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Jiao Y, Liu Z, Li J, Su Y, Chen X. Knowledge mapping of freezing of gait in Parkinson's disease: a bibliometric analysis. Front Neurosci 2024; 18:1388326. [PMID: 39315077 PMCID: PMC11417103 DOI: 10.3389/fnins.2024.1388326] [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: 02/19/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Objective Among the disturbing motor symptoms in Parkinson's disease (PD), freezing of gait (FOG) stands out as one of the most severe challenges. It typically arises during the initiation of gait or when turning. This phenomenon not only impose a heavy burden on patients, but also on their families. We conduct a bibliometric analysis to summarize current research hotspots and trends concerning freezing of gait in Parkinson's disease (PD-FOG) over past two decades. Methods We retrieved articles and reviews published in English about PD-FOG in the Web of science Core Collection database from 2000 to 2023 on November 30,2023. The tools VOSviewer and CiteSpace facilitated a visual analysis covering various aspects such as publications, countries/regions, organizations, authors, journals, cited references, and keywords. Result This study includes 1,340 articles from 64 countries/regions. There is a growth in publications related to PD-FOG over the past two decades, maintaining a stable high output since 2018, indicating a promising research landscape in the field of PD-FOG. The United States holds a leading position in this field, with Nieuwboer A and Giladi N being two of the most influential researchers. Over the past two decades, the research hotspots for PD-FOG have primarily encompassed the kinematic characteristics, diagnosis and detection, cognitive deficits and neural connectivity, as well as therapy and rehabilitation of PD-FOG. Topics including functional connectivity, virtual reality, deep learning and machine learning will be focal points of future research. Conclusion This is the first bibliometric analysis of PD-FOG. We construct this study to summarize the research in this field over past two decades, visually show the current hotspots and trends, and offer scholars in this field concepts and strategies for subsequent studies.
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Affiliation(s)
- Yue Jiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zaichao Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juan Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Su
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Wang Y, Yu L, Mao H, Chen X, Hu P, Ge Y, Liu Y, Zhang J, Cheng H. Deep Brain Stimulation Modulates the Visual Pathway to Improve Freezing of Gait in Parkinson's Disease Patients. World Neurosurg 2024; 187:e148-e155. [PMID: 38636635 DOI: 10.1016/j.wneu.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the involvement of the visual cortex in improving freezing of gait (FoG) after subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients using whole-brain seed-based functional connectivity. METHODS A total of 66 PD patients with FoG who underwent bilateral STN-DBS were included in our study. Patients were divided into a FoG responder group and an FoG nonresponder group according to whether FoG improved 1 year after DBS. We compared the differences in clinical characteristics, brain structural imaging, and seed-based functional connectivity between the 2 groups. The locations of active contacts were further analyzed. RESULTS All PD patients benefited from STN-DBS. No significant differences in the baseline characteristics or brain structures were found between the 2 groups. Seed-based functional connectivity analysis revealed that better connectivity in bilateral primary visual areas was associated with better clinical improvement in FoG (P < 0.05 familywise error corrected). Further analysis revealed that this disparity was associated with the location of the active contacts within the rostral region of the sensorimotor subregion in the FoG responder group, in contrast to the findings in the FoG nonresponder group. CONCLUSIONS This study suggested that DBS in the rostral region of the STN sensorimotor subregion may alleviate FoG by strengthening functional connectivity in primary visual areas, which has significant implications for guiding surgical strategies for FoG in the future.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Liangchen Yu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Ge
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Liu
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Jiarui Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China.
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Al Jaja A, Sue T, Prenger M, Seergobin KN, Grahn JA, MacDonald PA. Alprazolam Reduces Freezing of Gait (FOG) and Improves FOG-Related Gait Deficiencies. PARKINSON'S DISEASE 2024; 2024:3447009. [PMID: 38235044 PMCID: PMC10791478 DOI: 10.1155/2024/3447009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/07/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024]
Abstract
Background Freezing of gait (FOG) is an intractable motor symptom in Parkinson's disease (PD) that increases fall risk and impairs the quality of life. FOG has been associated with anxiety, with experimental support for the notion that anxiety itself provokes FOG. We investigated the effect of acute anxiety reduction via alprazolam on FOG in PD. Methods In ten patients with PD, FOG, and normal cognition, we administered 0.25 mg alprazolam in one session and placebo in another, in counterbalanced order. At each session, on separate days, patients walked on a pressure-sensitive walkway. Using Oculus Rift virtual-reality goggles, patients walked along a plank that appeared to be (a) level with the floor, in the low-anxiety condition or (b) raised high above the ground, in the high-anxiety conditions. In this way, we assessed the impacts of anxiety and alprazolam (i.e., anxiety reduction) on FOG frequency and other gait parameters. Results FOG events appeared only in the high-anxiety conditions. Alprazolam significantly reduced subjective and objective measures of anxiety, as well as the prevalence of FOG (p = 0.05). Furthermore, alprazolam improved swing time (p < 0.05) and gait variability in all conditions, particularly during the elevated plank trials. Interpretation. Our results suggest that (1) anxiety induces FOG, and (2) alprazolam concomitantly reduces anxiety and FOG. Alprazolam further improved gait stability (i.e., swing time and gait variability). These findings reveal that anxiety triggers FOG in PD. Treating anxiety can reduce FOG and improve gait stability, potentially offering new therapeutic avenues for this intractable and disabling symptom in PD.
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Affiliation(s)
- Abdullah Al Jaja
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Téa Sue
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Margaret Prenger
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- BrainsCAN, Western University, London, ON, Canada
| | - Ken N. Seergobin
- The Brain and Mind Institute, Western University, London, ON, Canada
| | - Jessica A. Grahn
- The Brain and Mind Institute, Western University, London, ON, Canada
- BrainsCAN, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Penny A. MacDonald
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- BrainsCAN, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Lin F, Jia W, Li X, Chen Y, Wan M. Cognitive Profiles Stratified by Education Using Montreal Cognitive Assessment in Parkinson's Disease Patients with Freezing of Gait. Neuropsychiatr Dis Treat 2024; 20:25-34. [PMID: 38223373 PMCID: PMC10785694 DOI: 10.2147/ndt.s439131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Parkinson's disease (PD) patients with freezing of gait (FOG) may present with complex and heterogeneous cognitive profiles. Owing to limited access to comprehensive neuropsychological battery in ordinary clinical practice, the Montreal Cognitive Assessment (MoCA) is likely to be easily available cognitive data for comparisons among studies. This study aims to explore the cognitive profiles stratified by education using MoCA in PD patients with FOG. Patients and Methods PD patients with FOG (FOG+, n = 52) and without FOG (FOG-, n = 71) were included in our study. MoCA items were categorized into five subsections (attention/working memory, executive function, episodic memory, language, and visuospatial function) referring to previously published criteria. Cognitive assessments were compared based on five subsections between groups stratified by three education levels (0-6 years, 7-12 years, and >12 years). The association of cognitive measurements with FOG were analyzed using binary logistic regression models with adjustment for variables. Results The total scores and subscores of each subsection of MoCA were similar between two groups of each education level. Further detailed analysis showed that a composite measure labeled "Attention/working memory-Composite" (abbreviated to Attention-C), consisting of the scores of four items (target detection task, serial sevens, digit forward and backward, and sentence repetition), were lower significantly in FOG+ group compared with FOG- group in patients with education year ≤6 years. The significant association of Attention-C with FOG held true when controlling for disease duration, but not for H-Y stage, MDS-UPDRS III, HAMA, and HAMD. Conclusion Overall, our findings gave a hint that Attention-C derived from MoCA might be a potential factor associated with FOG in PD patients with lower education level (education year ≤ 6 years), which will need to be validated in future studies.
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Affiliation(s)
- Fangju Lin
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Xuemei Li
- Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261031, People’s Republic of China
| | - Ying Chen
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Min Wan
- Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, 100043, People’s Republic of China
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Virmani T, Kemp AS, Pillai L, Glover A, Spencer H, Larson-Prior L. Development and implementation of the frog-in-maze game to study upper limb movement in people with Parkinson's disease. Sci Rep 2023; 13:22784. [PMID: 38123606 PMCID: PMC10733393 DOI: 10.1038/s41598-023-49382-w] [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: 02/21/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Upper-limb bradykinesia occurs early in Parkinson's disease (PD) and bradykinesia is required for diagnosis. Our goal was to develop, implement and validate a game "walking" a frog through a maze using bimanual, alternating finger-tapping movements to provide a salient, objective, and remotely monitorable method of tracking disease progression and response to therapy in PD. Twenty-five people with PD and 16 people without PD participated. Responses on 5 different mazes were quantified and compared to spatiotemporal gait parameters and standard disease metrics in these participants. Intertap interval (ITI) on maze 2 & 3, which included turns, was strongly inversely related to stride-length and stride-velocity and directly related to motor UPDRS scores. Levodopa decreased ITI, except in maze 4. PD participants with freezing of gait had longer ITI on all mazes. The responses quantified on maze 2 & 3 were related to disease severity and gait stride-length, were levodopa responsive, and were worse in people with freezing of gait, suggesting that these mazes could be used to quantify motor dysfunction in PD. Programming our frog-in-maze game onto a remotely distributable platform could provide a tool to monitor disease progression and therapeutic response in people with PD, including during clinical trials.
