostic tool in assessing the physical fitness of people with PD.
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Su D, Liu Z, Jiang X, Zhang F, Yu W, Ma H, Wang C, Wang Z, Wang X, Hu W, Manor B, Feng T, Zhou J. Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study. JMIR Mhealth Uhealth 2021; 9:e25451. [PMID: 33605894 PMCID: PMC7935653 DOI: 10.2196/25451] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 01/14/2023] Open
Abstract
Background Parkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD. Objective We previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD. Methods Fifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system. Results High correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: β=.39, P<.001; dual task: β=.37, P=.01), HAM-A (single-task: β=.49, P=.007; dual-task: β=.48, P=.009), and HAM-D (single task: β=.44, P=.01; dual task: β=.49, P=.009). Moreover, those with greater dual-task stride time variability (β=.48, P=.001) or dual-task cost of stride time variability (β=.44, P=.004) exhibited lower MoCA scores. Conclusions A smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD.
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Affiliation(s)
- Dongning Su
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Zhu Liu
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Xin Jiang
- The Second Clinical Medical College, Jinan University, Guangzhou, China.,Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, Guangdong, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Fangzhao Zhang
- Department of Computer Science, The University of British Columbia, Vancouver, BC, Canada
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
| | - Huizi Ma
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Wanli Hu
- Department of Hematology and Oncology, Jingxi Campus, Capital Medical University, Beijing ChaoYang Hospital, Beijing, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Merchant KM, Cedarbaum JM, Brundin P, Dave KD, Eberling J, Espay AJ, Hutten SJ, Javidnia M, Luthman J, Maetzler W, Menalled L, Reimer AN, Stoessl AJ, Weiner DM. A Proposed Roadmap for Parkinson's Disease Proof of Concept Clinical Trials Investigating Compounds Targeting Alpha-Synuclein. JOURNAL OF PARKINSONS DISEASE 2020; 9:31-61. [PMID: 30400107 PMCID: PMC6398545 DOI: 10.3233/jpd-181471] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The convergence of human molecular genetics and Lewy pathology of Parkinson's disease (PD) have led to a robust, clinical-stage pipeline of alpha-synuclein (α-syn)-targeted therapies that have the potential to slow or stop the progression of PD and other synucleinopathies. To facilitate the development of these and earlier stage investigational molecules, the Michael J. Fox Foundation for Parkinson's Research convened a group of leaders in the field of PD research from academia and industry, the Alpha-Synuclein Clinical Path Working Group. This group set out to develop recommendations on preclinical and clinical research that can de-risk the development of α-syn targeting therapies. This consensus white paper provides a translational framework, from the selection of animal models and associated end-points to decision-driving biomarkers as well as considerations for the design of clinical proof-of-concept studies. It also identifies current gaps in our biomarker toolkit and the status of the discovery and validation of α-syn-associated biomarkers that could help fill these gaps. Further, it highlights the importance of the emerging digital technology to supplement the capture and monitoring of clinical outcomes. Although the development of disease-modifying therapies targeting α-syn face profound challenges, we remain optimistic that meaningful strides will be made soon toward the identification and approval of disease-modifying therapeutics targeting α-syn.
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Affiliation(s)
- Kalpana M Merchant
- Vincere Biosciences, Inc., and Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Patrik Brundin
- Van Andel Research Institute, Center for Neurodegenerative Science, Grand Rapids, MI, USA
| | - Kuldip D Dave
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Jamie Eberling
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Alberto J Espay
- UC Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Samantha J Hutten
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Javidnia
- Center for Health and Technology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Liliana Menalled
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Alyssa N Reimer
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, Pacific Parkinson's Research Center, University of British Columbia, Vancouver, BC, Canada
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Eun JD, Bang YM, Youn J, Cho JW, Kim YH, Chang WH. Feasibility of Transcranial Direct Current Stimulation in Patients with Deep Brain Stimulation: a Case Report. BRAIN & NEUROREHABILITATION 2020; 13:e13. [PMID: 36741797 PMCID: PMC9879368 DOI: 10.12786/bn.2020.13.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022] Open
Abstract
Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS. Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.
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Affiliation(s)
- Jong Dae Eun
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Min Bang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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Lewis MM, Harkins E, Lee EY, Stetter C, Snyder B, Corson T, Du G, Kong L, Huang X. Clinical Progression of Parkinson's Disease: Insights from the NINDS Common Data Elements. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1075-1085. [PMID: 32538866 PMCID: PMC8177750 DOI: 10.3233/jpd-201932] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVE To synchronize data collection, the National Institute of Neurological Disorders and Stroke (NINDS) recommended Common Data Elements (CDEs) for use in Parkinson's disease (PD) research. This study delineated the progression patterns of these CDEs in a cohort of PD patients. METHODS One hundred-twenty-five PD patients participated in the PD Biomarker Program (PDBP) at Penn State. CDEs, including MDS-Unified PD Rating Scale (UPDRS)-total, questionnaire-based non-motor (-I) and motor (-II), and rater-based motor (-III) subscales; Montreal Cognitive Assessment (MoCA); Hamilton Depression Rating Scale (HDRS); University of Pennsylvania Smell Identification Test (UPSIT); and PD Questionnaire (PDQ-39) were obtained at baseline and three annual follow-ups. Annual change was delineated for PD or subgroups [early = PDE, disease duration (DD) <1 y; middle = PDM, DD = 1-5 y; and late = PDL, DD > 5 y] using mixed effects model analyses. RESULTS UPDRS-total, -II, and PDQ-39 scores increased significantly, and UPSIT decreased, whereas UPDRS-I, -III, MoCA, and HDRS did not change, over 36 months in the overall PD cohort. In the PDE subgroup, UPDRS-II increased and UPSIT decreased significantly, whereas MoCA and UPSIT decreased significantly in the PDM subgroup. In the PDL subgroup, UPDRS-II and PDQ-39 increased significantly. Other metrics within each individual subgroup did not change. Sensitivity analyses using subjects with complete data confirmed these findings. CONCLUSION Among CDEs, UPDRS-total, -II, PDQ-39, and UPSIT all are sensitive metrics to track PD progression. Subgroup analyses revealed that these CDEs have distinct stage-dependent sensitivities, with UPSIT for DD < 5 y, PDQ-39 for DD > 5 y, UPDRS-II for early (DD < 1) or later stages (DD > 5).
