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Manes JL, Bullock L, Meier AM, Turner RS, Richardson RM, Guenther FH. A neurocomputational view of the effects of Parkinson's disease on speech production. Front Hum Neurosci 2024; 18:1383714. [PMID: 38812472 PMCID: PMC11133703 DOI: 10.3389/fnhum.2024.1383714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
The purpose of this article is to review the scientific literature concerning speech in Parkinson's disease (PD) with reference to the DIVA/GODIVA neurocomputational modeling framework. Within this theoretical view, the basal ganglia (BG) contribute to several different aspects of speech motor learning and execution. First, the BG are posited to play a role in the initiation and scaling of speech movements. Within the DIVA/GODIVA framework, initiation and scaling are carried out by initiation map nodes in the supplementary motor area acting in concert with the BG. Reduced support of the initiation map from the BG in PD would result in reduced movement intensity as well as susceptibility to early termination of movement. A second proposed role concerns the learning of common speech sequences, such as phoneme sequences comprising words; this view receives support from the animal literature as well as studies identifying speech sequence learning deficits in PD. Third, the BG may play a role in the temporary buffering and sequencing of longer speech utterances such as phrases during conversational speech. Although the literature does not support a critical role for the BG in representing sequence order (since incorrectly ordered speech is not characteristic of PD), the BG are posited to contribute to the scaling of individual movements in the sequence, including increasing movement intensity for emphatic stress on key words. Therapeutic interventions for PD have inconsistent effects on speech. In contrast to dopaminergic treatments, which typically either leave speech unchanged or lead to minor improvements, deep brain stimulation (DBS) can degrade speech in some cases and improve it in others. However, cases of degradation may be due to unintended stimulation of efferent motor projections to the speech articulators. Findings of spared speech after bilateral pallidotomy appear to indicate that any role played by the BG in adult speech must be supplementary rather than mandatory, with the sequential order of well-learned sequences apparently represented elsewhere (e.g., in cortico-cortical projections).
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Latané Bullock
- Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Andrew M. Meier
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Robert S. Turner
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
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Manes JL, Kurani AS, Herschel E, Roberts AC, Tjaden K, Parrish T, Corcos DM. Premotor cortex is hypoactive during sustained vowel production in individuals with Parkinson's disease and hypophonia. Front Hum Neurosci 2023; 17:1250114. [PMID: 37941570 PMCID: PMC10629592 DOI: 10.3389/fnhum.2023.1250114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Hypophonia is a common feature of Parkinson's disease (PD); however, the contribution of motor cortical activity to reduced phonatory scaling in PD is still not clear. Methods In this study, we employed a sustained vowel production task during functional magnetic resonance imaging to compare brain activity between individuals with PD and hypophonia and an older healthy control (OHC) group. Results When comparing vowel production versus rest, the PD group showed fewer regions with significant BOLD activity compared to OHCs. Within the motor cortices, both OHC and PD groups showed bilateral activation of the laryngeal/phonatory area (LPA) of the primary motor cortex as well as activation of the supplementary motor area. The OHC group also recruited additional activity in the bilateral trunk motor area and right dorsal premotor cortex (PMd). A voxel-wise comparison of PD and HC groups showed that activity in right PMd was significantly lower in the PD group compared to OHC (p < 0.001, uncorrected). Right PMd activity was positively correlated with maximum phonation time in the PD group and negatively correlated with perceptual severity ratings of loudness and pitch. Discussion Our findings suggest that hypoactivation of PMd may be associated with abnormal phonatory control in PD.
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Ajay S. Kurani
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, United States
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Ellen Herschel
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
| | - Angela C. Roberts
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Canadian Centre for Activity and Aging, Western University, London, ON, Canada
- Department of Computer Science, Western University, London, ON, Canada
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Todd Parrish
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
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Wiesman AI, Donhauser PW, Degroot C, Diab S, Kousaie S, Fon EA, Klein D, Baillet S. Aberrant neurophysiological signaling associated with speech impairments in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:61. [PMID: 37059749 PMCID: PMC10104849 DOI: 10.1038/s41531-023-00495-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/16/2023] [Indexed: 04/16/2023] Open
Abstract
Difficulty producing intelligible speech is a debilitating symptom of Parkinson's disease (PD). Yet, both the robust evaluation of speech impairments and the identification of the affected brain systems are challenging. Using task-free magnetoencephalography, we examine the spectral and spatial definitions of the functional neuropathology underlying reduced speech quality in patients with PD using a new approach to characterize speech impairments and a novel brain-imaging marker. We found that the interactive scoring of speech impairments in PD (N = 59) is reliable across non-expert raters, and better related to the hallmark motor and cognitive impairments of PD than automatically-extracted acoustical features. By relating these speech impairment ratings to neurophysiological deviations from healthy adults (N = 65), we show that articulation impairments in patients with PD are associated with aberrant activity in the left inferior frontal cortex, and that functional connectivity of this region with somatomotor cortices mediates the influence of cognitive decline on speech deficits.
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Affiliation(s)
- Alex I Wiesman
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Peter W Donhauser
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
- Ernst Strüngmann Institute for Neuroscience, Frankfurt, Germany
| | - Clotilde Degroot
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Sabrina Diab
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Shanna Kousaie
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Edward A Fon
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada
| | - Denise Klein
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada.
- Center for Research on Brain, Language and Music, McGill University, Montreal, QC, Canada.
| | - Sylvain Baillet
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montreal, QC, Canada.