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Affiliation(s)
- Tuhin Virmani
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA.
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA.
| | - Aaron S Kemp
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
| | - Horace Spencer
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
| | - Linda Larson-Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
- Department of Neurobiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., #500, Little Rock, AR, 72205, USA
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Onder H, Oguz KK, Has AC, Elibol B. Comparative analysis of freezing of gait in distinct Parkinsonism types by diffusion tensor imaging method and cognitive profiles. J Neural Transm (Vienna) 2023; 130:521-535. [PMID: 36881182 DOI: 10.1007/s00702-023-02608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Freezing of gait (FOG) is an episodic gait pattern that is common in advanced Parkinson's disease (PD) and other atypical parkinsonism syndromes. Recently, disturbances in the pedunculopontine nucleus (PPN) and its connections have been suggested to play a critical role in the development of FOG. In this study, we aimed to demonstrate possible disturbances in PPN and its connections by performing the diffusion tensor imaging (DTI) technique. We included 18 patients of PD with FOG [PD-FOG], 13 patients of PD without FOG [PD-nFOG] and 12 healthy subjects as well as a group of patients with progressive supranuclear palsy (PSP), an atypical parkinsonism syndrome which is very often complicated with FOG [6 PSP-FOG, 5 PSP-nFOG]. To determine the specific cognitive parameters that can be related to FOG, deliberate neurophysiological evaluations of all the individuals were performed. The comparative analyses and correlation analyses were performed to reveal the neurophysiological and DTI correlates of FOG in either group. We have found disturbances in values reflecting microstructural integrity of the bilateral superior frontal gyrus (SFG), bilateral fastigial nucleus (FN), left pre-supplementary motor area (SMA) in the PD-FOG group relative to the PD-nFOG group. The analysis of the PSP group also demonstrated disturbance in left pre-SMA values in the PSP-FOG group likewise, while negative correlations were determined between right STN, left PPN values and FOG scores. In neurophysiological assessments, lower performances for visuospatial functions were demonstrated in FOG ( +) individuals for either patient group. The disturbances in the visuospatial abilities may be a critical step for the occurrence of FOG. Together with the results of DTI analyses, it might be suggested that impairment in the connectivity of disturbed frontal areas with disordered basal ganglia, maybe the key factor for the occurrence of FOG in the PD group, whereas left PPN which is a nondopaminergic nucleus may play a more prominent role in the process of FOG in PSP. Moreover, our results support the relationship between right STN, and FOG as mentioned before, as well as introduce the importance of FN as a new structure that may be involved in FOG pathogenesis.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, 06110, Ankara, Turkey.
| | - Kader Karli Oguz
- Department of Radiology, Hacettepe University Medical School, Ankara, Turkey
| | - Arzu Ceylan Has
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bulent Elibol
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
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Yang N, Sang S, Peng T, Hu W, Wang J, Bai R, Lu H. Impact of GBA variants on longitudinal freezing of gait progression in early Parkinson's disease. J Neurol 2023; 270:2756-2764. [PMID: 36790548 DOI: 10.1007/s00415-023-11612-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common disabling gait disturbance among patients with Parkinson's disease (PD), but the influence of genetic variants on the incidence of FOG has been poorly studied to date. OBJECTIVES We aimed to evaluate the association of GBA variants with the risk of FOG development in a large early PD cohort. METHODS This study included 371 early PD patients from the Parkinson's Progression Markers Initiative (PPMI) who were divided into a GBA variant carrier group (GBA-PD group, n = 44) and an idiopathic PD group without GBA variants (iPD group, n = 327). They were followed up for up to 5 years to examine the progression of FOG. The cumulative incidence of FOG and risk factors for FOG were assessed using Kaplan‒Meier and Cox regression analyses. RESULTS At baseline, the GBA-PD group had lower CSF β-amyloid 1-42 (Aβ42) levels and more severe motor and nonmotor symptoms than the iPD group. During the 5-year follow-up, the GBA-PD group had a higher incidence of FOG than the iPD group, and the FOG progression rate was related to GBA variant severity. In the multivariable Cox model without CSF Aβ42, GBA variants were significant predictors of future FOG, and the association remained significant after adding CSF Aβ42 to the model. In the subgroup analyses, the effect of GBA variants was not observed in the "low-level" group. However, in the "high-level" group, GBA variants independently increased the risk of FOG, and this association was stronger than the association with CSF Aβ42. CONCLUSION GBA variants are novel genetic risk factors for future FOG development in early PD patients. This association seemed to be mediated by both Aβ-dependent pathways and Aβ-independent pathways.
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Affiliation(s)
- Nannan Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Shushan Sang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tao Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wentao Hu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jingtao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Rong Bai
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hong Lu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Nwogo RO, Kammermeier S, Singh A. Abnormal neural oscillations during gait and dual-task in Parkinson’s disease. Front Syst Neurosci 2022; 16:995375. [PMID: 36185822 PMCID: PMC9522469 DOI: 10.3389/fnsys.2022.995375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Gait dysfunctions are debilitating motor symptoms of Parkinson’s disease (PD) and may result in frequent falling with health complications. The contribution of the motor-cognitive network to gait disturbance can be studied more thoroughly by challenging motor-cognitive dual-task gait performances. Gait is a complex motor task that requires an appropriate contribution from motor and cognitive networks, reflected in frequency modulations among several cortical and subcortical networks. Electrophysiological recordings by scalp electroencephalography and implanted deep brain stimulation (DBS) electrodes have unveiled modulations of specific oscillatory patterns in the cortical-subcortical circuits in PD. In this review, we summarize oscillatory contributions of the cortical, basal ganglia, mesencephalic locomotor, and cerebellar regions during gait and dual-task activities in PD. We detail the involvement of the cognitive network in dual-task settings and compare how abnormal oscillations in the specific frequency bands in the cortical and subcortical regions correlate with gait deficits in PD, particularly freezing of gait (FOG). We suggest that altered neural oscillations in different frequencies can cause derangements in broader brain networks, so neuromodulation and pharmacological therapies should be considered to normalize those network oscillations to improve challenged gait and dual-task motor functions in PD. Specifically, the theta and beta bands in premotor cortical areas, subthalamic nucleus, as well as alpha band activity in the brainstem prepontine nucleus, modulate under clinically effective levodopa and DBS therapies, improving gait and dual-task performance in PD with FOG, compared to PD without FOG and age-matched healthy control groups.
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Affiliation(s)
- Rachel O. Nwogo
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States
| | | | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States
- *Correspondence: Arun Singh,
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Morelli N. Patients with Parkinson's disease and a history of falls have decreased cerebellar grey matter volumes in the cognitive cerebellum. Rev Neurol (Paris) 2022; 178:924-931. [PMID: 35871015 DOI: 10.1016/j.neurol.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/17/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
The objective of this study was to determine if cerebellar gray matter (GM) structure differs between fallers and non-fallers with Parkinson's disease (PD) and their respective association to cognitive function. A total of 48 fallers and 63 non-fallers with PD were identified from the Parkinson's Progression Markers Initiative database. Fallers were categorized as those who self-reported a fall within the past year. Unified Parkinson's Disease Rating Scale-III (UPDRS-III), Montreal Cognitive Assessment (MoCA), Trail Making Test parts A (TMT-A) and B (TMT-B) scores were collected for each patient. Cerebellar GM volumes were derived from magnetic resonance imaging data. Analyses of covariance were used to compare group differences. Partial Pearson's correlations were used to assess the relationship between cerebellar GM volumes to UPDRS-III and cognitive outcomes. Significance was set at P ≤ 0.01. Fallers had significantly decreased GM volumes in lobules V, Crus-1, Crus-2, and VIIb (P<0.01). Cerebellar GM volumes in non-fallers demonstrated little-to-no relationship with UPDRS-III, MoCA, and TMT-B (P>0.01). However, TMT-A performance demonstrated significant, fair association to GM volumes in lobules I-IV, V, VI, Crus-1, and Crus-2 (r=-0.44 - -0.34, P<0.01) in non-fallers. Patients with PD and a history of falls have significantly decreased GM volumes in cerebellar lobules associated with cognitive functions. However, these lobule volumes become disassociated with cognitive function compared to non-fallers.
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Affiliation(s)
- N Morelli
- Medtronic PLC, Minneapolis, MN, USA.
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10
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Wilkins KB, Petrucci MN, Kehnemouyi Y, Velisar A, Han K, Orthlieb G, Trager MH, O’Day JJ, Aditham S, Bronte-Stewart H. Quantitative Digitography Measures Motor Symptoms and Disease Progression in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1979-1990. [PMID: 35694934 PMCID: PMC9535590 DOI: 10.3233/jpd-223264] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Assessment of motor signs in Parkinson's disease (PD) requires an in-person examination. However, 50% of people with PD do not have access to a neurologist. Wearable sensors can provide remote measures of some motor signs but require continuous monitoring for several days. A major unmet need is reliable metrics of all cardinal motor signs, including rigidity, from a simple short active task that can be performed remotely or in the clinic. OBJECTIVE Investigate whether thirty seconds of repetitive alternating finger tapping (RAFT) on a portable quantitative digitography (QDG) device, which measures amplitude and timing, produces reliable metrics of all cardinal motor signs in PD. METHODS Ninety-six individuals with PD and forty-two healthy controls performed a thirty-second QDG-RAFT task and clinical motor assessment. Eighteen individuals were followed longitudinally with repeated assessments for an average of three years and up to six years. RESULTS QDG-RAFT metrics showed differences between PD and controls and provided correlated metrics for total motor disability (MDS-UPDRS III) and for rigidity, bradykinesia, tremor, gait impairment, and freezing of gait (FOG). Additionally, QDG-RAFT tracked disease progression over several years off therapy and showed differences between akinetic-rigid and tremor-dominant phenotypes, as well as people with and without FOG. CONCLUSIONS QDG is a reliable technology, which could be used in the clinic or remotely. This could improve access to care, allow complex remote disease management based on data received in real time, and accurate monitoring of disease progression over time in PD. QDG-RAFT also provides the comprehensive motor metrics needed for therapeutic trials.