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Affiliation(s)
- Mechelle M. Lewis
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
- Department of Pharmacology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Elias Harkins
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Eun-Young Lee
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Christy Stetter
- Department of Public Health Sciences, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Bethany Snyder
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Tyler Corson
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Guangwei Du
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Lan Kong
- Department of Public Health Sciences, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
- Department of Pharmacology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
- Department of Radiology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
- Department of Neurosurgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
- Department of Kinesiology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, US
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12
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Gaprielian P, Scott SH, Lowrey C, Reid S, Pari G, Levy R. Integrated robotics platform with haptic control differentiates subjects with Parkinson's disease from controls and quantifies the motor effects of levodopa. J Neuroeng Rehabil 2019; 16:124. [PMID: 31655612 PMCID: PMC6815040 DOI: 10.1186/s12984-019-0598-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 02/01/2023] Open
Abstract
Background The use of integrated robotic technology to quantify the spectrum of motor symptoms of Parkinson’s Disease (PD) has the potential to facilitate objective assessment that is independent of clinical ratings. The purpose of this study is to use the KINARM exoskeleton robot to (1) differentiate subjects with PD from controls and (2) quantify the motor effects of dopamine replacement therapies (DRTs). Methods Twenty-six subjects (Hoehn and Yahr mean 2.2; disease duration 0.5 to 15 years) were evaluated OFF (after > 12 h of their last dose) and ON their DRTs with the Unified Parkinson’s Disease Rating Scale (UPDRS) and the KINARM exoskeleton robot. Bilateral upper extremity bradykinesia, rigidity, and postural stability were quantified using a repetitive movement task to hit moving targets, a passive stretch task, and a torque unloading task, respectively. Performance was compared against healthy age-matched controls. Results Mean hand speed was 41% slower and 25% fewer targets were hit in subjects with PD OFF medication than in controls. Receiver operating characteristic (ROC) area for hand speed was 0.94. The torque required to stop elbow movement during the passive stretch task was 34% lower in PD subjects versus controls and resulted in an ROC area of 0.91. The torque unloading task showed a maximum displacement that was 29% shorter than controls and had an ROC area of 0.71. Laterality indices for speed and end total torque were correlated to the most affected side. Hand speed laterality index had an ROC area of 0.80 against healthy controls. DRT administration resulted in a significant reduction in a cumulative score of parameter Z-scores (a measure of global performance compared to healthy controls) in subjects with clinically effective levodopa doses. The cumulative score was also correlated to UPDRS scores for the effect of DRT. Conclusions Robotic assessment is able to objectively quantify parkinsonian symptoms of bradykinesia, rigidity and postural stability similar to the UPDRS. This integrated testing platform has the potential to aid clinicians in the management of PD and help assess the effects of novel therapies.
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Affiliation(s)
- Pauline Gaprielian
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Catherine Lowrey
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stuart Reid
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Giovanna Pari
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Ron Levy
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada. .,Department of Surgery, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
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13
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Dan X, Liu J, Doyon J, Zhou Y, Ma J, Chan P. Impaired Fine Motor Function of the Asymptomatic Hand in Unilateral Parkinson's Disease. Front Aging Neurosci 2019; 11:266. [PMID: 31636557 PMCID: PMC6787142 DOI: 10.3389/fnagi.2019.00266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/13/2019] [Indexed: 01/05/2023] Open
Abstract
The early detection of Parkinson's disease (PD) still remains a challenge to date. Although studies have previously reported subtle motor function abnormalities in early PD patients, it is unclear whether such clinical signs can be better detected while patients are concurrently performing a cognitive task, and whether they can be useful in predicting patients' clinical conversion state. Seventy-two right-handed participants (40 drug-naive patients with idiopathic unilateral PD and 32 age-matched healthy controls) were enrolled in this study. All participants were asked to perform the Purdue Pegboard test (PPT) either alone (single-task condition) or during a concurrent mental subtraction-by-3 task (dual-task condition). A 4-year telephone follow-up was later conducted to determine whether PD patients converted to bilateral signs. We found that PD patients showed a significant reduction in dexterity on the PPT compared to the controls in both single- and dual-task conditions. Yet patients' performance in the dual-task condition revealed a greater interference effect when patients performed the task with their right hand than with their left hand. PPT also revealed reasonable discriminative ability for prediagnosing PD. However, dual-tasking did not have added value in differentiating early patients and controls. At follow-up, the baseline PPT performance of the asymptomatic hands was positively correlated with time to convert from unilaterally to bilaterally affected states (r = 0.62, P = 0.031). Together, these findings suggest that PPT can serve as a useful auxiliary tool in evaluating early PD, and shed light on the neuroplasticity mechanism of fine motor deficit at this very early stage.
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Affiliation(s)
- Xiaojuan Dan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Jia Liu
- Department of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Julien Doyon
- McConnell Brain Imaging Center, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Yongtao Zhou
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Jinghong Ma
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China
| | - Piu Chan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Key Laboratory on Parkinson's Disease of Beijing, Beijing, China.,Department of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China.,Beijing Institute for Brain Disorders Parkinson's Disease Center, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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14
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Acaröz Candan S, Özcan TŞ. Dual-task interference during hand dexterity is a predictor for activities of daily living performance in Parkinson's disease. Parkinsonism Relat Disord 2019; 66:100-104. [DOI: 10.1016/j.parkreldis.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 12/11/2022]
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15
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de Vries NM, Smilowska K, Hummelink J, Abramiuc B, van Gilst MM, Bloem BR, de With PHN, Overeem S. Exploring the Parkinson patients' perspective on home-based video recording for movement analysis: a qualitative study. BMC Neurol 2019; 19:71. [PMID: 31029123 PMCID: PMC6486968 DOI: 10.1186/s12883-019-1301-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background Parkinson’s disease is a complex neurological disorder characterized by a variety of motor- as well as non-motor symptoms. Video-based technology (using continuous home monitoring) may bridge the gap between the fragmented in-clinic observations and the need for a comprehensive understanding of the progression and fluctuation of disease symptoms. However, continuous monitoring can be intrusive, raising questions about feasibility as well as potential privacy violation. Methods We used a grounded theory approach in which we performed semi-structured interviews to explore the opinion of Parkinson’s patients on home-based video recording used for vision-based movement analysis. Results Saturation was reached after sixteen interviews. Three first–level themes were identified that specify the conditions required to perform continuous video monitoring: Camera recording (e.g. being able to turn off the camera), privacy protection (e.g. patient’s behaviour, patient’s consent, camera location) and perceived motivation (e.g. contributing to science or clinical practice). Conclusion Our findings show that Parkinson patients’ perception of continuous, home-based video recording is positive, when a number of requirements are taken into account. This knowledge will enable us to start using this technology in future research and clinical practice in order to better understand the disease and to objectify outcomes in the patients’ own homes.