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Chung JW, Bower AE, Malik I, Martello JP, Knight CA, Jeka JJ, Burciu RG. Imaging the lower limb network in Parkinson's disease. Neuroimage Clin 2023; 38:103399. [PMID: 37058977 PMCID: PMC10131075 DOI: 10.1016/j.nicl.2023.103399] [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] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Despite the significant impact of lower limb symptoms on everyday life activities in Parkinson's disease (PD), knowledge of the neural correlates of lower limb deficits is limited. OBJECTIVE We ran an fMRI study to investigate the neural correlates of lower limb movements in individuals with and without PD. METHODS Participants included 24 PD and 21 older adults who were scanned while performing a precisely controlled isometric force generation task by dorsiflexing their ankle. A novel MRI-compatible ankle dorsiflexion device that limits head motion during motor tasks was used. The PD were tested on their more affected side, whereas the side in controls was randomized. Importantly, PD were tested in the off-state, following overnight withdrawal from antiparkinsonian medication. RESULTS The foot task revealed extensive functional brain changes in PD compared to controls, with reduced fMRI signal during ankle dorsiflexion within the contralateral putamen and M1 foot area, and ipsilateral cerebellum. The activity of M1 foot area was negatively correlated with the severity of foot symptoms based on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III). CONCLUSION Overall, current findings provide new evidence of brain changes underlying motor symptoms in PD. Our results suggest that pathophysiology of lower limb symptoms in PD appears to involve both the cortico-basal ganglia and cortico-cerebellar motor circuits.
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Affiliation(s)
- Jae Woo Chung
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Abigail E Bower
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Ibrahim Malik
- Center for Biomedical & Brain Imaging, University of Delaware, Newark, DE, United States
| | - Justin P Martello
- Department of Neurosciences, Christiana Care Health System, Newark, DE, United States
| | - Christopher A Knight
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States
| | - John J Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States
| | - Roxana G Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States; Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States.
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Tykalova T, Novotny M, Ruzicka E, Dusek P, Rusz J. Short-term effect of dopaminergic medication on speech in early-stage Parkinson's disease. NPJ Parkinsons Dis 2022; 8:22. [PMID: 35256614 PMCID: PMC8901688 DOI: 10.1038/s41531-022-00286-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
The effect of dopaminergic medication on speech has rarely been examined in early-stage Parkinson’s disease (PD) and the respective literature is inconclusive and limited by inappropriate design with lack of PD control group. The study aims to examine the short-term effect of dopaminergic medication on speech in PD using patients with good motor responsiveness to levodopa challenge compared to a control group of PD patients with poor motor responsiveness. A total of 60 early-stage PD patients were investigated before (OFF) and after (ON) acute levodopa challenge and compared to 30 age-matched healthy controls. PD patients were categorised into two clinical subgroups (PD responders vs. PD nonresponders) according to the comparison of their motor performance based on movement disorder society-unified Parkinson’s disease rating scale, part III. Seven distinctive parameters of hypokinetic dysarthria were examined using quantitative acoustic analysis. We observed increased monopitch (p > 0.01), aggravated monoloudness (p > 0.05) and longer duration of stop consonants (p > 0.05) in PD compared to healthy controls, confirming the presence of hypokinetic dysarthria in early PD. No speech alterations from OFF to ON state were revealed in any of the two PD groups and speech dimensions investigated including monopitch, monoloudness, imprecise consonants, harsh voice, slow sequential motion rates, articulation rate, or inappropriate silences, although a subgroup of PD responders manifested obvious improvement in motor function after levodopa intake (p > 0.001). Since the short-term usage of levodopa does not easily affect voice and speech performance in PD, speech assessment may provide a medication state-independent motor biomarker of PD.
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Affiliation(s)
- Tereza Tykalova
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | - Michal Novotny
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.,Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Rusz J, Tykalova T, Novotny M, Zogala D, Sonka K, Ruzicka E, Dusek P. Defining Speech Subtypes in De Novo Parkinson Disease: Response to Long-term Levodopa Therapy. Neurology 2021; 97:e2124-e2135. [PMID: 34607922 DOI: 10.1212/wnl.0000000000012878] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy. METHODS We recorded speech data from a total of 111 participants with de novo PD; 83 of the participants completed the 12-month follow-up (69 patients with PD on stable dopaminergic medication and 14 untreated controls with PD). Unsupervised k-means cluster analysis was performed on 8 distinctive parameters of hypokinetic dysarthria examined with quantitative acoustic analysis. RESULTS Three distinct speech subtypes with similar prevalence, symptom duration, and motor severity were detected: prosodic, phonatory-prosodic, and articulatory-prosodic. Besides monopitch and monoloudness, which were common in each subtype, speech impairment was more severe in the phonatory-prosodic subtype with predominant dysphonia and the articulatory-prosodic subtype with predominant imprecise consonant articulation than in the prosodic subtype. Clinically, the prosodic subtype was characterized by a prevalence of women and younger age, while articulatory-prosodic subtype was characterized by the prevalence of men, older age, greater severity of axial gait symptoms, and poorer cognitive performance. The phonatory-prosodic subtype clinically represented intermediate status in age with mostly men and preserved cognitive performance. While speech of untreated controls with PD deteriorated over 1 year (p = 0.02), long-term dopaminergic medication maintained stable speech impairment severity in the prosodic and articulatory-prosodic subtypes and improved speech performance in patients with the phonatory-prosodic subtype (p = 0.002). DISCUSSION Distinct speech phenotypes in de novo PD reflect divergent underlying mechanisms and allow prediction of response of speech impairment to levodopa therapy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that, in patients with newly diagnosed PD with speech impairment, speech phenotype is associated with levodopa responsiveness.
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Affiliation(s)
- Jan Rusz
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Tereza Tykalova
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michal Novotny
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Zogala
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Sonka
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evzen Ruzicka
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- From the Department of Circuit Theory (J.R., T.T., M.N.), Faculty of Electrical Engineering, Czech Technical University in Prague; Department of Neurology and Centre of Clinical Neuroscience (J.R., K.S., E.R., P.D.), First Faculty of Medicine, Charles University; and Institute of Nuclear Medicine (D.Z.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Atkinson-Clement C, Cavazzini É, Zénon A, Legou T, Witjas T, Fluchère F, Azulay JP, Baunez C, Pinto S, Eusebio A. Subthalamic stimulation breaks the balance between distal and axial signs in Parkinson's disease. Sci Rep 2021; 11:21810. [PMID: 34750479 PMCID: PMC8575789 DOI: 10.1038/s41598-021-01386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
In Parkinson’s disease (PD), the effects of both Ldopa and subthalamic deep brain stimulation (STN-DBS) are known to change cost-valuation. However, this was mostly studied through reward-effort task involving distal movements, while axial effort, less responsive to treatments, have been barely studied. Thus, our objective was to compare the influence of both Ldopa and STN-DBS on cost-valuation between two efforts modalities: vowel production (as an example of axial movement) and hand squeezing (as an example of distal movement). Twelve PD patients were recruited to participate in this study. The task consisted in deciding whether to accept or reject trials based on a reward-effort trade-off. Participants performed two blocks with hand squeezing, and two with vowel production, in the four treatment conditions (LdopaOn/Off; STN-DBS On/Off). We found that STN-DBS changed the ratio difference between hand and phonation efforts. Vowel production effort was estimated easier to perform with STN-DBS alone, and harder when associated with Ldopa. The difference between hand and phonation efforts was correlated with quality of life in Off/Off and On Ldopa alone conditions, and with impulsive assessment On STN-DBS alone. We highlighted that STN-DBS could introduce an imbalance between the actual motor impairments and their subjective costs. With this finding, we also suggest paying particular attention to the different treatment effects that should be expected for axial and distal movement dysfunctions.