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Affiliation(s)
- Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew N. Petrucci
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasmine Kehnemouyi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, USA
| | - Katie Han
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerrit Orthlieb
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Megan H. Trager
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Johanna J. O’Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Sudeep Aditham
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Lench DH, Keith K, Wilson S, Padgett L, Benitez A, Ramakrishnan V, Jensen JH, Bonilha L, Revuelta GJ. Neurodegeneration of the Globus Pallidus Internus as a Neural Correlate to Dopa-Response in Freezing of Gait. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1241-1250. [PMID: 35367969 PMCID: PMC10792667 DOI: 10.3233/jpd-213062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Background: Parkinson's disease (PD) patients who develop freezing of gait (FOG) have reduced mobility and independence. While some patients experience improvement in their FOG symptoms with dopaminergic therapies, a subset of patients have little to no response. To date, it is unknown what changes in brain structure underlie dopa-response and whether this can be measured using neuroimaging approaches. OBJECTIVE We tested the hypothesis that structural integrity of brain regions (subthalamic nucleus and globus pallidus internus, GPi) which link basal ganglia to the mesencephalic locomotor region (MLR), a region involved in automatic gait, would be associated with FOG response to dopaminergic therapy. METHODS In this observational study, thirty-six participants with PD and definite FOG were recruited to undergo diffusion kurtosis imaging (DKI) and multiple assessments of dopa responsiveness (UPDRS scores, gait times ON versus OFF medication). RESULTS The right GPi in participants with dopa-unresponsive FOG showed reduced fractional anisotropy, mean kurtosis (MK), and increased radial diffusivity relative to those with dopa-responsive FOG. Furthermore, using probabilistic tractography, we observed reduced MK and increased mean diffusivity along the right GPi-MLR tract in dopa-unresponsive FOG. MK in the right GPi was associated with a subjective dopa-response for FOG (r = -0.360, df = 30, p = 0.043) but not overall motor dopa-response. CONCLUSION These results support structural integrity of the GPi as a correlate to dopa-response in FOG. Additionally, this study suggests DKI metrics may be a sensitive biomarker for clinical studies targeting dopaminergic circuitry and improvements in FOG behavior.
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Affiliation(s)
- Daniel H. Lench
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Kathryn Keith
- Department of Public Health Sciences, Medical University of South Carlina, Charleston, SC, USA
| | - Sandra Wilson
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Lucas Padgett
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Andreana Benitez
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carlina, Charleston, SC, USA
| | | | - Jens H. Jensen
- Department of Neuroscience, Medical University of South Carlina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carlina, Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Gonzalo J. Revuelta
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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12
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Park H, Shin S, Youm C, Cheon SM, Lee M, Noh B. Classification of Parkinson's disease with freezing of gait based on 360° turning analysis using 36 kinematic features. J Neuroeng Rehabil 2021; 18:177. [PMID: 34930373 PMCID: PMC8686361 DOI: 10.1186/s12984-021-00975-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a sensitive problem, which is caused by motor control deficits and requires greater attention during postural transitions such as turning in people with Parkinson's disease (PD). However, the turning characteristics have not yet been extensively investigated to distinguish between people with PD with and without FOG (freezers and non-freezers) based on full-body kinematic analysis during the turning task. The objectives of this study were to identify the machine learning model that best classifies people with PD and freezers and reveal the associations between clinical characteristics and turning features based on feature selection through stepwise regression. METHODS The study recruited 77 people with PD (31 freezers and 46 non-freezers) and 34 age-matched older adults. The 360° turning task was performed at the preferred speed for the inner step of the more affected limb. All experiments on the people with PD were performed in the "Off" state of medication. The full-body kinematic features during the turning task were extracted using the three-dimensional motion capture system. These features were selected via stepwise regression. RESULTS In feature selection through stepwise regression, five and six features were identified to distinguish between people with PD and controls and between freezers and non-freezers (PD and FOG classification problem), respectively. The machine learning model accuracies revealed that the random forest (RF) model had 98.1% accuracy when using all turning features and 98.0% accuracy when using the five features selected for PD classification. In addition, RF and logistic regression showed accuracies of 79.4% when using all turning features and 72.9% when using the six selected features for FOG classification. CONCLUSION We suggest that our study leads to understanding of the turning characteristics of people with PD and freezers during the 360° turning task for the inner step of the more affected limb and may help improve the objective classification and clinical assessment by disease progression using turning features.
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Affiliation(s)
- Hwayoung Park
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Sungtae Shin
- Department of Mechanical Engineering, College of Engineering, Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea.
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, 37 Nakdong‑Daero, 550 Beon‑gil, Hadan 2-dong, Saha-gu, Busan, 49315, Republic of Korea.
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
| | - Myeounggon Lee
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Byungjoo Noh
- Department of Kinesiology, Jeju National University, Jeju-si, Jeju-do, Republic of Korea
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13
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Scholl JL, Espinoza AI, Rai W, Leedom M, Baugh LA, Berg-Poppe P, Singh A. Relationships between Freezing of Gait Severity and Cognitive Deficits in Parkinson's Disease. Brain Sci 2021; 11:brainsci11111496. [PMID: 34827496 PMCID: PMC8615553 DOI: 10.3390/brainsci11111496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
Freezing of gait (FOG) is one of the most debilitating motor symptoms experienced by patients with Parkinson’s disease (PD), as it can lead to falls and a reduced quality of life. Evidence supports an association between FOG severity and cognitive functioning; however, results remain debatable. PD patients with (PDFOG+, n = 41) and without FOG (PDFOG–, n = 39) and control healthy subjects (n = 41) participated in this study. The NIH toolbox cognition battery, the Montreal Cognitive Assessment (MoCA), and the interval timing task were used to test cognitive domains. Measurements were compared between groups using multivariable models and adjusting for covariates. Correlation analyses, linear regression, and mediation models were applied to examine relationships among disease duration and severity, FOG severity, and cognitive functioning. Significant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG– exhibited differences in Dimensional Change Card Sort (DCCS) test, interval timing task, and MoCA scores. After adjusting for covariates in two different models, PDFOG+ and PDFOG– differed in both MoCA and DCCS scores. In addition, significant relationships between FOG severity and cognitive function (MoCA, DCCS, and interval timing) were also found. Regression models suggest that FOG severity may be a predictor of cognitive impairment, and mediation models show the effects of cognitive impairment on the relationship between disease severity and FOG severity. Overall, this study provides insight into the relationship between cognitive and FOG severity in patients with PD, which could aid in the development of therapeutic interventions to manage both.
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Affiliation(s)
- Jamie L. Scholl
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
| | | | - Wijdan Rai
- Department of Neurosciences, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105, USA;
| | | | - Lee A. Baugh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
| | - Patti Berg-Poppe
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
- Department of Physical Therapy, University of South Dakota, Vermillion, SD 57069, USA
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA; (J.L.S.); (L.A.B.)
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD 57069, USA;
- Correspondence:
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14
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Chung SJ, Yoo HS, Lee HS, Lee YH, Baik K, Jung JH, Ye BS, Sohn YH, Lee PH. Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson's disease. J Neurol 2021; 268:4203-4212. [PMID: 33942161 DOI: 10.1007/s00415-021-10529-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson's disease (PD). METHODS We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED). RESULTS Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED. CONCLUSIONS These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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15
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Droby A, Pelosin E, Putzolu M, Bommarito G, Marchese R, Mazzella L, Avanzino L, Inglese M. A Multimodal Imaging Approach Demonstrates Reduced Midbrain Functional Network Connectivity Is Associated With Freezing of Gait in Parkinson's Disease. Front Neurol 2021; 12:583593. [PMID: 33995237 PMCID: PMC8120105 DOI: 10.3389/fneur.2021.583593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The pathophysiological mechanisms underlying freezing of gait (FOG) are poorly defined. MRI studies in FOG showed a distinct pattern of cortical atrophy and decreased functional connectivity (FC) within motor and cognitive networks. Furthermore, reduced rs-FC within midbrain, frontal, and temporal areas has been also described. This study investigated the patterns of whole-brain FC alterations within midbrain inter-connected regions in PD-FOG patients, and whether these patterns are linked to midbrain structural damage using a multi-modal imaging approach, combing structural and functional imaging techniques. Methods: Thirty three PD patients (16 PD-FOG, 17 PD noFOG), and 21 sex- and age-matched healthy controls (HCs) were prospectively enrolled. All subjects underwent MRI scan at 1.5T, whereas only PD patients underwent clinical and cognitive assessment. Grey matter (GM) integrity was measured using voxel-based morphometry (VBM). VBM findings served as basis to localize midbrain damage, and were further used as a seed region for investigating whole-brain FC alterations using rs-fMRI. Results: In rs-fMRI, patients with PD and FOG demonstrated significant decrease of midbrain-cortical FC levels in the R PCG, right postcentral, and supramarginal gyri compared to controls and the middle cingulate compared to noFOG group. Based on the regression analysis, MOCA, UPDRS-III total score, and FOG severity scores were associated with FC levels in several frontal, parietal and temporal regions. Discussion: The present results suggest that midbrain structural damage as well as decreased FC within the brainstem functional network might contribute to FOG occurrence in PD patients.