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Affiliation(s)
- N M de Vries
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - K Smilowska
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - J Hummelink
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - B Abramiuc
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - M M van Gilst
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
| | - B R Bloem
- Department of Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - P H N de With
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands
| | - S Overeem
- Eindhoven University of Technology, Electrical Engineering, Eindhoven, the Netherlands.,Eindhoven University of Technology, Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands
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16
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Bryant MS, Hou JGG, Workman CD, Protas EJ. Predictive ability of functional tests for postural instability and gait difficulty in Parkinson's disease. Eur Geriatr Med 2018; 9:83-88. [PMID: 34654285 DOI: 10.1007/s41999-017-0021-3] [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: 09/28/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022]
Abstract
The objective of this study is to identify clinical determinants for postural instability and gait difficulty in persons with Parkinson's disease (PD). Ninety-one persons (68 males; 74.7%) with PD were studied. Their mean age was 68.73 ± 8.74 years. The average time since diagnosis was 7.69 ± 5.23 years. The average Hoehn and Yahr stage was 2.43 ± 0.44. Age, gender, disease duration, disease severity and motor impairment were recorded. Participants were asked to perform timed clinical mobility tests that included a 5-step test, turns, forward walk, backward walk, and a sideways walk. The mobility tests were investigated for their contribution to predict the postural instability and gait difficulty (PIGD) score (falling, freezing, walking, gait and postural stability) of the Unified Parkinson Disease Rating Scale (UPDRS). PIGD score was significantly correlated with age, disease duration, Hoehn and Yahr score, comorbidity, UPDRS motor score, gait speed of forward, backward and sideways walks, and time to turn. PIGD score was marginally significantly correlated with timed 5-step test. After controlling for age, disease duration, disease severity, comorbidity, and motor impairment, sideway gait speed (β = - 0.335; p = 0.024), timed 5-step test (β = - 0.397; p = 0.003) and time to turn (β = 0.289; p = 0.028) significantly predicted postural instability and gait difficulty. Walking sideways, 5-step test, and turning are significant predictors of PIGD score. These simple mobility tests can be quickly applied in clinical practice to determine postural instability and gait problems in persons with PD.
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Affiliation(s)
- Mon S Bryant
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Mail Code 153, Houston, TX, 77030, USA. .,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. .,School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA.
| | - Jyh-Gong Gabriel Hou
- Lehigh Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Craig D Workman
- Research Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Mail Code 153, Houston, TX, 77030, USA.,Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Elizabeth J Protas
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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17
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Manor B, Yu W, Zhu H, Harrison R, Lo OY, Lipsitz L, Travison T, Pascual-Leone A, Zhou J. Smartphone App-Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability. JMIR Mhealth Uhealth 2018; 6:e36. [PMID: 29382625 PMCID: PMC5811655 DOI: 10.2196/mhealth.8815] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and "dual-task" walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings. OBJECTIVE The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings. METHODS We created an iPhone app that used the phone's motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user's pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard-instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times-a clinically meaningful metric of locomotor control-from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses. RESULTS Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r2=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r2=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94). CONCLUSIONS The iPhone app we created enabled valid and reliable assessment of stride timing-with the smartphone in the pocket-during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations.
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Affiliation(s)
- Brad Manor
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Wanting Yu
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Hao Zhu
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Rachel Harrison
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - On-Yee Lo
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Lewis Lipsitz
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Thomas Travison
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Interventional Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Junhong Zhou
- Hebrew SeniorLife Institute for Aging Research, Harvard Medical School, Roslindale, MA, United States
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18
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Historical perspective: The pros and cons of conventional outcome measures in Parkinson's disease. Parkinsonism Relat Disord 2018; 46 Suppl 1:S47-S52. [DOI: 10.1016/j.parkreldis.2017.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/29/2017] [Indexed: 11/18/2022]
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19
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Heinzel S, Bernhard FP, Roeben B, Nussbaum S, Heger T, Martus P, Hobert MA, Maetzler W, Berg D. Progression markers of motor deficits in Parkinson's disease: A biannual 4-year prospective study. Mov Disord 2017; 32:1254-1256. [PMID: 28681985 DOI: 10.1002/mds.27062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/18/2017] [Accepted: 05/01/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Clinic of Tuebingen, Tuebingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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20
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Cerebellar theta burst stimulation does not improve freezing of gait in patients with Parkinson's disease. J Neurol 2017; 264:963-972. [PMID: 28382420 PMCID: PMC5413528 DOI: 10.1007/s00415-017-8479-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Abstract
Freezing of gait (FOG) in Parkinson’s disease (PD) likely results from dysfunction within a complex neural gait circuitry involving multiple brain regions. Herein, cerebellar activity is increased in patients compared to healthy subjects. This cerebellar involvement has been proposed to be compensatory. We hypothesized that patients with FOG would have a reduced ability to recruit the cerebellum to compensate for dysfunction in other brain areas. In this study cerebellar activity was modified unilaterally by either excitatory or inhibitory theta burst stimulation (TBS), applied during two separate sessions. The ipsilateral cerebellar hemisphere, corresponding to the body side most affected by PD, was stimulated. Seventeen patients with PD showing ‘off’ state FOG participated. The presence of FOG was verified objectively upon inclusion. We monitored gait and bimanual rhythmic upper limb movements before and directly after TBS. Gait was evaluated with a FOG-provoking protocol, including rapid 360° turns and a 10-m walking test with small fast steps. Upper limb movement performance was evaluated with a repetitive finger flexion–extension task. TBS did not affect the amount of freezing during walking or finger tapping. However, TBS did increase gait speed when walking with small steps, and decreased gait speed when walking as fast as possible with a normal step size. The changes in gait speed were not accompanied by changes in corticospinal excitability of M1. Unilateral cerebellar TBS did not improve FOG. However, changes in gait speed were found which suggests a role of the cerebellum in PD.
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Mancini M, Horak FB. Potential of APDM mobility lab for the monitoring of the progression of Parkinson's disease. Expert Rev Med Devices 2017; 13:455-62. [PMID: 26872510 DOI: 10.1586/17434440.2016.1153421] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
APDM's Mobility Lab system provides portable, validated, reliable, objective measures of balance and gait that are sensitive to Parkinson's disease (PD). In this review, we describe the potential of objective measures collected with the Mobility Lab system for tracking longitudinal progression of PD. Balance and gait are among the most important motor impairments influencing quality of life for people with PD. Mobility Lab uses body-worn, Opal sensors on the legs, trunk and arms during prescribed tasks, such as the instrumented Get Up and Go test or quiet stance, to quickly quantify the quality of balance and gait in the clinical environment. The same Opal sensors can be sent home with patients to continuously monitor the quality of their daily activities. Objective measures have the potential to monitor progression of mobility impairments in PD throughout its course to improve patient care and accelerate clinical trials.