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Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière (DMU 6), Paris, France.
| | | | - Alexandre Zénon
- INCIA, Université de Bordeaux, CNRS UMR5287, Bordeaux, France
| | - Thierry Legou
- Aix-Marseille Univ, CRNS, LPL, Aix-en-Provence, France
| | - Tatiana Witjas
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Frédérique Fluchère
- Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France.,Aix-Marseille Univ, CNRS, LNC, Marseille, France
| | - Jean-Philippe Azulay
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France
| | - Serge Pinto
- Aix-Marseille Univ, CRNS, LPL, Aix-en-Provence, France
| | - Alexandre Eusebio
- Institut de Neurosciences de la Timone, UMR7289, CNRS and Aix-Marseille Univ, Marseille, France.,Department of Neurology and Movement Disorders, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
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Manes JL, Herschel E, Aveni K, Tjaden K, Parrish T, Simuni T, Corcos DM, Roberts AC. The effects of a simulated fMRI environment on voice intensity in individuals with Parkinson's disease hypophonia and older healthy adults. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106149. [PMID: 34543846 PMCID: PMC8627501 DOI: 10.1016/j.jcomdis.2021.106149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Functional magnetic resonance imaging (fMRI) has promise for understanding neural mechanisms of neurogenic speech and voice disorders. However, performing vocal tasks within the fMRI environment may not always be analogous to performance outside of the scanner. Using a mock MRI scanner, this study examines the effects of a simulated scanning environment on vowel intensity in individuals with Parkinson's disease (PD) and hypophonia and older healthy control (OHC) participants. METHOD Thirty participants (15 PD, 15 OHC) performed a sustained /ɑ/ vowel production task in three conditions: 1) Upright, 2) Mock Scanner + No Noise, and 3) Mock Scanner + MRI noise. We used a linear mixed-effects (multi-level) model to evaluate the contributions of group and recording environment to vowel intensity. A second linear mixed-effects model was also used to evaluate the contributions of PD medication state (On vs. Off) to voice intensity. RESULTS Vowel intensity was significantly lower for PD compared to the OHC group. The intensity of vowels produced in the Upright condition was significantly lower compared to the Mock Scanner + No Noise condition, while vowel intensity in the Mock Scanner + MRI Noise condition was significantly higher compared to the Mock Scanner + No Noise condition. A group by condition interaction also indicated that the addition of scanner noise had a greater impact on the PD group. A second analysis conducted within the PD group showed no effects of medication state on vowel intensity. CONCLUSION Our findings demonstrate that performance on voice production tasks is altered for PD and OHC groups when translated into the fMRI environment, even in the absence of acoustic scanner noise. For fMRI studies of voice in PD hypophonia, careful thought should be given to how the presence of acoustic noise may differentially affect PD and OHC, for both group and task comparisons.
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Affiliation(s)
- Jordan L Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA.
| | - Ellen Herschel
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA
| | - Katharine Aveni
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY
| | - Todd Parrish
- Department of Radiology, Northwestern University, Chicago, IL
| | - Tanya Simuni
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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Hannaway N, Lao-Kaim NP, Martín-Bastida A, Roussakis AA, Howard J, Wall MB, Loane C, Barker RA, Piccini P. Longitudinal changes in movement-related functional MRI activity in Parkinson's disease patients. Parkinsonism Relat Disord 2021; 87:61-69. [PMID: 33975081 DOI: 10.1016/j.parkreldis.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Functional brain imaging has shown alterations in the basal ganglia, cortex and cerebellum in Parkinson's disease patients. However, few functional imaging studies have tested how these changes evolve over time. Our study aimed to test the longitudinal progression of movement-related functional activity in Parkinson's disease patients. METHODS At baseline, 48 Parkinson's disease patients and 16 healthy controls underwent structural and functional magnetic resonance imaging during a joystick motor task. Patients had repeated imaging after 18-months (n = 42) and 36-months (n = 32). T-tests compared functional responses between Parkinson's disease patients and controls, and linear mixed effects models examined longitudinal differences within Parkinson's disease. Correlations of motor-activity with bradykinesia, rigidity and tremor were undertaken. All contrasts used whole-brain analyses, thresholded at Z > 3.1 with a cluster-wise P < 0.05. RESULTS Baseline activation was significantly greater in patients than controls across contralateral parietal and occipital regions, ipsilateral precentral gyrus and thalamus. Longitudinally, patients showed significant increases in cerebellar activity at successive visits following baseline. Task-related activity also increased in the contralateral motor, parietal and temporal areas at 36 months compared to baseline, however this was reduced when controlling for motor task performance. CONCLUSION We have shown that there are changes over time in the blood-activation level dependent response of patients with Parkinson's disease undertaking a simple motor task. These changes are observed primarily in the ipsilateral cerebellum and may be compensatory in nature.
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Affiliation(s)
- Naomi Hannaway
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Nicholas P Lao-Kaim
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | - Antonio Martín-Bastida
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom; Neurology Department, Clinica Universidad de Navarra, Pamplona, Navarra, 31008, Spain.
| | - Andreas-Antonios Roussakis
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
| | | | | | - Clare Loane
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, SE5 9RT, United Kingdom.