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Affiliation(s)
- Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
| | - Martina Putzolu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Roberta Marchese
- Ospedale Policlinico San Martino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
| | - Luca Mazzella
- Asl3, Genovese Centri per i Disturbi Cognitivi e le Demenze (CDCD) Ponente, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy.,Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
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16
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Taximaimaiti R, Wang XP. Comparing the Clinical and Neuropsychological Characteristics of Parkinson's Disease With and Without Freezing of Gait. Front Neurosci 2021; 15:660340. [PMID: 33986641 PMCID: PMC8110824 DOI: 10.3389/fnins.2021.660340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Freezing of gait (FOG) is one of the most common walking problems in Parkinson’s disease (PD). Impaired cognitive function is believed to play an important role in developing and aggravating FOG in PD. But some evidence suggests that motor function discrepancy may affect testing results. Therefore, we think it is necessary for PD-FOG(+) and PD-FOG(−) patients to complete neuropsychological tests under similar motor conditions. Methods This study recruited 44 idiopathic PD patients [PD-FOG(+) n = 22, PD-FOG(−) n = 22] and 20 age-matched healthy controls (HC). PD-FOG(+) and PD-FOG(−) patients were matched for age, year of education, and Hoehn and Yahr score (H&Y). All participants underwent a comprehensive battery of neuropsychological assessment, and demographical and clinical information was also collected. Results PD patients showed poorer cognitive function, higher risks of depression and anxiety, and more neuropsychiatric symptoms compared with HC. When controlling for age, years of education, and H&Y, there were no statistical differences in cognitive function between PD-FOG(+) and PD-FOG(−) patients. But PD-FOG(+) patients had worse motor and non-motor symptoms than PD-FOG(−) patients. PD patients whose motor symptoms initiated with rigidity and initiated unilaterally were more likely to experience FOG. Conclusion Traditional neuropsychological testing may not be sensitive enough to detect cognitive impairment in PD. Motor symptoms initiated with rigidity and initiated unilaterally might be an important predictor of FOG.
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Affiliation(s)
- Reyisha Taximaimaiti
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Freezing of Gait in Parkinson's Disease: Risk Factors, Their Interactions, and Associated Nonmotor Symptoms. PARKINSONS DISEASE 2021; 2021:8857204. [PMID: 33505652 PMCID: PMC7815408 DOI: 10.1155/2021/8857204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
Background Freezing of gait (FOG) is a debilitating and incompletely understood symptom in Parkinson's disease (PD). Objective To determine the principal clinical factors predisposing to FOG in PD, their interactions, and associated nonmotor symptoms. Methods 164 PD subjects were assessed in a cross-sectional retrospective study, using the MDS-UPDRS scale, MMSE, and Clinical Dementia Rating Scale. Clinical factors associated with FOG were determined using univariate analysis and nominal logistic regression. Receiver operating characteristic curves were computed, to obtain measures of sensitivity and specificity of predictors of FOG. Subgroups of patients with FOG were compared with those without FOG, based on defining aspects of their clinical phenotype. Results Relative to non-FOG patients, those with FOG had a longer disease duration, higher PIGD and balance-gait score, higher LED, and more motor complications (p < 0.0001) and were more likely to exhibit urinary dysfunction (p < 0.0003), cognitive impairment, hallucinations, and psychosis (p=0.003). The balance-gait score and motor complications, at their optimum cutoff values, together predicted FOG with 86% accuracy. Interactions were noted between cognitive dysfunction and both the Bal-Gait score and motor complication status, cognitive impairment or dementia increasing the likelihood of FOG in subjects without motor complications (p=0.0009), but not in those with motor complications. Conclusions Both disease and treatment-related factors, notably LED, influence the risk of FOG in PD, with a selective influence of cognitive dysfunction in patients with balance-gait disorder but not in those with motor fluctuations. These findings may help to inform clinical management and highlight distinct subgroups of patients with PD-FOG, which are likely to differ in their network pathophysiology.
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18
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Apolipoprotein E ε4 genotype and risk of freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2020; 81:173-178. [DOI: 10.1016/j.parkreldis.2020.10.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
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19
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Jung JH, Kim BH, Chung SJ, Yoo HS, Lee YH, Baik K, Ye BS, Sohn YH, Lee JM, Lee PH. Motor Cerebellar Connectivity and Future Development of Freezing of Gait in De Novo Parkinson's Disease. Mov Disord 2020; 35:2240-2249. [PMID: 32926481 DOI: 10.1002/mds.28243] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To investigate the role of motor cerebellar connectivity in future development of freezing of gait, because it is a complex network disorder in Parkinson's disease (PD). METHODS We recruited 26 de novo patients with PD who experienced freezing of gait within 5 years from magnetic resonance imaging acquisition (vulnerable PD group), 61 patients with PD who had not experienced freezing of gait within 5 years (resistant PD group), and 27 healthy control subjects. We compared the resting state functional connectivity between the motor cerebellum and the whole brain between the groups. In addition, we evaluated the relationship between motor cerebellar connectivity and freezing of gait latency. RESULTS The vulnerable PD group had increased functional connectivity between the motor cerebellum and parieto-occipito-temporal association cortices compared with the control group or the resistant PD group. Connectivity between lobule VI and the right superior parietal lobule, right fusiform gyrus, and left inferior temporal gyrus; between lobule VIIb and the right superior parietal lobule, right hippocampus, and right middle temporal gyrus; and between lobule VIIIb and the bilateral fusiform gyri, right middle occipital gyrus, and bilateral parietal lobes was inversely proportional to freezing of gait latency. The freezing of gait latency-related cortical functional connectivity from the motor cerebellum was also significantly higher in the vulnerable PD group compared with the control group, as well as the resistant PD group. CONCLUSIONS The data suggest that the motor cerebellar functional connectivity with the posterior cortical areas play an important role in future development of freezing of gait in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo-Hyun Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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20
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Rezvanian S, Litvan I, Standaert D, Jankovic J, Reich SG, Hall D, Shprecher DR, Bordelon Y, Dubinsky R, Kluger B. Understanding the relationship between freezing of gait and other progressive supranuclear palsy features. Parkinsonism Relat Disord 2020; 78:56-60. [PMID: 32731191 DOI: 10.1016/j.parkreldis.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Freezing of gait (FoG) leads to falls and reduces quality of life, but little is known about FoG in progressive supranuclear palsy (PSP). This study aim was to identify the clinical parameters associated with FoG in PSP patients. METHODS 349 patients meeting the National Institute for Neurological Disorders and Society for PSP (NINDS-SPSP) clinical diagnostic criteria were divided into two groups: PSP with FoG (n = 159) and PSP without FoG (n = 190). To determine if FoG in PSP associates with demographics, motor performance, visual difficulties, and executive function, we used the Frontal Assessment Battery (FAB), Mattis Dementia Rating Scale (DRS), Unified Parkinson's Disease Rating Scale (UPDRS), PSP Rating Scale (PSPRS), Modified Hoehn & Yahr staging, and Schwab and England Activities Daily Living (S&EADL) scale. UPDRS was used to identify FoG. Individual items of each clinical assessment with p-value < 0.05 in the univariate logistic regression analyses were included in the backward stepwise multivariate regression analysis. RESULTS Both groups were similar in demographics. 45.6% of patients had FoG, which was present at onset and increased with disease duration. There were no between-group significant associations between FoG and visual disturbances, executive function and overall cognition, but on univariate analyses, FoG was significantly associated with bradykinesia, rigidity, gait, and posture. In the multivariate model FoG was associated with disease duration and speech. CONCLUSIONS Our findings indicate that disease duration and speech have the most significant association with FoG. These findings may suggest that FoG and speech difficulties in PSP share a similar pathophysiology.