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Affiliation(s)
- Martina Mancini
- a Veterans Affairs Portland Healthcare System (VAPORHCS) , Portland , OR , USA.,b Department of Neurology , Oregon Health & Science University , Portland , OR , USA
| | - Fay B Horak
- a Veterans Affairs Portland Healthcare System (VAPORHCS) , Portland , OR , USA.,b Department of Neurology , Oregon Health & Science University , Portland , OR , USA
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22
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Tests of manual dexterity and speed in Parkinson’s disease: Not all measure the same. Parkinsonism Relat Disord 2016; 28:118-23. [DOI: 10.1016/j.parkreldis.2016.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 04/29/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022]
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Zietsma RC, Borgemeester RWK, van Laar T, Maurits NM. Graphical Tasks to Measure Upper Limb Function in Patients With Parkinson's Disease: Validity and Response to Dopaminergic Medication. IEEE J Biomed Health Inform 2015; 21:283-289. [PMID: 26625435 DOI: 10.1109/jbhi.2015.2503802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The most widely used method to assess motor functioning in Parkinson's disease (PD) patients is the unified Parkinson's disease rating scale-III (UPDRS-III). The UPDRS-III has limited ability to detect subtle changes in motor symptoms. Alternatively, graphical tasks can be used to provide objective measures of upper limb motor dysfunction. This study investigated the validity of such graphical tasks to assess upper limb function in PD patients and their ability to detect subtle changes in performance. Fourteen PD patients performed graphical tasks before and after taking dopaminergic medication. Graphical tasks included figure tracing, writing, and a modified Fitts' task. The Purdue pegboard test was performed to validate these graphical tasks. Movement time (MT), writing size, and the presence of tremor were assessed. MT on the graphical tasks correlated significantly with performance on the Purdue pegboard test (Spearman's ρ > 0.65; p < 0.05). MT decreased significantly after the intake of dopaminergic medication. Tremor power decreased after taking dopaminergic medication in most PD patients who suffered from tremor. Writing size did not correlate with performance on the Purdue pegboard test, nor did it change after taking medication. Our set of graphical tasks is valid to assess upper limb function in PD patients. MT proved to be the most useful measure for this purpose. The response on dopaminergic medication was optimally reflected by an improved MT on the graphical tasks in combination with a decreased tremor power, whereas writing size did not respond to dopaminergic treatment.
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van Gilst MM, van Mierlo P, Bloem BR, Overeem S. Quantitative Motor Performance and Sleep Benefit in Parkinson Disease. Sleep 2015; 38:1567-73. [PMID: 25902811 DOI: 10.5665/sleep.5048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/26/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Many people with Parkinson disease experience "sleep benefit": temporarily improved mobility upon awakening. Here we used quantitative motor tasks to assess the influence of sleep on motor functioning in Parkinson disease. DESIGN Eighteen Parkinson patients with and 20 without subjective sleep benefit and 20 healthy controls participated. Before and directly after a regular night sleep and an afternoon nap, subjects performed the timed pegboard dexterity task and quantified finger tapping task. Subjective ratings of motor functioning and mood/vigilange were included. Sleep was monitored using polysomnography. RESULTS On both tasks, patients were overall slower than healthy controls (night: F2,55 = 16.938, P < 0.001; nap: F2,55 = 15.331, P < 0.001). On the pegboard task, there was a small overall effect of night sleep (F1,55 = 9.695, P = 0.003); both patients and controls were on average slightly slower in the morning. However, in both tasks there was no sleep*group interaction for nighttime sleep nor for afternoon nap. There was a modest correlation between the score on the pegboard task and self-rated motor symptoms among patients (rho = 0.233, P = 0.004). No correlations in task performance and mood/vigilance or sleep time/efficiency were found. CONCLUSIONS A positive effect of sleep on motor function is commonly reported by Parkinson patients. Here we show that the subjective experience of sleep benefit is not paralleled by an actual improvement in motor functioning. Sleep benefit therefore appears to be a subjective phenomenon and not a Parkinson-specific reduction in symptoms.
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Affiliation(s)
- Merel M van Gilst
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Sebastiaan Overeem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands.,Sleep Medicine Centre Kempenhaeghe, Heeze, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands
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25
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Fujishiro H, Nakamura S, Sato K, Iseki E. Prodromal dementia with Lewy bodies. Geriatr Gerontol Int 2015; 15:817-26. [PMID: 25690399 DOI: 10.1111/ggi.12466] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementing disorder after Alzheimer's disease (AD), but there is limited information regarding the prodromal DLB state compared with that of AD. Parkinson's disease (PD) and DLB share common prodromal symptoms with Lewy body disease (LBD), allowing us to use a common strategy for identifying the individuals with an underlying pathophysiology of LBD. Dysautonomia, olfactory dysfunction, rapid eye movement sleep behavior disorder (RBD) and psychiatric symptoms antedate the onset of dementia by years or even decades in patients with DLB. Although RBD is the most potentially accurate prodromal predictor of DLB, disease progression before the onset of dementia could differ between the prodromal DLB state with and without RBD. Experts who specialize in idiopathic RBD and DLB might need communication in order to clarify the clinical relevance of RBD with the disease progression of DLB. The presence of prodromal LBD symptoms or findings of occipital hypoperfusion/hypometabolism helps us to predict the possible pathophysiological process of LBD in non-demented patients. This approach might provide the opportunity for additional neuroimaging, including cardiac (123) I-metaiodobenzylguanidine scintigraphy and dopamine transporter imaging. Although limited radiological findings in patients with prodromal DLB states have been reported, there is now a need for larger clinical multisite studies with pathological verification. The long prodromal phase of DLB provides a critical opportunity for potential intervention with disease-modifying therapy, but only if we are able to clearly identify the diversity in the clinical courses of DLB. In the present article, we reviewed the limited literature regarding the clinical profiles of prodromal DLB.