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, United Kingdom and WT-MRC Cambridge Stem Cell, Cambridge, United Kingdom.
| | - Paola Piccini
- Neurology Imaging Unit, Division of Neurology, Department of Brain Sciences, Imperial College London, London, W12 0NN, United Kingdom.
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10
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Herz DM, Meder D, Camilleri JA, Eickhoff SB, Siebner HR. Brain Motor Network Changes in Parkinson's Disease: Evidence from Meta-Analytic Modeling. Mov Disord 2021; 36:1180-1190. [PMID: 33427336 PMCID: PMC8127399 DOI: 10.1002/mds.28468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Motor‐related brain activity in Parkinson's disease has been investigated in a multitude of functional neuroimaging studies, which often yielded apparently conflicting results. Our previous meta‐analysis did not resolve inconsistencies regarding cortical activation differences in Parkinson's disease, which might be related to the limited number of studies that could be included. Therefore, we conducted a revised meta‐analysis including a larger number of studies. The objectives of this study were to elucidate brain areas that consistently show abnormal motor‐related activation in Parkinson's disease and to reveal their functional connectivity profiles using meta‐analytic approaches. Methods We applied a quantitative meta‐analysis of functional neuroimaging studies testing limb movements in Parkinson's disease comprising data from 39 studies, of which 15 studies (285 of 571 individual patients) were published after the previous meta‐analysis. We also conducted meta‐analytic connectivity modeling to elucidate the connectivity profiles of areas showing abnormal activation. Results We found consistent motor‐related underactivation of bilateral posterior putamen and cerebellum in Parkinson's disease. Primary motor cortex and the supplementary motor area also showed deficient activation, whereas cortical regions localized directly anterior to these areas expressed overactivation. Connectivity modeling revealed that areas showing decreased activation shared a common pathway through the posterior putamen, whereas areas showing increased activation were connected to the anterior putamen. Conclusions Despite conflicting results in individual neuroimaging studies, this revised meta‐analytic approach identified consistent patterns of abnormal motor‐related activation in Parkinson's disease. The distinct patterns of decreased and increased activity might be determined by their connectivity with different subregions of the putamen. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Julia A Camilleri
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Simon B Eickhoff
- Research Center Juelich, Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Juelich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Narayana S, Parsons MB, Zhang W, Franklin C, Schiller K, Choudhri AF, Fox PT, LeDoux MS, Cannito M. Mapping typical and hypokinetic dysarthric speech production network using a connected speech paradigm in functional MRI. NEUROIMAGE-CLINICAL 2020; 27:102285. [PMID: 32521476 PMCID: PMC7284131 DOI: 10.1016/j.nicl.2020.102285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/18/2022]
Abstract
We developed a task paradigm whereby subjects spoke aloud while minimizing head motion during functional MRI (fMRI) in order to better understand the neural circuitry involved in motor speech disorders due to dysfunction of the central nervous system. To validate our overt continuous speech paradigm, we mapped the speech production network (SPN) in typical speakers (n = 19, 10 females) and speakers with hypokinetic dysarthria as a manifestation of Parkinson disease (HKD; n = 21, 8 females) in fMRI. We then compared it with the SPN derived during overt speech production by 15O-water PET in the same group of typical speakers and another HKD cohort (n = 10, 2 females). The fMRI overt connected speech paradigm did not result in excessive motion artifacts and successfully identified the same brain areas demonstrated in the PET studies in the two cohorts. The SPN derived in fMRI demonstrated significant spatial overlap with the corresponding PET derived maps (typical speakers: r = 0.52; speakers with HKD: r = 0.43) and identified the components of the neural circuit of speech production belonging to the feedforward and feedback subsystems. The fMRI study in speakers with HKD identified significantly decreased activity in critical feedforward (bilateral dorsal premotor and motor cortices) and feedback (auditory and somatosensory areas) subsystems replicating previous PET study findings in this cohort. These results demonstrate that the overt connected speech paradigm is feasible during fMRI and can accurately localize the neural substrates of typical and disordered speech production. Our fMRI paradigm should prove useful for study of motor speech and voice disorders, including stuttering, apraxia of speech, dysarthria, and spasmodic dysphonia.
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Affiliation(s)
- Shalini Narayana
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA; Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
| | - Megan B Parsons
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN 38152, USA
| | - Wei Zhang
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Katherine Schiller
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Asim F Choudhri
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA; Department of Radiology, Division of Neuroradiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Mark S LeDoux
- Veracity Neuroscience LLC, Memphis, TN 38157, USA; Department of Psychology and School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Michael Cannito
- Department of Communicative Disorders, University of Louisiana at Lafayette, USA
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12
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Ardenghi LG, Signorini AV, Maahs GS, Selaimen F, Deutsch KM, Dornelles S, Rieder CRDM. Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status. Int Arch Otorhinolaryngol 2020; 25:e41-e47. [PMID: 33542750 PMCID: PMC7850888 DOI: 10.1055/s-0039-3402440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/26/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction
Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously.
Objective
The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES).
Methods
A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS).
Results
The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL:
p
≤ 0.001; 5 mL:
p
≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found.
Conclusion
These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.
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Affiliation(s)
| | - Alana Verza Signorini
- Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
| | - Gerson Schulz Maahs
- Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabio Selaimen
- Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
| | - Konrado Massing Deutsch
- Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Silvia Dornelles
- Department of Developmental Psychology and Personality Ramiro Barcelos, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto de Mello Rieder
- Department of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Neurology, Distúrbios do Movimento, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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13
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Chen Y, Zhu G, Liu D, Liu Y, Yuan T, Zhang X, Jiang Y, Du T, Zhang J. Brain morphological changes in hypokinetic dysarthria of Parkinson's disease and use of machine learning to predict severity. CNS Neurosci Ther 2020; 26:711-719. [PMID: 32198848 PMCID: PMC7298984 DOI: 10.1111/cns.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/13/2020] [Accepted: 03/01/2020] [Indexed: 01/26/2023] Open
Abstract
Background Up to 90% of patients with Parkinson's disease (PD) eventually develop the speech and voice disorder referred to as hypokinetic dysarthria (HD). However, the brain morphological changes associated with HD have not been investigated. Moreover, no reliable model for predicting the severity of HD based on neuroimaging has yet been developed. Methods A total of 134 PD patients were included in this study and divided into a training set and a test set. All participants underwent a structural magnetic resonance imaging (MRI) scan and neuropsychological evaluation. Individual cortical thickness, subcortical structure, and white matter volume were extracted, and their association with HD severity was analyzed. After feature selection, a machine‐learning model was established using a support vector machine in the training set. The severity of HD was then predicted in the test set. Results Atrophy of the right precentral cortex and the right fusiform gyrus was significantly associated with HD. No association was found between HD and volume of white matter or subcortical structures. Favorable and optimal performance of machine learning on HD severity prediction was achieved using feature selection, giving a correlation coefficient (r) of .7516 and a coefficient of determination (R2) of .5649 (P < .001). Conclusion The brain morphological changes were associated with HD. Excellent prediction of the severity of HD was achieved using machine learning based on neuroimaging.