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Affiliation(s)
- Saba Rezvanian
- Department of Neurosciences, University of California San Diego, CA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, CA, USA.
| | - David Standaert
- Department of Neurology, University of Alabama at Birmingham, AL, USA
| | | | | | - Deborah Hall
- Department of Neurological Sciences, Rush University, IL, USA
| | - David R Shprecher
- University of Utah, UT, USA; Banner Sun Health Research Institute, AZ, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, CA, USA
| | | | - Benzi Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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21
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Ehgoetz Martens KA, Peterson DS, Almeida QJ, Lewis SJG, Hausdorff JM, Nieuwboer A. Behavioural manifestations and associated non-motor features of freezing of gait: A narrative review and theoretical framework. Neurosci Biobehav Rev 2020; 116:350-364. [PMID: 32603716 DOI: 10.1016/j.neubiorev.2020.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Over the past decade, non-motor related symptoms and provocative contexts have offered unique opportunities to gain insight into the potential mechanisms that may underpin freezing of gait (FOG) in Parkinson's disease (PD). While this large body of work has informed several theoretical models, to date, few are capable of explaining behavioural findings across multiple domains (i.e. cognitive, sensory-perceptual and affective) and in different behavorial contexts. As such, the exact nature of these interrelationships and their neural basis remain quite enigmatic. Here, the non-motor, behavioural evidence for cognitive, sensory-perceptual and affective contributors to FOG are reviewed and synthesized by systematically examining (i) studies that manipulated contextual environments that provoke freezing of gait, (ii) studies that uncovered factors that have been proposed to contribute to freezing, and (iii) studies that longitudinally tracked factors that predict the future development of freezing of gait. After consolidating the evidence, we offer a novel perspective for integrating these multi-faceted behavioural patterns and identify key challenges that warrant consideration in future work.
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Affiliation(s)
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Arizona, USA; Phoenix Veterans Affairs Medical Centre, Arizona, USA
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Laurier University, Waterloo, ON, Canada
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Dept of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science, University of Leuven, Leuven, Belgium
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Labeit B, Claus I, Muhle P, Lapa S, Suntrup-Krueger S, Dziewas R, Osada N, Warnecke T. Oropharyngeal freezing and its relation to dysphagia – An analogy to freezing of gait. Parkinsonism Relat Disord 2020; 75:1-6. [DOI: 10.1016/j.parkreldis.2020.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/25/2020] [Accepted: 05/02/2020] [Indexed: 11/24/2022]
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Singh A, Cole RC, Espinoza AI, Brown D, Cavanagh JF, Narayanan NS. Frontal theta and beta oscillations during lower-limb movement in Parkinson's disease. Clin Neurophysiol 2020; 131:694-702. [PMID: 31991312 DOI: 10.1016/j.clinph.2019.12.399] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/12/2019] [Accepted: 12/01/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Patients with Parkinson's disease (PD) have deficits in lower-limb functions such as gait, which involves both cognitive and motor dysfunction. In PD, theta and beta brain rhythms are associated with cognitive and motor functions, respectively. We tested the hypothesis that PD patients with lower-limb abnormalities would exhibit abnormal theta and beta rhythms in the mid-frontal cortical region during lower-limb action. METHODS This study included thirty-nine participants; 13 PD patients with FOG (PDFOG+), 13 without FOG (PDFOG-), and 13 demographically-matched controls. We recorded scalp electroencephalograms (EEG) during a lower-limb pedaling motor task, which required intentional initiation and stopping of a motor movement. RESULTS FOG scores were correlated with disease severity and cognition. PDFOG+ patients pedaled with reduced speed and decreased acceleration compared to PDFOG- patients and controls. PDFOG+ patients exhibited attenuated theta-band (4-8 Hz) power and increased beta-band (13-30 Hz) power at mid-frontal electrode Cz during pedaling. Frontal theta- and beta-band oscillations also correlated with motor and cognitive deficits. CONCLUSION Frontal theta and beta oscillations are predictors of lower-limb motor symptoms in PD and could be used to design neuromodulation for PD-related lower-limb abnormalities. SIGNIFICANCE These data provide insight into mechanisms of lower-limb dysfunction in PD with FOG.
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Affiliation(s)
- Arun Singh
- Neurology Department, University of Iowa, Iowa City, IA, USA.
| | - Rachel C Cole
- Neurology Department, University of Iowa, Iowa City, IA, USA
| | | | - Darin Brown
- Psychology Department, University of New Mexico, Albuquerque, NM, USA
| | - James F Cavanagh
- Psychology Department, University of New Mexico, Albuquerque, NM, USA
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Cantú H, Nantel J, Millán M, Paquette C, Côté JN. Abnormal Muscle Activity and Variability Before, During, and After the Occurrence of Freezing in Parkinson's Disease. Front Neurol 2019; 10:951. [PMID: 31551912 PMCID: PMC6733893 DOI: 10.3389/fneur.2019.00951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Freezing of gait (FOG) is often experienced in advanced stages of Parkinson's disease (PD) and can lead to an increased risk of falls. Although spatiotemporal characteristics of FOG are well-described, their underlying neuromuscular mechanisms remain poorly understood. Several studies have demonstrated an abnormal activation of distal muscles of the lower limb and coordination impairments during gait in people with PD (pwPD). However, few have investigated how various characteristics of electromyograms (EMGs) change before, during and after a freezing episode (FE). Our objective was to quantify changes in proximal and distal leg muscle activity associated with FEs. In this study, 12 pwPD, confirmed as freezers, performed a repetitive stepping-in-place task used to elicit FE. Surface EMGs were collected from proximal [rectus femoris and biceps femoris (BF)] and distal [tibialis anterior (TA) and gastrocnemius medialis (GM)] muscles. Data epochs of 500 ms were extracted from EMG time series at four different periods: baseline, 2 s before a FE, during a FE, and 2 s after a FE. For each epoch, EMG amplitude [root-mean-square (RMS)], variability [coefficient of variation (CoV)], and inter-muscle functional connectivity (mutual information) were quantified. Results from the analysis of 21 FEs show a significant main effect of Period for EMG amplitude in bilateral TA and in the least affected GM (p < 0.01), with decreased activation before freezing that remained low during and after the FE. On the other hand, a main effect of Period was also found in bilateral BF muscles (p < 0.01) but with increased activation before freezing that was generally sustained during and after FE. Main effects of Period were also found for all measures of variability, except for the least affected GM, showing reduced variability during the FE that returned to baseline in all muscles except both TA. Moreover, an increase in functional connectivity between the least affected distal muscles was seen before the FE. Our findings confirm that many characteristics of EMG patterns of both distal and proximal leg muscles change throughout periods of a FE, suggesting both impairment and adaptive strategies from proximal muscles.
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Affiliation(s)
- Hiram Cantú
- Departamento de Ingeniería Biomédica, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Mexico.,Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, QC, Canada.,Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Millán
- Departamento de Ingeniería Biomédica, Vicerrectoría de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Mexico
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Julie N Côté
- Occupational Biomechanics and Ergonomics Laboratory, Michael Feil and Ted Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital, Laval, QC, Canada.,Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
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A novel single-sensor-based method for the detection of gait-cycle breakdown and freezing of gait in Parkinson's disease. J Neural Transm (Vienna) 2019; 126:1029-1036. [PMID: 31154512 DOI: 10.1007/s00702-019-02020-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
Objective measurement of walking speed and gait deficits are an important clinical tool in chronic illness management. We previously reported in Parkinson's disease that different types of gait tests can now be implemented and administered in the clinic or at home using Ambulosono smartphone-sensor technology, whereby movement sensing protocols can be standardized under voice instruction. However, a common challenge that remains for such wearable sensor systems is how meaningful data can be extracted from seemingly "noisy" raw sensor data, and do so with a high level of accuracy and efficiency. Here, we describe a novel pattern recognition algorithm for the automated detection of gait-cycle breakdown and freezing episodes. Ambulosono-gait-cycle-breakdown-and-freezing-detection (Free-D) integrates a nonlinear m-dimensional phase-space data extraction method with machine learning and Monte Carlo analysis for model building and pattern generalization. We first trained Free-D using a small number of data samples obtained from thirty participants during freezing of gait tests. We then tested the accuracy of Free-D via Monte Carlo cross-validation. We found Free-D to be remarkably effective at detecting gait-cycle breakdown, with mode error rates of 0% and mean error rates < 5%. We also demonstrate the utility of Free-D by applying it to continuous holdout traces not used for either training or testing, and found it was able to identify gait-cycle breakdown and freezing events of varying duration. These results suggest that advanced artificial intelligence and automation tools can be developed to enhance the quality, efficiency, and the expansion of wearable sensor data processing capabilities to meet market and industry demand.
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Broeder S, Heremans E, Pinto Pereira M, Nackaerts E, Meesen R, Verheyden G, Nieuwboer A. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study. Hum Mov Sci 2019; 65:S0167-9457(17)30936-3. [DOI: 10.1016/j.humov.2018.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
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Koshy Cherian A, Kucinski A, Wu R, de Jong IEM, Sarter M. Co-treatment with rivastigmine and idalopirdine reduces the propensity for falls in a rat model of falls in Parkinson's disease. Psychopharmacology (Berl) 2019; 236:1701-1715. [PMID: 30607479 DOI: 10.1007/s00213-018-5150-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022]
Abstract
RATIONALE Falls in patients with Parkinson's disease (PD) are associated with cognitive, specifically attentional impairments and with losses in cholinergic projection systems. We previously established an animal model of the combined basal forebrain cholinergic-striatal dopaminergic losses of PD fallers (Dual Lesioned, DL, rats) and demonstrated that treating DL rats with an acetylcholinesterase inhibitor (AChEI), donepezil, together with a 5HT6 receptor antagonist, idalopirdine, reduced fall frequency and improved associated aspects of the performance of DL rats traversing rotating rods. OBJECTIVES Here, we employed a longer and more taxing rotating beam apparatus to determine the potential therapeutic efficacy of idalopirdine when combined with the pseudo-irreversible, and thus relatively long-acting, AChE- and butyrylcholinesterase- (BuChE) inhibitor rivastigmine. RESULTS As before, vehicle-treated DL rats fell more frequently, committed more slips, and exhibited more movement stoppages than intact control rats. Repeated intermittent administration of rivastigmine and idalopirdine significantly improved the performance of DL rats. Rivastigmine alone also produced strong trends for reducing falls and slips. The combination treatment was more effective than rivastigmine alone in reducing stoppages and stoppage-associated falls. As before, idalopirdine treatment alone was ineffective. CONCLUSIONS These results extend the prediction that the combined treatment with idalopirdine and an AChEI improves complex movement control and reduces the propensity for falls in patients with movement disorders. Because of the importance of finding better treatments for gait and balance deficits in PD, the present results may further motivate a clinical exploration of the usefulness of this combination treatment.