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Affiliation(s)
- Hiroshige Fujishiro
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kiyoshi Sato
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
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Roberts HC, Syddall HE, Butchart JW, Stack EL, Cooper C, Sayer AA. The Association of Grip Strength With Severity and Duration of Parkinson’s. Neurorehabil Neural Repair 2015; 29:889-96. [DOI: 10.1177/1545968315570324] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Weakness is reported in Parkinson’s but always unadjusted for recognized factors that influence muscle strength such as participants’ age, gender, and body size. This may obscure the true association of Parkinson’s with muscle strength. Objective. To evaluate the relationship between grip strength, Parkinson’s severity, and duration adjusting for these factors. Methods. Age, gender, height, weight, grip strength, Unified Parkinson’s Disease Rating Score (UPDRS) motor score, Hoehn and Yahr (H&Y) stage, disease duration, number of comorbidities and medications, Barthel score, Mini Mental State Examination (MMSE) score, and Malnutrition Universal Screening Tool (MUST) score were recorded. Results. Fifty-seven of 79 (72%) people with Parkinson’s resident in one town were recruited. Age, gender, height, and Parkinson’s severity were the most significant determinants of grip strength. Each unit increase in UPDRS motor score and H&Y stage was associated with lower grip strength in univariate linear regression analyses adjusted for gender: −0.3 kg strength (95% confidence interval = −0.51, −0.09), P = .006 for each additional UPDRS point, and −3.87 kg strength (95% confidence interval = −6.54, −1.21), P = .005 for each additional H&Y stage. Disease duration was not associated with grip strength. In multivariate regression, Parkinson’s severity remained strongly associated with grip strength (UPDRS score P = .09; H&Y stage P = .04). Conclusions. This is the first demonstration that increasing severity of Parkinson’s was associated with weaker grip after adjustment for known influences on muscle strength. Participants’ age, gender, and body size also had a significant impact on strength. Adjustment of reported values for all these factors is essential to allow accurate reporting of grip strength values in intervention trials and comparison between different groups.
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Affiliation(s)
- Helen C. Roberts
- University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Joe W. Butchart
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Avan A. Sayer
- University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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27
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Hubel KA, Reed B, Yund EW, Herron TJ, Woods DL. Computerized measures of finger tapping: effects of hand dominance, age, and sex. Percept Mot Skills 2014; 116:929-52. [PMID: 24175464 DOI: 10.2466/25.29.pms.116.3.929-952] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computerized measures of digit tapping rate were obtained over 3 successive, 10-sec. periods in the right and left index fingers, from a community sample of 1,519 participants (ages 18 to 65 years; 607 men, 912 women). Differences between the dominant and non-dominant hands were found for tapping rate, movement initiation, and button down times, and the decline in tapping rate over the successive, 10-sec. periods. Declines were found in tapping rate in older participants in association with increased intertap variability. Men had higher tapping rates than women in all age ranges. The computerized finger tapping test is an efficient and precise measure of tapping speed and kinetics of potential utility in research and clinical studies of motor performance.
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Affiliation(s)
- Kerry A Hubel
- Human Cognitive Neurophysiology Laboratory, VANCHCS, Martinez, CA 94553, USA
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28
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Rocchi L, Palmerini L, Weiss A, Herman T, Hausdorff JM. Balance Testing With Inertial Sensors in Patients With Parkinson's Disease: Assessment of Motor Subtypes. IEEE Trans Neural Syst Rehabil Eng 2014; 22:1064-71. [DOI: 10.1109/tnsre.2013.2292496] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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29
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Manenti R, Brambilla M, Rosini S, Orizio I, Ferrari C, Borroni B, Cotelli M. Time up and go task performance improves after transcranial direct current stimulation in patient affected by Parkinson's disease. Neurosci Lett 2014; 580:74-7. [DOI: 10.1016/j.neulet.2014.07.052] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 11/16/2022]
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Shefner JM, Mihaila D. Assessment of disease progression and functional benefit in neurodegenerative disease: can we tell the difference? Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:337-43. [PMID: 24918689 DOI: 10.3109/21678421.2014.918150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Therapeutic strategies for neurodegenerative diseases include modalities intended to modulate disease progression as well as those whose intent is to improve or maintain functional capacity. As the search for pharmacodynamic markers has proved elusive, treatment outcomes most commonly reflect patient function. As a result, even when clinical trials show a beneficial effect, the underlying etiology of that benefit can be difficult to determine. This review summarizes recent trials in ALS and Parkinson's disease, with the goal of increasing understanding of how the choice of outcome measures influences what can be concluded from the results. Although most ALS trials have been negative in recent years, outcomes are reviewed in terms of potential conclusions that could have been drawn. Functional benefit has been established in a number of recent trials; however, the outcomes used have lead to uncertainty as to whether specific agents modify disease or alter function. In the absence of specific markers sensitive to alteration of disease specific pathways, the distinction between agents that alter underlying disease versus those that affect function may depend on underlying hypotheses rather than clinical trial results.
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Affiliation(s)
- Jeremy M Shefner
- Department of Neurology, SUNY Upstate Medical University , Syracuse, New York , USA
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31
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Aarts E, Nusselein AAM, Smittenaar P, Helmich RC, Bloem BR, Cools R. Greater striatal responses to medication in Parkinson׳s disease are associated with better task-switching but worse reward performance. Neuropsychologia 2014; 62:390-7. [PMID: 24912070 DOI: 10.1016/j.neuropsychologia.2014.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 01/19/2023]
Abstract
Dopaminergic medication in Parkinson's disease has been proposed to improve cognitive processing by modulating the severely depleted dorsal striatum, while impairing reward processing by modulating the relatively intact ventral striatum. However, there is no direct (neural) evidence for this hypothesis. Here we fill this gap by scanning Parkinson's disease patients (n=15) ON and relatively OFF their dopaminergic medication using functional magnetic resonance imaging. During scanning, patients performed a task that enabled the simultaneous measurement of task-switching and reward-related processing. Brain-behavior correlations revealed that medication-related increases (ON-OFF) in switch-related BOLD signal (switch-repeat) in the dorsomedial striatum were associated, on an individual basis, with improvements in task-switching (i.e. a decreased switch cost). Conversely, medication-related increases (ON-OFF) in reward-related BOLD signal (high-low) in the ventromedial striatum were associated, on an individual basis, with impairments in performance in anticipation of reward (i.e. an increased reward cost). Linear regression analyses demonstrated that the positive relationship between medication-related changes in BOLD and the reward cost was unique to the ventromedial striatum, whereas the negative relationship between medication-related changes in BOLD and the switch cost was not unique to the dorsomedial striatum. These findings extend the dopamine overdose hypothesis, according to which dopamine-induced changes in dorsal and ventral striatal processing lead to cognitive improvement and impairment respectively.