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Affiliation(s)
- Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Defeng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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14
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Solstrand Dahlberg L, Lungu O, Doyon J. Cerebellar Contribution to Motor and Non-motor Functions in Parkinson's Disease: A Meta-Analysis of fMRI Findings. Front Neurol 2020; 11:127. [PMID: 32174883 PMCID: PMC7056869 DOI: 10.3389/fneur.2020.00127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Parkinson's disease (PD) results in both motor and non-motor symptoms. Traditionally, the underlying mechanism of PD has been linked to neurodegeneration of the basal ganglia. Yet it does not adequately account for the non-motor symptoms of the disease, suggesting that other brain regions may be involved. One such region is the cerebellum, which is known to be involved, together with the basal ganglia, in both motor and non-motor functions. Many studies have found the cerebellum to be hyperactive in PD patients, a finding that is seldom discussed in detail, and warrants further examination. The current study thus aims to examine quantitively the current literature on the cerebellar involvement in both motor and non-motor functioning in PD. Methods: A meta-analysis of functional neuroimaging literature was conducted with Seed-based D mapping. Only the studies testing functional activation in response to motor and non-motor paradigms in PD and healthy controls (HC) were included in the meta-analysis. Separate analyses were conducted by including only studies with non-motor paradigms, as well as meta-regressions with UPDRS III scores and disease duration. Results: A total of 57 studies with both motor and non-motor paradigms fulfilled our inclusion criteria and were included in the meta-analysis, which revealed hyperactivity in Crus I-II and vermal III in PD patients compared to HC. An analysis including only studies with cognitive paradigms revealed a cluster of increased activity in PD patients encompassing lobule VIIB and VIII. Another meta-analysis including the only 20 studies that employed motor paradigms did not reveal any significant group differences. However, a descriptive analysis of these studies revealed that 60% of them reported cerebellar hyperactivations in PD and included motor paradigm with significant cognitive task demands, as opposed to 40% presenting the opposite pattern and using mainly force grip tasks. The meta-regression with UPDRS III scores found a negative association between motor scores and activation in lobule VI and vermal VII-VIII. No correlation was found with disease duration. Discussion: The present findings suggest that one of the main cerebellar implications in PD is linked to cognitive functioning. The negative association between UPDRS scores and activation in regions implicated in motor functioning indicate that there is less involvement of these areas as the disease severity increases. In contrast, the lack of correlation with disease duration seems to indicate that the cerebellar activity may be a compensatory mechanism to the dysfunctional basal ganglia, where certain sub-regions of the cerebellum are employed to cope with motor demands. Yet future longitudinal studies are needed to fully address this possibility.
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Affiliation(s)
- Linda Solstrand Dahlberg
- Department of Neurology & Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Ovidiu Lungu
- Department of Neurology & Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, University of Montreal, Montreal, QC, Canada
| | - Julien Doyon
- Department of Neurology & Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Functional Neuroimaging Unit, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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15
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Puyjarinet F, Bégel V, Gény C, Driss V, Cuartero MC, Kotz SA, Pinto S, Dalla Bella S. Heightened orofacial, manual, and gait variability in Parkinson's disease results from a general rhythmic impairment. NPJ PARKINSONS DISEASE 2019; 5:19. [PMID: 31583269 PMCID: PMC6761142 DOI: 10.1038/s41531-019-0092-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 01/06/2023]
Abstract
Individuals with Parkinson’s disease (PD) experience rhythm disorders in a number of motor tasks, such as (i) oral diadochokinesis, (ii) finger tapping, and (iii) gait. These common motor deficits may be signs of “general dysrhythmia”, a central disorder spanning across effectors and tasks, and potentially sharing the same neural substrate. However, to date, little is known about the relationship between rhythm impairments across domains and effectors. To test this hypothesis, we assessed whether rhythmic disturbances in three different domains (i.e., orofacial, manual, and gait) can be related in PD. Moreover, we investigated whether rhythmic motor performance across these domains can be predicted by rhythm perception, a measure of central rhythmic processing not confounded with motor output. Twenty-two PD patients (mean age: 69.5 ± 5.44) participated in the study. They underwent neurological and neuropsychological assessments, and they performed three rhythmic motor tasks. For oral diadochokinesia, participants had to repeatedly produce a trisyllable pseudoword. For gait, they walked along a computerized walkway. For the manual task, patients had to repeatedly produce finger taps. The first two rhythmic motor tasks were unpaced, and the manual tapping task was performed both without a pacing stimulus and musically paced. Rhythm perception was also tested. We observed that rhythmic variability of motor performances (inter-syllable, inter-tap, and inter-stride time error) was related between the three functions. Moreover, rhythmic performance was predicted by rhythm perception abilities, as demonstrated with a logistic regression model. Hence, rhythm impairments in different motor domains are found to be related in PD and may be underpinned by a common impaired central rhythm mechanism, revealed by a deficit in rhythm perception. These results may provide a novel perspective on how interpret the effects of rhythm-based interventions in PD, within and across motor domains.