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Affiliation(s)
- Ajeesh Koshy Cherian
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | - Aaron Kucinski
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | - Ryan Wu
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | | | - Martin Sarter
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA.
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Palermo G, Frosini D, Corsi A, Giuntini M, Mazzucchi S, Del Prete E, Bonuccelli U, Ceravolo R. Freezing of gait and dementia in parkinsonism: A retrospective case-control study. Brain Behav 2019; 9:e01247. [PMID: 31074064 PMCID: PMC6577616 DOI: 10.1002/brb3.1247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To support the cognitive model of Freezing of Gait (FoG) we investigated FoG in a cohort of patients with Dementia with Lewy Bodies (DLB). MATERIALS AND METHODS We assessed FoG frequency in 19 DLB patients compared to 19 control PD patients within 2 years from symptom onset and with at least 5 years follow-up. The two groups were matched by age and motor presentation at onset, severity of parkinsonism and disease duration. The presence and severity of FoG was identified as those with a score of 1 or greater on subitem 14 of the Unified Parkinson's Disease Rating Scale Part II (UPDRS II). RESULTS At T0, 68.4% DLB and 10.5% PD patients experienced FoG ≥1. The prevalence of FoG increased with disease progression (94.7% DLB and 47.3% PD subjects had FoG ≥1 at T5). DLB also showed a more severe FoG (FoG ≥2) than PD (21% vs. 0% at T0 and 52.6% vs. 10.5% at T5), consistently with previous studies reporting FoG prevalence in DLB. CONCLUSION This is the first study looking specifically at FoG in DLB, identifying it as a frequent and early feature of DLB and emphasizing the crucial role of cognitive impairment in the occurrence of this mysterious phenomenon.
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Affiliation(s)
- Giovanni Palermo
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Daniela Frosini
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Andrea Corsi
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Martina Giuntini
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Eleonora Del Prete
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Unit of NeurologyUniversity of PisaPisaItaly
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Heremans E, Broeder S, Nieuwboer A, Bekkers EM, Ginis P, Janssens L, Nackaerts E. When motor control gets out of hand: Speeding up triggers freezing in the upper limb in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:163-168. [PMID: 30987896 DOI: 10.1016/j.parkreldis.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/10/2018] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) can suffer from sudden movement arrests during upper limb tasks. The current study investigated a test to assess freezing of the upper limbs (FOUL) at two speed conditions to improve the sensitivity of FOUL detection. METHODS Forty-nine patients with PD and 10 age-matched controls (HC) performed a freezing-provoking writing task, requiring up- and down-stroke writing at varying sizes in-between visual target zones indicating funnel-shapes on a touch-sensitive tablet. They performed five trials at their preferred speed, referred to as the Normal Funnel Task (NFT) and five trials at maximum speed, referred to as the Fast Funnel Task (FFT), in a random order. RESULTS Based on a combination of kinematic criteria and video analysis, 183 FOUL episodes were detected in 24 participants (23 PD, 1 HC). The number of patients with FOUL, number of FOUL episodes and percentage time frozen were significantly higher during FFT than NFT. Most FOUL episodes occurred during writing at small (51.6%) and decreasing size (36.3%). Additionally, FOUL outcomes significantly correlated with the Montreal Cognitive Assessment and New Freezing of Gait Questionnaire. CONCLUSION As FOUL is more prevalent under higher task demands, these data offer support for the "threshold model", previously proposed to provide insight in freezing of gait (FOG) and underscoring the presupposed link between FOG and FOUL. As well, this study may provide a novel paradigm to assess FOUL in both laboratory and clinical settings.
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Affiliation(s)
- Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Sanne Broeder
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Esther Mj Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Luc Janssens
- Electrical Engineering (ESAT), Group T Leuven Campus, KU Leuven, Belgium
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium.
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Kim R, Lee J, Kim HJ, Kim A, Jang M, Jeon B, Kang UJ. CSF β-amyloid 42 and risk of freezing of gait in early Parkinson disease. Neurology 2018; 92:e40-e47. [PMID: 30504429 DOI: 10.1212/wnl.0000000000006692] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/06/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether CSF biomarkers can be used as a predictor of freezing of gait (FOG) in Parkinson disease (PD) and to investigate the predictive value of clinical, dopamine transporter (DAT) imaging, and CSF parameters both separately and in combination. METHODS This study using the PPMI data included 393 patients with newly diagnosed PD without FOG at baseline. We evaluated CSF for β-amyloid 1-42 (Aβ42), α-synuclein, total tau, phosphorylated tau181, and the calculated ratio of Aβ42 to total tau at baseline. Demographic and clinical data and DAT imaging results were also investigated. Cox proportional-hazards regression analyses were performed to identify the factors predictive of FOG. From these results, we constructed a predictive model for the development of FOG. RESULTS During a median follow-up of 4.0 years, only Aβ42 among the CSF biomarkers was associated with the development of FOG (hazard ratio 0.997, 95% confidence interval [CI] 0.996-0.999, p = 0.009). Postural instability gait difficulty (PIGD) score, caudate DAT uptake, and, to a lesser extent, male sex, Movement Disorders Society Unified Parkinson's Disease Rating Scale motor score, and Montreal Cognitive Assessment score were also predictive of FOG. The combined model integrating the PIGD score, caudate DAT uptake, and CSF Aβ42 achieved a better discriminative ability (area under the curve 0.755, 95% CI 0.700-0.810) than any factor alone. CONCLUSION We found CSF Aβ42 to be a predictor of FOG in patients with early PD. Furthermore, the development of FOG within 4 years after diagnosis of PD can be predicted with acceptable accuracy with our risk model.
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Affiliation(s)
- Ryul Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Joongyub Lee
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Han-Joon Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Aryun Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Mihee Jang
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Beomseok Jeon
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY.
| | - Un Jung Kang
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
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Lichter DG, Benedict RHB, Hershey LA. Importance of Balance-Gait Disorder as a Risk Factor for Cognitive Impairment, Dementia and Related Non-Motor Symptoms in Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2018; 8:539-552. [DOI: 10.3233/jpd-181375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- David Gordon Lichter
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- VA Western NY Healthcare System, Buffalo, NY, USA
| | | | - Linda Ann Hershey
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Bluett B, Banks S, Cordes D, Bayram E, Mishra V, Cummings J, Litvan I. Neuroimaging and neuropsychological assessment of freezing of gait in Parkinson's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:387-394. [PMID: 30211293 PMCID: PMC6131985 DOI: 10.1016/j.trci.2018.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Freezing of gait (FOG) is a disabling phenomenon characterized by a brief, episodic absence or reduction of forward progression of the feet despite the intention to walk. It is a common cause of falls and mortality in cases with Parkinson's disease (PD). This article reviews neuropsychological and neuroimaging studies to date and introduces a new study of multimodal imaging and cognition in PD-FOG. Methods A comprehensive literature search identified studies using neuropsychological evaluation and/or neuroimaging to evaluate PD-FOG. Results Several studies have evaluated PD-FOG, but few have combined neuropsychological and comprehensive neuroimaging and none longitudinally. Discussion A study using a combined approach longitudinally evaluating cognitive dysfunction and underlying neural networks in FOG is needed. We introduce the framework of a study which demonstrates the use of establishing an infrastructure for studying neurodegenerative disorders using the National Institutes of Health/National Institute of General Medical Science Center of Biomedical Research Excellence grant mechanism.
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Affiliation(s)
- Brent Bluett
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Sarah Banks
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Ece Bayram
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Virendra Mishra
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Haghshomar M, Dolatshahi M, Ghazi Sherbaf F, Sanjari Moghaddam H, Shirin Shandiz M, Aarabi MH. Disruption of Inferior Longitudinal Fasciculus Microstructure in Parkinson's Disease: A Systematic Review of Diffusion Tensor Imaging Studies. Front Neurol 2018; 9:598. [PMID: 30093877 PMCID: PMC6070770 DOI: 10.3389/fneur.2018.00598] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder accompanied by a series of pathological mechanisms which contribute to a variety of motor and non-motor symptoms. Recently, there has been an increasing interest in structural diffusion tensor imaging (DTI) in PD which has shed light on our understanding of structural abnormalities underlying PD symptoms or its associations with pathological mechanisms. One of the white matter tracts shown to be disrupted in PD with a possible contribution to some PD symptoms is the inferior longitudinal fasciculus (ILF). On the whole, lower ILF integrity contributes to thought disorders, impaired visual emotions, cognitive impairments such as semantic fluency deficits, and mood disorders. This review outlines the microstructural changes in ILF associated with systemic inflammation and various PD symptoms like cognitive decline, facial emotion recognition deficit, depression, color discrimination deficit, olfactory dysfunction, and tremor genesis. However, few studies have investigated DTI correlates of each symptom and larger studies with standardized imaging protocols are required to extend these preliminary findings and lead to more promising results.