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Affiliation(s)
- Esther Aarts
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Abraham A M Nusselein
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Peter Smittenaar
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Rick C Helmich
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Centre Nijmegen (ParC), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Centre Nijmegen (ParC), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Roshan Cools
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Zackrisson T, Bergquist F, Eklund M, Holmberg B, Thorlin T. The discriminating properties of an optoelectronic movement analysis method in patients with parkinsonism. J Mot Behav 2013; 45:415-22. [PMID: 23972026 DOI: 10.1080/00222895.2013.815152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Several partly overlapping diseases have Parkinsonism as a symptom and tools that may differentiate between these disorders would be helpful. The authors evaluated the discriminating properties of the objective automated posturo-locomotor-manual (PLM) L-DOPA test in regard to health, and the movement disorders Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). A PLM test-retest procedure was performed in healthy controls (n = 37) and results were compared with PLM L-DOPA tests performed by 132 patients with Parkinsonism in intermediate to advanced stages (56 PD, 53 MSA, 23 PSP). The movement time (MT) for the standardized movement and its different components was measured. The discriminating abilities of individual, or combinations of, test variables were determined by forward stepwise multiple logistic regression and evaluated with receiver-operating characteristic (ROC) analysis. Each PLM variable separated healthy persons from patients with Parkinsonism before administration of L-DOPA (area under the curve (AUC) = 0.94-0.99, p < .001 for any separate variable). A combination of (MToff - MTon)/MToff and MTon had the highest ability to separate patients with PD from patients with atypical Parkinsonism (area under the curve = 0.91, p < .001). The PLM test discriminates between healthy controls and patients with Parkinsonism, and between patients with Parkinson's disease and patients with atypical Parkinsonism.
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Affiliation(s)
- Theresa Zackrisson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden.
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Hubel KA, Reed B, Yund EW, Herron TJ, Woods DL. COMPUTERIZED MEASURES OF FINGER TAPPING: EFFECTS OF HAND DOMINANCE, AGE, AND SEX1,2. Percept Mot Skills 2013. [DOI: 10.2466/25.29.pms.116.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Norman KE, Héroux ME. Measures of fine motor skills in people with tremor disorders: appraisal and interpretation. Front Neurol 2013; 4:50. [PMID: 23717299 PMCID: PMC3650669 DOI: 10.3389/fneur.2013.00050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/24/2013] [Indexed: 12/04/2022] Open
Abstract
People with Parkinson's disease, essential tremor, or other movement disorders involving tremor have changes in fine motor skills that are among the hallmarks of these diseases. Numerous measurement tools have been created and other methods devised to measure such changes in fine motor skills. Measurement tools may focus on specific features - e.g., motor skills or dexterity, slowness in movement execution associated with parkinsonian bradykinesia, or magnitude of tremor. Less obviously, some tools may be better suited than others for specific goals such as detecting subtle dysfunction early in disease, revealing aspects of brain function affected by disease, or tracking changes expected from treatment or disease progression. The purpose of this review is to describe and appraise selected measurement tools of fine motor skills appropriate for people with tremor disorders. In this context, we consider the tools' content - i.e., what movement features they focus on. In addition, we consider how measurement tools of fine motor skills relate to measures of a person's disease state or a person's function. These considerations affect how one should select and interpret the results of these tools in laboratory and clinical contexts.
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Affiliation(s)
- Kathleen E. Norman
- School of Rehabilitation Therapy, Queen’s UniversityKingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s UniversityKingston, ON, Canada
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Mancini M, King L, Salarian A, Holmstrom L, McNames J, Horak FB. Mobility Lab to Assess Balance and Gait with Synchronized Body-worn Sensors. ACTA ACUST UNITED AC 2013; Suppl 1:007. [PMID: 24955286 DOI: 10.4172/2155-9538.s1-007] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper is a commentary to introduce how rehabilitation professionals can use a new, body-worn sensor system to obtain objective measures of balance and gait. Current assessments of balance and gait in clinical rehabilitation are largely limited to subjective scales, simple stop-watch measures, or complex, expensive machines not practical or largely available. Although accelerometers and gyroscopes have been shown to accurately quantify many aspects of gait and balance kinematics, only recently a comprehensive, portable system has become available for clinicians. By measuring body motion during tests that clinicians are already performing, such as the Timed Up and Go test (TUG) and the Clinical Test of Sensory Integration for Balance (CITSIB), the additional time for assessment is minimal. By providing instant analysis of balance and gait and comparing a patient's performance to age-matched control values, therapists receive an objective, sensitive screening profile of balance and gait strategies. This motion screening profile can be used to identify mild abnormalities not obvious with traditional clinical testing, measure small changes due to rehabilitation, and design customized rehabilitation programs for each individual's specific balance and gait deficits.
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Affiliation(s)
- Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Laurie King
- Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Arash Salarian
- Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | | | | | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA ; APDM Inc, Portland, OR 97201 USA
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ISway: a sensitive, valid and reliable measure of postural control. J Neuroeng Rehabil 2012; 9:59. [PMID: 22913719 PMCID: PMC3481400 DOI: 10.1186/1743-0003-9-59] [Citation(s) in RCA: 313] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 08/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians need a practical, objective test of postural control that is sensitive to mild neurological disease, shows experimental and clinical validity, and has good test-retest reliability. We developed an instrumented test of postural sway (ISway) using a body-worn accelerometer to offer an objective and practical measure of postural control. METHODS We conducted two separate studies with two groups of subjects. Study I: sensitivity and experimental concurrent validity. Thirteen subjects with early, untreated Parkinson's disease (PD) and 12 age-matched control subjects (CTR) were tested in the laboratory, to compare sway from force-plate COP and inertial sensors. Study II: test-retest reliability and clinical concurrent validity. A different set of 17 early-to-moderate, treated PD (tested ON medication), and 17 age-matched CTR subjects were tested in the clinic to compare clinical balance tests with sway from inertial sensors. For reliability, the sensor was removed, subjects rested for 30 min, and the protocol was repeated. Thirteen sway measures (7 time-domain, 5 frequency-domain measures, and JERK) were computed from the 2D time series acceleration (ACC) data to determine the best metrics for a clinical balance test. RESULTS Both center of pressure (COP) and ACC measures differentiated sway between CTR and untreated PD. JERK and time-domain measures showed the best test-retest reliability (JERK ICC was 0.86 in PD and 0.87 in CTR; time-domain measures ICC ranged from 0.55 to 0.84 in PD and from 0.60 to 0.89 in CTR). JERK, all but one time-domain measure, and one frequency measure were significantly correlated with the clinical postural stability score (r ranged from 0.50 to 0.63, 0.01 < p < 0.05). CONCLUSIONS Based on these results, we recommend a subset of the most sensitive, reliable, and valid ISway measures to characterize posture control in PD: 1) JERK, 2) RMS amplitude and mean velocity from the time-domain measures, and 3) centroidal frequency as the best frequency measure, as valid and reliable measures of balance control from ISway.