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Affiliation(s)
- Frédéric Puyjarinet
- 1EuroMov Laboratory, University of Montpellier, 700 Avenue du Pic Saint Loup, 34090 Montpellier, France
| | - Valentin Bégel
- Charles-de-Gaulle University, Lille 3, 42 Rue Paul Duez, 59 000 Lille, France
| | - Christian Gény
- 3Neurology Department, CHRU of Montpellier, 80 Avenue Augustin Fliche, 34000 Montpellier, France
| | - Valérie Driss
- 4Investigation Clinic Center, CHRU of Montpellier, 80 Avenue Augustin Fliche, 34000 Montpellier, France
| | | | - Sonja A Kotz
- 6Department of Neuropsychology and Psychopharmacology, University of Maastricht, Universiteitssingel, 6200 MD Maastricht, Netherlands
| | - Serge Pinto
- 5Aix Marseille Univ, CNRS, LPL, Aix-en-Provence, France
| | - Simone Dalla Bella
- 1EuroMov Laboratory, University of Montpellier, 700 Avenue du Pic Saint Loup, 34090 Montpellier, France.,7International Laboratory for Brain, Music and Sound Research (BRAMS), 90 Vincent-d'Indy Ave., Outremont, QC H2V 2S9 Canada.,8Department of Psychology, University of Montreal, 2900 Boulevard Edouard-Montpetit, Montréal, QCH3T 1J4 Montreal, Canada.,University of Economics and Human Sciences in Warsaw, Okopowa59, 01-043 Warsaw, Poland
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16
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Moreau C, Pinto S. Misconceptions about speech impairment in Parkinson's disease. Mov Disord 2019; 34:1471-1475. [DOI: 10.1002/mds.27791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/17/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Caroline Moreau
- Expert center for Parkinson's disease, Neurological department, CHU Lille, Inserm UMR 1171 University of Lille Lille France
| | - Serge Pinto
- Aix Marseille University, CNRS, LPL Aix‐en‐Provence France
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17
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Speech disorders in Parkinson’s disease: early diagnostics and effects of medication and brain stimulation. J Neural Transm (Vienna) 2017; 124:303-334. [PMID: 28101650 DOI: 10.1007/s00702-017-1676-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/04/2017] [Indexed: 01/31/2023]
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18
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Comparative analysis of speech impairment and upper limb motor dysfunction in Parkinson’s disease. J Neural Transm (Vienna) 2016; 124:463-470. [DOI: 10.1007/s00702-016-1662-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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19
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Atkinson-Clement C, Maillet A, LeBars D, Lavenne F, Redouté J, Krainik A, Pollak P, Thobois S, Pinto S. Subthalamic nucleus stimulation effects on single and combined task performance in Parkinson’s disease patients: a PET study. Brain Imaging Behav 2016; 11:1139-1153. [DOI: 10.1007/s11682-016-9588-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Mak MKY, Cheung V, Ma S, Lu ZL, Wang D, Lou W, Shi L, Mok VCT, Chu WCW, Hallett M. Increased Cognitive Control During Execution of Finger Tap Movement in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 6:639-50. [PMID: 27372216 DOI: 10.3233/jpd-160849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies employed demanding and complex hand tasks to study the brain activation in people with Parkinson's Disease (PD). There is inconsistent finding about the cerebellar activity during movement execution of this patient population. OBJECTIVES This study aimed to examine the brain activation patterns of PD individuals in the on-state and healthy control subjects in a simple finger tapping task. METHODS Twenty-seven patients with PD and 22 age-matched healthy subjects were recruited for the study. Subjects were instructed to perform simple finger tapping tasks under self- and cue-initiated conditions in separate runs while their brain activations were captured using fMRI. RESULTS Healthy subjects had higher brain activity in contralateral precentral gyrus during the self-initiated task, and higher brain activity in the ipsilateral middle occipital gyrus during the cue-initiated task. PD patients had higher brain activity in the cerebellum Crus I (bilateral) and lobules VI (ipsilateral) during the self-initiated task and higher brain activity in the contralateral middle frontal gyrus during the cue-initiated task. When compared with healthy controls, PD patients had lower brain activity in the contralateral inferior parietal lobule during the self-initiated task, and lower brain activity in the ipsilateral cerebellum lobule VIII, lobule VIIB and vermis VIII, and thalamus during the cue-initiated task. Conjunction analysis indicated that both groups had activation in bilateral cerebellum and SMA and ipsilateral precentral gyrus and postcentral gyrus during both self- and cue-initiated movement. Individuals with PD exhibited higher brain activity in the executive zone (cerebellum Crus I and II) during self-initiated movement, and lower brain activity in the sensorimotor zone (i.e. lobule VIIb and VIII of the cerebellum) during cue-initiated movement. DISCUSSIONS The findings suggest that individuals with PD may use more executive control when performing simple movements.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Vinci Cheung
- Department of Counselling & Psychology, Shue Yan University, Hong Kong
| | - Shuangye Ma
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Zhong L Lu
- Center for Cognitive and Behavioral Brain Imaging, Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Wutao Lou
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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21
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Effects of dopaminergic replacement therapy on motor speech disorders in Parkinson’s disease: longitudinal follow-up study on previously untreated patients. J Neural Transm (Vienna) 2016; 123:379-87. [DOI: 10.1007/s00702-016-1515-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
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22
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Atkinson-Clement C, Sadat J, Pinto S. Behavioral treatments for speech in Parkinson's disease: meta-analyses and review of the literature. Neurodegener Dis Manag 2015; 5:233-48. [DOI: 10.2217/nmt.15.16] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SUMMARY Parkinson's disease (PD) results from neurodegenerative processes leading to alteration of motor functions. Most motor symptoms respond well to pharmacological and neurosurgical treatments, except some axial symptoms such as speech impairment, so-called dysarthria. However, speech therapy is rarely proposed to PD patients. This review aims at evaluating previous research on the effects of speech behavioral therapies in patients with PD. We also performed two meta-analyses focusing on speech loudness and voice pitch. We showed that intensive therapies in PD are the most effective for hypophonia and can lead to some improvement of voice pitch. Although speech therapy is effective in handling PD dysarthria, behavioral speech rehabilitation in PD still needs further validation.