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Affiliation(s)
- Maryam Haghshomar
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Dolatshahi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mehdi Shirin Shandiz
- Department of Medical Physics, Zahedan University of Medical Sciences, Zahedan, Iran
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Kim R, Lee J, Kim Y, Kim A, Jang M, Kim HJ, Jeon B, Kang UJ, Fahn S. Presynaptic striatal dopaminergic depletion predicts the later development of freezing of gait in de novo Parkinson's disease: An analysis of the PPMI cohort. Parkinsonism Relat Disord 2018. [DOI: 10.1016/j.parkreldis.2018.02.047] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson's Disease. Neural Plast 2018; 2018:4897276. [PMID: 29977280 PMCID: PMC5994277 DOI: 10.1155/2018/4897276] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
Freezing of gait (FoG) is among the most disabling symptoms of Parkinson's disease (PD) patients. Recent studies showed that action observation training (AOT) with repetitive practice of the observed actions represents a strategy to induce longer-lasting effects compared with standard physiotherapy. We investigated whether AOT may improve FoG and mobility in PD, when AOT is applied in a group-based setting. Sixty-four participants with PD and FoG were assigned to the experimental (AO) or control groups and underwent a 45-minute training session, twice a week, for 5 weeks. AOT consisted in physical training combined with action observation whereas the control group executed the same physical training combined with landscape-videos observation. Outcome measures (FoG questionnaire, Timed Up and Go test, 10-meter walking test, and Berg balance scale) were evaluated before training, at the end of training, and 4 weeks later (FU-4w). Both groups showed positive changes in all outcome measures at posttraining assessment. Improvements in FoG questionnaire, Timed Up and Go test, and Berg balance scale were retained at FU-4w evaluation only in the AOT group. AOT group-based training is feasible and effective on FoG and motor performance in PD patients and may be introduced as an adjunctive option in PD rehabilitation program.
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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37
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Schlenstedt C, Mancini M, Nutt J, Hiller AP, Maetzler W, Deuschl G, Horak F. Are Hypometric Anticipatory Postural Adjustments Contributing to Freezing of Gait in Parkinson's Disease? Front Aging Neurosci 2018; 10:36. [PMID: 29497374 PMCID: PMC5818427 DOI: 10.3389/fnagi.2018.00036] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: This study aims at investigating whether impaired anticipatory postural adjustments (APA) during gait initiation contribute to the occurrence of freezing of gait (FOG) or whether altered APAs compensate for FOG in Parkinson’s disease (PD). Methods: Gait initiation after 30 s quiet stance was analyzed without and with a cognitive dual task (DT) in 33 PD subjects with FOG (PD+FOG), 30 PD subjects without FOG (PD-FOG), and 32 healthy controls (HC). APAs were characterized with inertial sensors and muscle activity of the tensor fasciae latae (TFL), gastrocnemius, and tibialis anterior was captured with electromyography recordings. Nine trials (of 190) were associated with start hesitation/FOG and analyzed separately. Results: PD+FOG and PD-FOG did not differ in disease duration, disease severity, age, or gender. PD+FOG had significantly smaller medio-lateral (ML) and anterio-posterior APAs compared to PD-FOG (DT, p < 0.05). PD+FOG had more co-contraction of left and right TFL during APAs compared to PD-FOG (p < 0.01). Within the PD+FOG, the ML size of APA (DT) was positively correlated with the severity of FOG history (NFOG-Q), with larger APAs associated with worse FOG (rho = 0.477, p = 0.025). ML APAs were larger during trials with observed FOG compared to trials of PD+FOG without FOG. Conclusions: People with PD who have a history of FOG have smaller ML APAs (weight shifting) during gait initiation compared to PD-FOG and HC. However, start hesitation (FOG) is not caused by an inability to sufficiently displace the center of mass toward the stance leg because APAs were larger during trials with observed FOG. We speculate that reducing the acceleration of the body center of mass with hip abductor co-contraction for APAs might be a compensatory strategy in PD+FOG, to address postural control deficits and enable step initiation.
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Affiliation(s)
- Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.,Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States
| | - Martina Mancini
- Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States
| | - Jay Nutt
- Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States
| | - Amie P Hiller
- Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Fay Horak
- Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, United States
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Fietzek UM, Stuhlinger L, Plate A, Ceballos-Baumann A, Bötzel K. Spatial constraints evoke increased number of steps during turning in Parkinson's disease. Clin Neurophysiol 2017; 128:1954-1960. [PMID: 28829978 DOI: 10.1016/j.clinph.2017.07.399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Turning and limitations to step length were shown to trigger progressive shortening of steps, which can lead to freezing of gait. By reducing the base area in which the turn had to take place, we aimed to evaluate the contribution of spatial constraints on 360° axial turns in people with Parkinson's disease with and without freezing. METHODS We evaluated 40 patients with and without freezing and 16 age-matched healthy subjects. We assessed clinical data, and used body-worn inertial sensors to describe stepping and turn duration of 360° in quadratic squares of different sizes marked on the floor. RESULTS We found that, when subjects had to perform turns in smaller as compared to larger squares, this spatial constraint strongly affected the turning behavior, i.e. increased the number of steps, and the duration of turns. However, turning was significantly more impaired in patients as compared to controls, and patients with freezing were significantly worse as patients without freezing. CONCLUSION Our data show that spatial constraint during axial turning has the potential to deteriorate stepping performance, especially in patients reporting freezing of gait. SIGNIFICANCE The size of the base area needs to be defined in any item or scale that makes diagnostic use of turning.
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Affiliation(s)
- Urban M Fietzek
- Schön Klinik München Schwabing, Dept. of Neurology and Clinical Neurophysiology, Munich, Germany.
| | | | - Annika Plate
- Dept. of Neurology, University of Munich (LMU), Germany
| | - Andres Ceballos-Baumann
- Schön Klinik München Schwabing, Dept. of Neurology and Clinical Neurophysiology, Munich, Germany; Dept. of Neurology, Technical University of Munich (TUM), Germany
| | - Kai Bötzel
- Dept. of Neurology, University of Munich (LMU), Germany
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Bekkers EMJ, Dijkstra BW, Dockx K, Heremans E, Verschueren SMP, Nieuwboer A. Clinical balance scales indicate worse postural control in people with Parkinson's disease who exhibit freezing of gait compared to those who do not: A meta-analysis. Gait Posture 2017; 56:134-140. [PMID: 28544951 DOI: 10.1016/j.gaitpost.2017.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 02/02/2023]
Abstract
Postural instability and freezing of gait (FOG) are key features of Parkinson's disease (PD) that are closely related to falls. Uncovering the postural control differences between individuals with and without FOG contributes to our understanding of the relationship between these phenomena. The objective of this meta-analysis was to investigate whether postural control deficits, as detected by clinical balance scales, were more apparent in FOG+ compared to FOG-. Furthermore, we aimed to identify whether different scales were equally sensitive to detect postural control deficits and whether medication affected postural control differentially in each subgroup. Relevant articles were identified via five electronic databases. We performed a meta-analysis on nine studies which reported clinical balance scale scores in 249 freezers and 321 non-freezers. Methodological analysis showed that in 5/9 studies disease duration differed between subgroups. Despite this drawback, postural control was found to be significantly worse in FOG+ compared to FOG-. All included clinical balance scales were found to be sufficiently sensitive to detect the postural control differences. Levodopa did not differentially affect postural control (p=0.21), as in both medication states FOG+ had worse postural stability than FOG-. However, this finding warrants a cautious interpretation given the limitations of the studies included. From subscore analysis, we found that reactive and dynamic postural control were the most affected postural control systems in FOG+. We conclude that our findings provide important evidence for pronounced postural instability in individuals with FOG, which can be easily picked up with clinical evaluation tools. Posturographic measures in well-matched subgroups are needed to highlight the exact nature of these deficits.
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Affiliation(s)
- Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium.
| | - Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Kim Dockx
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Sabine M P Verschueren
- Research Group for Musculoskeletal Research, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
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Wang YX, Zhao J, Li DK, Peng F, Wang Y, Yang K, Liu ZY, Liu FT, Wu JJ, Wang J. Associations between cognitive impairment and motor dysfunction in Parkinson's disease. Brain Behav 2017; 7:e00719. [PMID: 28638722 PMCID: PMC5474720 DOI: 10.1002/brb3.719] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Numerous studies have been carried out to explore the potential association between neurologic deficits and variable clinical manifestations of Parkinson's disease (PD). The aim of our study was to investigate the association between cognitive performance and motor dysfunction in Chinese patients with PD. METHODS Data from 96 patients with PD were obtained from the Parkinson's disease patient cohort database of Huashan Hospital. All participants underwent a comprehensive neuropsychological evaluation to assess cognitive status, that included scoring on the Mini-mental state examination (MMSE), followed by more detailed cognitive assessment on five main cognitive domains (verbal memory, nonverbal memory, visuospatial function, language and attention/executive function). Correlations between cognitive and motor scores were investigated after controlling for age, disease duration, education, and gender. RESULTS We report a significant correlation between subdomains of cognitive impairment and motor dysfunction using analyses of the multiple linear regression. Notably, executive function and attention was significantly associated with bradykinesia and rigidity, while visuospatial function was associated with bradykinesia and tremor. CONCLUSIONS The association between motor dysfunction and cognitive decline in PD might highlight deficits represented by a shared neurochemical pathway.