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The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease. J Neurol Phys Ther 2012; 35:157-63. [PMID: 22020457 DOI: 10.1097/npt.0b013e318235da08] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Pegboard tests of hand dexterity are commonly used in clinical settings to assess upper extremity function in various populations. For individuals with Parkinson disease (PD), the clinical utility of pegboard tests has not been fully evaluated. Our purpose was to examine the commercially available 9-Hole Peg Test (9HPT) using a large sample of individuals with PD to determine average values, test-retest reliability, and factors predictive of 9HPT performance. METHODS A total of 262 participants with PD (67% men, Hoehn & Yahr stage = 2.3 ± 0.7) completed the 9HPT along with a battery of other tests including the Movement Disorder Society Unified PD Rating Scale-Motor Subscale III and Freezing of Gait Questionnaire. RESULTS Average time to complete the 9HPT was 31.4 ± 15.7 s with the dominant and 32.2 ± 12.4 s with the nondominant hand. Test-retest reliability of 2 trials performed with the same hand was high (dominant ICC2,1 = 0.88, nondominant ICC2,1 = 0.91). Women performed the test significantly faster than men, and nonfreezers significantly faster than freezers. For either hand, age, bradykinesia, and freezing of gait scores individually predicted significant portions of the variance in 9HPT time. Sex also was a significant predictor, but for the nondominant hand only. Tremor and rigidity did not predict performance. DISCUSSION AND CONCLUSIONS The 9HPT appears to be a clinically useful measure for assessing upper extremity function in individuals with PD. The 9HPT has advantages over previously used methods including standardization, known normative values for healthy controls, commercial availability, transportability, and ease of administration.
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Maetzler W, Hausdorff JM. Motor signs in the prodromal phase of Parkinson's disease. Mov Disord 2012; 27:627-33. [PMID: 22437964 DOI: 10.1002/mds.24973] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 11/06/2022] Open
Abstract
Relatively subtle deterioration of the motor system likely occurs well before the patient meets established motor criteria for a clinical diagnosis of Parkinson's disease; ie, the occurrence of at least 2 of the cardinal motor deficits: bradykinesia, rigidity, tremor, and/or postural instability. Powerful compensatory mechanisms may mask these clinical symptoms and make them difficult to identify and evaluate in the earliest stages of the illness. This review summarizes our current knowledge of motor signs that are thought to occur in the prodromal phase of Parkinson's disease and suggests how motor assessment batteries could be designed to detect these subclinical motor deficits with a high degree of accuracy and sensitivity.
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Affiliation(s)
- Walter Maetzler
- Center of Neurology, Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
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Abstract
To date, no pharmacological agent has convincingly demonstrated the ability to slow the progression of Parkinson disease (PD). The development of treatments that slow down the progressive degeneration of the nigrostriatal dopaminergic system (true neuroprotection), which is ultimately responsible for the patients' functional decline, has become one of the basic goals of PD research. In this review, we have attempted to analyze the role of different methods that measure PD severity (basically, clinical scales, timed tests, and neuroimaging techniques) in the evaluation of the "neuroprotection" provided by different types of treatment for the disease, on the basis of clinical evidence.
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Cancela J, Ayán C, Gutiérrez-Santiago A, Prieto I, Varela S. The Senior Fitness Test as a functional measure in Parkinson’s disease: A pilot study. Parkinsonism Relat Disord 2012; 18:170-3. [DOI: 10.1016/j.parkreldis.2011.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 09/10/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
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Gerlach M, Maetzler W, Broich K, Hampel H, Rems L, Reum T, Riederer P, Stöffler A, Streffer J, Berg D. Biomarker candidates of neurodegeneration in Parkinson's disease for the evaluation of disease-modifying therapeutics. J Neural Transm (Vienna) 2012; 119:39-52. [PMID: 21755462 PMCID: PMC3250615 DOI: 10.1007/s00702-011-0682-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/21/2011] [Indexed: 12/16/2022]
Abstract
Reliable biomarkers that can be used for early diagnosis and tracking disease progression are the cornerstone of the development of disease-modifying treatments for Parkinson's disease (PD). The German Society of Experimental and Clinical Neurotherapeutics (GESENT) has convened a Working Group to review the current status of proposed biomarkers of neurodegeneration according to the following criteria and to develop a consensus statement on biomarker candidates for evaluation of disease-modifying therapeutics in PD. The criteria proposed are that the biomarker should be linked to fundamental features of PD neuropathology and mechanisms underlying neurodegeneration in PD, should be correlated to disease progression assessed by clinical rating scales, should monitor the actual disease status, should be pre-clinically validated, and confirmed by at least two independent studies conducted by qualified investigators with the results published in peer-reviewed journals. To date, available data have not yet revealed one reliable biomarker to detect early neurodegeneration in PD and to detect and monitor effects of drug candidates on the disease process, but some promising biomarker candidates, such as antibodies against neuromelanin, pathological forms of α-synuclein, DJ-1, and patterns of gene expression, metabolomic and protein profiling exist. Almost all of the biomarker candidates were not investigated in relation to effects of treatment, validated in experimental models of PD and confirmed in independent studies.
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Affiliation(s)
- Manfred Gerlach
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Füchsleinstrasse 15, 97080 Würzburg, Germany.
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Nicolai S, Mirelman A, Herman T, Zijlstra A, Mancini M, Becker C, Lindemann U, Berg D, Maetzler W. Improvement of balance after audio-biofeedback. A 6-week intervention study in patients with progressive supranuclear palsy. Z Gerontol Geriatr 2011; 43:224-8. [PMID: 20814797 DOI: 10.1007/s00391-010-0125-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease with no sufficient treatment options to date. The most devastating symptom is the loss of balance with consecutive falls. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the effects of this training in PSP patients. Eight PSP patients were included into an uncontrolled 6-week intervention trial. The focus of the training was the improvement of posture and dynamic balance by using audio-biofeedback. The device was well accepted. No adverse events occurred. A significant improvement in the Berg Balance Scale was observed (T2 vs. T1, p=0.016), which remained significant at the 4-week follow-up (T3 vs. T1, p=0.008). Significant improvement of the Parkinson's disease questionnaire was demonstrated. No significant changes were found in the Timed Up-and-Go Test, the Five Chair Rise Test, and in specific clinical scales. To our knowledge, the present study is the first to demonstrate that audio-biofeedback training with PSP patients is associated with improvements of balance and psychosocial aspects.