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Affiliation(s)
- Cyril Atkinson-Clement
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Jasmin Sadat
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
| | - Serge Pinto
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage (LPL), UMR 7309, 13100, Aix-en-Provence, France
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23
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New AB, Robin DA, Parkinson AL, Eickhoff CR, Reetz K, Hoffstaedter F, Mathys C, Sudmeyer M, Michely J, Caspers J, Grefkes C, Larson CR, Ramig LO, Fox PT, Eickhoff SB. The intrinsic resting state voice network in Parkinson's disease. Hum Brain Mapp 2015; 36:1951-62. [PMID: 25627959 PMCID: PMC4782783 DOI: 10.1002/hbm.22748] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 01/09/2023] Open
Abstract
Over 90 percent of patients with Parkinson's disease experience speech-motor impairment, namely, hypokinetic dysarthria characterized by reduced pitch and loudness. Resting-state functional connectivity analysis of blood oxygen level-dependent functional magnetic resonance imaging is a useful measure of intrinsic neural functioning. We utilized resting-state functional connectivity modeling to analyze the intrinsic connectivity in patients with Parkinson's disease within a vocalization network defined by a previous meta-analysis of speech (Brown et al., 2009). Functional connectivity of this network was assessed in 56 patients with Parkinson's disease and 56 gender-, age-, and movement-matched healthy controls. We also had item 5 and 18 of the UPDRS, and the PDQ-39 Communication subscale available for correlation with the voice network connectivity strength in patients. The within-group analyses of connectivity patterns demonstrated a lack of subcortical-cortical connectivity in patients with Parkinson's disease. At the cortical level, we found robust (homotopic) interhemispheric connectivity but only inconsistent evidence for many intrahemispheric connections. When directly contrasted to the control group, we found a significant reduction of connections between the left thalamus and putamen, and cortical motor areas, as well as reduced right superior temporal gyrus connectivity. Furthermore, most symptom measures correlated with right putamen, left cerebellum, left superior temporal gyrus, right premotor, and left Rolandic operculum connectivity in the voice network. The results reflect the importance of (right) subcortical nodes and the superior temporal gyrus in Parkinson's disease, enhancing our understanding of the neurobiological underpinnings of vocalization impairment in Parkinson's disease.
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Affiliation(s)
- Anneliese B. New
- University of Texas Health Science Center at San Antonio, Research Imaging InstituteSan AntonioTexas
| | - Donald A. Robin
- University of Texas Health Science Center at San Antonio, Research Imaging InstituteSan AntonioTexas
- University of Texas Health Science Center at San Antonio, Department of NeurologySan AntonioTexas
- University of Texas Health Science Center at San Antonio, Department of RadiologySan AntonioTexas
- University of Texas Health Science Center at San Antonio and University of Texas at San Antonio, Joint Program in Biomedical EngineeringSan AntonioTexas
| | - Amy L. Parkinson
- University of Texas Health Science Center at San Antonio, Research Imaging InstituteSan AntonioTexas
| | - Claudia R. Eickhoff
- Research Center JulichInstitute of Neuroscience and Medicine (INM‐1)Department of PsychiatryPsychotherapy and Psychosomatics, University HospitalJulichGermany
- University Hospital Aachen, Department of Psychiatry, Psychotherapy and PsychosomaticsAachenGermany
| | - Kathrin Reetz
- Department of NeurologyUniversity of AachenAachenGermany
- Research Center JulichInstitute of Neuroscience and Medicine (INM‐4)Department of NeurologyUniversity HospitalJulichGermany
- Julich Aachen Research AllianceTranslational Brain MedicineJulich and AachenGermany
| | - Felix Hoffstaedter
- Research Center JulichInstitute of Neuroscience and Medicine (INM‐1)Department of PsychiatryPsychotherapy and Psychosomatics, University HospitalJulichGermany
- Department of Clinical Neuroscience and Medical PsychologyHeinrich Heine University–DüsseldorfDusseldorfGermany
| | - Christian Mathys
- Department of Diagnostic and Interventional RadiologyUniversity Dusseldorf, Medical FacultyDusseldorfGermany
| | - Martin Sudmeyer
- Department of NeurologyHeinrich Heine University – Dusseldorf, University HospitalDusseldorfGermany
| | - Jochen Michely
- Department of Neurology, Cologne UniversityCologneGermany
| | - Julian Caspers
- Research Center JulichInstitute of Neuroscience and Medicine (INM‐1)Department of PsychiatryPsychotherapy and Psychosomatics, University HospitalJulichGermany
- Department of Diagnostic and Interventional RadiologyUniversity Dusseldorf, Medical FacultyDusseldorfGermany
| | - Christian Grefkes
- Department of Neurology, Cologne UniversityCologneGermany
- Max‐Planck‐Institute for Neurological ResearchNeuromodulation, and NeurorehabilitationCologneGermany
| | - Charles R. Larson
- Northwestern University, Communication Sciences and DisordersEvanstonIllinois
| | - Loraine O. Ramig
- Department of SpeechLanguage and Hearing Science, University of Colorado – BoulderColorado
- National Center for Voice and SpeechSalt Lake CityUtah
| | - Peter T. Fox
- University of Texas Health Science Center at San Antonio, Research Imaging InstituteSan AntonioTexas
- University of Texas Health Science Center at San Antonio, Department of NeurologySan AntonioTexas
- University of Texas Health Science Center at San Antonio, Department of RadiologySan AntonioTexas
- South Texas Veterans Health Care System, Department of NeurologySan AntonioTexas
| | - Simon B. Eickhoff
- Research Center JulichInstitute of Neuroscience and Medicine (INM‐1)Department of PsychiatryPsychotherapy and Psychosomatics, University HospitalJulichGermany
- Department of Clinical Neuroscience and Medical PsychologyHeinrich Heine University–DüsseldorfDusseldorfGermany
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24
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Skodda S. Steadiness of syllable repetition in early motor stages of Parkinson's disease. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2014.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Koganemaru S, Sawamoto N, Aso T, Sagara A, Ikkaku T, Shimada K, Kanematsu M, Takahashi R, Domen K, Fukuyama H, Mima T. Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke. Neurosci Res 2014; 92:29-38. [PMID: 25450315 DOI: 10.1016/j.neures.2014.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
Recently, we have developed a new hybrid-rehabilitation combining 5Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.
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Affiliation(s)
- Satoko Koganemaru
- Brain Integrative Science, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Nobukatsu Sawamoto
- Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akiko Sagara
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Tomoko Ikkaku
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kenji Shimada
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Madoka Kanematsu
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazuhisa Domen
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuya Mima
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
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Herz DM, Eickhoff SB, Løkkegaard A, Siebner HR. Functional neuroimaging of motor control in Parkinson's disease: a meta-analysis. Hum Brain Mapp 2013; 35:3227-37. [PMID: 24123553 DOI: 10.1002/hbm.22397] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/07/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022] Open
Abstract
Functional neuroimaging has been widely used to study the activation patterns of the motor network in patients with Parkinson's disease (PD), but these studies have yielded conflicting results. This meta-analysis of previous neuroimaging studies was performed to identify patterns of abnormal movement-related activation in PD that were consistent across studies. We applied activation likelihood estimation (ALE) of functional neuroimaging studies probing motor function in patients with PD. The meta-analysis encompassed data from 283 patients with PD reported in 24 functional neuroimaging studies and yielded consistent alterations in neural activity in patients with PD. Differences in cortical activation between PD patients and healthy controls converged in a left-lateralized fronto-parietal network comprising the presupplementary motor area, primary motor cortex, inferior parietal cortex, and superior parietal lobule. Both, increases as well as decreases in motor cortical activity, which were related to differences in movement timing and selection in the applied motor tasks, were reported in these cortical areas. In the basal ganglia, PD patients expressed a decrease of motor activation in the posterior motor putamen, which improved with dopaminergic medication. The likelihood of detecting a decrease in putaminal activity increased with motor impairment. This reduced motor activation of the posterior putamen across previous neuroimaging studies indicates that nigrostriatal dopaminergic denervation affects neural processing in the denervated striatal motor territory. In contrast, fronto-parietal motor areas display both increases as well as decreases in movement related activation. This points to a more complex relationship between altered cortical physiology and nigrostriatal dopaminergic denervation in PD.
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Affiliation(s)
- Damian M Herz
- Danish Research Center for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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27
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Holiga Š, Mueller K, Möller HE, Sieger T, Schroeter ML, Vymazal J, Růžička E, Jech R. Motor matters: tackling heterogeneity of Parkinson's disease in functional MRI studies. PLoS One 2013; 8:e56133. [PMID: 23418522 PMCID: PMC3572025 DOI: 10.1371/journal.pone.0056133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/05/2013] [Indexed: 12/22/2022] Open
Abstract
To tackle the heterogeneity of Parkinson’s disease symptoms, most functional imaging studies tend to select a uniform group of subjects. We hypothesize that more profound considerations are needed to account for intra/inter-subject clinical variability and possibly for differing pathophysiological processes. Twelve patients were investigated using functional magnetic resonance imaging during visually-guided finger tapping. To account for disease heterogeneity, the motor score and individual symptom scores from the Unified Parkinson’s Disease Rating Scale (UPDRS-III) were utilized in the group-level model using two approaches either as the explanatory variable or as the effect of interest. Employment of the UPDRS-III score and symptom scores was systematically tested on the resulting group response to the levodopa challenge, which further accentuated the diversity of the diseased state of participants. Statistics revealed a bilateral group response to levodopa in the basal ganglia. Interestingly, systematic incorporation of individual motor aspects of the disease in the modelling amended the resulting activity patterns conspicuously, evidencing a manifold amount of explained variability by the particular score. In conclusion, the severity of clinical symptoms expressed in the UPDRS-III scores should be considered in the analysis to attain unbiased statistics, draw reliable conclusions and allow for comparisons between research groups studying Parkinson’s disease using functional magnetic resonance imaging.
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Affiliation(s)
- Štefan Holiga
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Harald E. Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Matthias L. Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology & Leipzig Research Center for Civilization Diseases, University of Leipzig and FTLD Consortium, Leipzig, Germany
| | - Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
- * E-mail:
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Jech R, Mueller K, Urgošík D, Sieger T, Holiga Š, Růžička F, Dušek P, Havránková P, Vymazal J, Růžička E. The subthalamic microlesion story in Parkinson's disease: electrode insertion-related motor improvement with relative cortico-subcortical hypoactivation in fMRI. PLoS One 2012; 7:e49056. [PMID: 23145068 PMCID: PMC3492182 DOI: 10.1371/journal.pone.0049056] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/08/2012] [Indexed: 11/19/2022] Open
Abstract
Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9-15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.
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Affiliation(s)
- Robert Jech
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
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Levodopa effects on hand and speech movements in patients with Parkinson's disease: a FMRI study. PLoS One 2012; 7:e46541. [PMID: 23056337 PMCID: PMC3467207 DOI: 10.1371/journal.pone.0046541] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/31/2012] [Indexed: 11/25/2022] Open
Abstract
Levodopa (L-dopa) effects on the cardinal and axial symptoms of Parkinson’s disease (PD) differ greatly, leading to therapeutic challenges for managing the disabilities in this patient’s population. In this context, we studied the cerebral networks associated with the production of a unilateral hand movement, speech production, and a task combining both tasks in 12 individuals with PD, both off and on levodopa (L-dopa). Unilateral hand movements in the off medication state elicited brain activations in motor regions (primary motor cortex, supplementary motor area, premotor cortex, cerebellum), as well as additional areas (anterior cingulate, putamen, associative parietal areas); following L-dopa administration, the brain activation profile was globally reduced, highlighting activations in the parietal and posterior cingulate cortices. For the speech production task, brain activation patterns were similar with and without medication, including the orofacial primary motor cortex (M1), the primary somatosensory cortex and the cerebellar hemispheres bilaterally, as well as the left- premotor, anterior cingulate and supramarginal cortices. For the combined task off L-dopa, the cerebral activation profile was restricted to the right cerebellum (hand movement), reflecting the difficulty in performing two movements simultaneously in PD. Under L-dopa, the brain activation profile of the combined task involved a larger pattern, including additional fronto-parietal activations, without reaching the sum of the areas activated during the simple hand and speech tasks separately. Our results question both the role of the basal ganglia system in speech production and the modulation of task-dependent cerebral networks by dopaminergic treatment.
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