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Affiliation(s)
- S Nicolai
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376 Stuttgart.
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Haaxma CA, Bloem BR, Overeem S, Borm GF, Horstink MWIM. Timed motor tests can detect subtle motor dysfunction in early Parkinson's disease. Mov Disord 2010; 25:1150-6. [PMID: 20629141 DOI: 10.1002/mds.23100] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Early diagnosis of Parkinson's disease (PD) is important for putative neuroprotective therapies to be initiated in the earliest stage of the disease. We investigated whether a previously validated timed motor test (TMT) battery could detect subtle motor dysfunction in early PD patients and even in clinically unaffected limbs of strictly hemiparkinsonian patients. We assessed 107 PD patients (symptom duration <or=2 years; dopa-naive) and 100 healthy, age-matched controls with eight simple TMTs based on aspects of (a) walking, (b) writing, (c) single and double-handed pegboard performance, (d) finger tapping, and (e) diadochokinesis. We evaluated the ability of individual and combined TMTs to discriminate patients from controls using ROC curves. Second, we investigated whether these TMTs could identify motor dysfunction of the clinically unaffected limb in 42 strictly hemiparkinsonian patients. The pegboard dexterity test had the best ROC curve (AUC 0.97; 95% sensitivity, 89% specificity) for patients versus controls. It retained reasonable accuracy when testing the clinically unaffected limb of hemiparkinsonian patients versus the mean of right and left-hand scores in controls (AUC 0.73). The pegboard dexterity test is a sensitive and inexpensive instrument to detect motor dysfunction in early PD. Therefore, it may be worth evaluating as a diagnostic tool in everyday clinical practice to assess patients with early symptomatic PD, or as part of a more elaborate screening battery in a defined population at risk.
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Affiliation(s)
- Charlotte A Haaxma
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Haaxma C, Helmich R, Borm G, Kappelle A, Horstink M, Bloem B. Side of symptom onset affects motor dysfunction in Parkinson's disease. Neuroscience 2010; 170:1282-5. [DOI: 10.1016/j.neuroscience.2010.07.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/21/2010] [Accepted: 07/15/2010] [Indexed: 12/16/2022]
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Wylie SA, Ridderinkhof KR, Elias WJ, Frysinger RC, Bashore TR, Downs KE, van Wouwe NC, van den Wildenberg WPM. Subthalamic nucleus stimulation influences expression and suppression of impulsive behaviour in Parkinson's disease. ACTA ACUST UNITED AC 2010; 133:3611-24. [PMID: 20861152 DOI: 10.1093/brain/awq239] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Past studies show beneficial as well as detrimental effects of subthalamic nucleus deep-brain stimulation on impulsive behaviour. We address this paradox by investigating individuals with Parkinson's disease treated with subthalamic nucleus stimulation (n = 17) and healthy controls without Parkinson's disease (n = 17) on performance in a Simon task. In this reaction time task, conflict between premature response impulses and goal-directed action selection is manipulated. We applied distributional analytic methods to separate the strength of the initial response impulse from the proficiency of inhibitory control engaged subsequently to suppress the impulse. Patients with Parkinson's disease were tested when stimulation was either turned on or off. Mean conflict interference effects did not differ between controls and patients, or within patients when stimulation was on versus off. In contrast, distributional analyses revealed two dissociable effects of subthalamic nucleus stimulation. Fast response errors indicated that stimulation increased impulsive, premature responding in high conflict situations. Later in the reaction process, however, stimulation improved the proficiency with which inhibitory control was engaged to suppress these impulses selectively, thereby facilitating selection of the correct action. This temporal dissociation supports a conceptual framework for resolving past paradoxical findings and further highlights that dynamic aspects of impulse and inhibitory control underlying goal-directed behaviour rely in part on neural circuitry inclusive of the subthalamic nucleus.
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Affiliation(s)
- Scott A Wylie
- Neurology Department, University of Virginia Health Systems, Charlottesville, VA 22908, USA.
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Lee MS, Lyoo CH, Lee MJ, Sim J, Cho H, Choi YH. Impaired finger dexterity in patients with parkinson's disease correlates with discriminative cutaneous sensory dysfunction. Mov Disord 2010; 25:2531-5. [DOI: 10.1002/mds.23304] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Macleod AD, Counsell CE. Timed tests of motor function in Parkinson’s disease. Parkinsonism Relat Disord 2010; 16:442-6. [DOI: 10.1016/j.parkreldis.2010.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 04/01/2010] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
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Chung KA, Lobb BM, Nutt JG, McNames J, Horak F. Objective measurement of dyskinesia in Parkinson's disease using a force plate. Mov Disord 2010; 25:602-8. [PMID: 20213818 DOI: 10.1002/mds.22856] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Clinical investigation of levodopa-induced dyskinesia (LID) in Parkinson's disease (PD) is limited because of lack of objective measurements and no consensus on use of a standard measuring tool. Currently, clinical trials use subject-completed diaries of dyskinesia throughout the day or investigator-administered clinical rating scales. An objective and valid method of measuring LID would reduce bias, variability, and decrease the time and number needed in trials of potential anti-dyskinetic agents. We have investigated using a force plate under standing subjects, which records movement of the center of pressure (CoP) to quantify LID over a levodopa (L-dopa) cycle. Twenty-two PD subjects (15 with LID, 7 without LID) admitted to an inpatient research facility had their PD meds withheld overnight, followed by a 2 hours intravenous L-dopa infusion the next day. The root mean squared of the velocity in the anterior-posterior direction (RMSV) derived from an analysis of the CoP, and, the modified Abnormal Involuntary Movement Scale (mAIMS) were performed repeatedly for 6 hours, initially as subjects were OFF before the infusion, through infusion until OFF again. There was a high correlation between the area under the curve (AUC) of the mAIMS and the RMSV within and between subjects. As a measure of LID, RMSV had excellent validity and reliability between subjects, and using a force plate was feasible. Sensitivity to changes in LID was initially demonstrated but should be repeated. Thus, CoP recordings on a force plate can objectively quantify LID in PD and may be very useful in clinical trials or other investigations of dyskinesia.
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Affiliation(s)
- Kathryn A Chung
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
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Joint CA, Fletcher C, Foxcroft D, Aziz TZ. The Relationship Between Self-Perception of Ability and Actual Ability in Parkinsonian Patients Performing Motor Tasks. J Neurosci Nurs 2010. [DOI: 10.1097/jnn.0b013e3181ce5b57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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