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Affiliation(s)
- Yi-Xuan Wang
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Jue Zhao
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Da-Ke Li
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Fang Peng
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Ying Wang
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Ke Yang
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Zhen-Yang Liu
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Feng-Tao Liu
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Jian-Jun Wu
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
| | - Jian Wang
- Department & Institute of Neurology Huashan Hospital & National Clinical Research Center for Aging and Medicine Fudan University Shanghai China
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Bluett B, Litvan I, Cheng S, Juncos J, Riley DE, Standaert DG, Reich SG, Hall DA, Kluger B, Shprecher D, Marras C, Jankovic J. Understanding falls in progressive supranuclear palsy. Parkinsonism Relat Disord 2016; 35:75-81. [PMID: 28007518 DOI: 10.1016/j.parkreldis.2016.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) is characterized by frequent falls which worsen with disease progression, causing substantial morbidity and mortality. Few studies have investigated which factors contribute to falls in PSP, and all have involved few participants, thus lacking necessary statistical power. The aim of this study was to identify clinical parameters most significantly associated with increasing falls in PSP, using the largest sample of patients to date. METHODS Comprehensive clinical data were collected from 339 not demented PSP patients meeting the NINDS-SPSP criteria, who were divided into two groups - Infrequent Fallers (IF; n = 118) with rare falls, and Frequent Fallers (FF; n = 221) who fell occasionally to multiple times a day. Of 198 clinical parameters, we hypothesized 38 to be correlated with an increasing risk of falls. These 38 parameters were analyzed via univariate regression analysis to determine the strength of their association with fall frequency. Unit odds ratios identified the magnitude with which each parameter resulted in an increasing risk of falls. RESULTS Twenty-five of 38 parameters analyzed were significantly associated with fall frequency based on univariate analysis. Symptom duration, clinical measures of disease severity, and several motoric and oculomotor clinical parameters were associated with FF. Examined cognitive parameters and slowing of vertical saccades were not. CONCLUSIONS The clinical parameters identified as associated with increased frequency of falls improve our understanding of why they occur and may help identify not demented PSP patients at risk for increasing falls.
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Affiliation(s)
- Brent Bluett
- Cleveland Clinic Lou Ruvo Center for Brain Health, USA; University of California San Diego, Department of Neurosciences, USA
| | - Irene Litvan
- University of California San Diego, Department of Neurosciences, USA.
| | | | | | | | | | | | | | | | - David Shprecher
- University of Utah, USA; Banner Sun Health Research Institute, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Canada
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Delval A, Rambour M, Tard C, Dujardin K, Devos D, Bleuse S, Defebvre L, Moreau C. Freezing/festination during motor tasks in early-stage Parkinson's disease: A prospective study. Mov Disord 2016; 31:1837-1845. [PMID: 27618808 DOI: 10.1002/mds.26762] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinsonian patients have a tendency to speed up during repetitive motor tasks (festination) and to experience sudden motor blocks (freezing). In this article, we prospectively studied the appearance and progression of these phenomena in 30 early-stage PD patients. METHODS A total of 30 controls and early-stage PD patients were assessed in the "off-drug" condition at baseline and 2 years later. Freezing of gait was evaluated using a standardized gait trajectory with the usual triggers. Patients also performed diadochokinetic tasks with 3 different effectors (repetitive, antiphase movements for the hands and feet, and repetitive syllable production for the orofacial effector) at frequencies ranging from 1 to 7 Hz (in random order). The primary endpoint was the occurrence of freezing and festination. RESULTS At baseline, freezing was observed in 6.5% of the trials in PD patients (43% of the patients) and 2.3% of the trials in controls, and festination was observed in 5.7% of the trials in patients (53% of the patients) and 0.8% of the trials in controls. These proportions were slightly higher in patients 2 years later. None of the patients presented freezing of gait at baseline, but 2 displayed this condition 2 years later. These phenomena occurred more frequently for the limb effectors than for the orofacial effector. Freezing and festination were associated with the akinetic-rigid subtype, although tremor-dominant patients displayed greater rhythm variability outside episodes. CONCLUSION Freezing and festination of the upper and lower limbs are observed soon after the diagnosis of PD and may be early biomarkers for disease progression. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Arnaud Delval
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurophysiologie Clinique-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille cedex, France
| | - Mélanie Rambour
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Céline Tard
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurophysiologie Clinique-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille cedex, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Kathy Dujardin
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - David Devos
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Séverine Bleuse
- Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Luc Defebvre
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Caroline Moreau
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
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Motor symptoms in Parkinson’s disease: A unified framework. Neurosci Biobehav Rev 2016; 68:727-740. [DOI: 10.1016/j.neubiorev.2016.07.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/11/2016] [Indexed: 01/18/2023]
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Kucinski A, de Jong IEM, Sarter M. Reducing falls in Parkinson's disease: interactions between donepezil and the 5-HT 6 receptor antagonist idalopirdine on falls in a rat model of impaired cognitive control of complex movements. Eur J Neurosci 2016; 45:217-231. [PMID: 27469080 DOI: 10.1111/ejn.13354] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 11/30/2022]
Abstract
Falls are a leading cause of death in the elderly and, in a majority of patients with Parkinson's disease (PD), the leading levodopa-insensitive cause of hospitalization and long-term care. Falling in PD has been attributed to degeneration of forebrain cholinergic neurons that, in interaction with striatal dopamine losses, impairs the cognitive control of balance, gait, and movement. We previously established an animal model of these dual cholinergic-dopaminergic losses ("DL rats") and a behavioral test system (Michigan Complex Motor Control Task, MCMCT) to measure falls associated with traversing dynamic surfaces and distractors. Because the combined treatment of the acetylcholinesterase inhibitor donepezil and the 5-HT6 receptor antagonist idalopirdine (Lu AE58054) was reported to exhibit synergistic pro-cholinergic activity in rats and improved cognition in patients with moderate Alzheimer's disease, here we assessed the effects of this treatment on MCMCT performance and attention in DL rats. Compared with the vehicle-treated group, the combined treatment greatly reduced (Cohen's d = 0.96) falls in DL rats when traversing dynamic surfaces and when exposed to a passive distractor. However, falls associated with a dual task distractor and sustained attentional performance did not benefit from this treatment. Analyses of the behavior in fall-prone moments suggested that this treatment improved the efficacy and speed of re-instating forward movement after relatively short stoppages. This treatment may reduce fall propensity in PD patients via maintaining planned movement sequences in working memory and improving the vigor of executing such movements following brief periods of freezing of gait.
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Affiliation(s)
- Aaron Kucinski
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
| | | | - Martin Sarter
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA
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45
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Vitale C, Falco F, Trojano L, Erro R, Moccia M, Allocca R, Agosti V, Santangelo F, Barone P, Santangelo G. Neuropsychological correlates of Pisa syndrome in patients with Parkinson's disease. Acta Neurol Scand 2016; 134:101-7. [PMID: 26427765 DOI: 10.1111/ane.12514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A complex relationship exists between postural control and cognition in the elderly. Namely, neural mechanisms that are required for the regulation of posture have been variably associated with cognitive dysfunctions. Parkinson's disease (PD) is the second most common neurodegenerative disease among the elderly, and it has been associated with both cognitive and postural abnormalities such as Pisa syndrome (PS). Although its onset has been considered to be multifactorial, the pathophysiological mechanisms underpinning PS are still not fully explained. Until now, no study investigated the possible contribution of cognitive dysfunction to occurrence of PS in PD. PATIENTS AND METHODS Twenty PD patients with PS and 20 PD patients without PS were enrolled. All patients with PD underwent neuropsychological battery to assess behavioural disturbances, memory, attention, frontal/executive and visuospatial functions. RESULTS The two groups did not differ on demographic features, age at PD onset and disease duration, whereas they significantly differed on UPDRS-Part III, and levodopa-equivalent daily dose (LEDD). MANCOVA with above-mentioned clinical variable as covariates revealed significant differences on tasks tapping verbal long-term memory, and attentional and visuoperceptual abilities between groups. The binary logistic regression revealed that higher LEDD and lower performance on visuospatial task (Benton Judgment of Lines Orientation test) significantly predicted occurrence of PS. CONCLUSION Our results revealed a significant association of PS with altered attention and visuoperceptual functions in PD, suggesting that the occurrence of PS may be associated with alteration of both frontal-striatal systems and posterior cortical areas.
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Affiliation(s)
- Carmine Vitale
- University Parthenope; Naples Italy
- IDC-Hermitage-Capodimonte; Naples Italy
| | - Fabrizia Falco
- Department of Psychology; Second University of Naples; Caserta Italy
| | - Luigi Trojano
- Department of Psychology; Second University of Naples; Caserta Italy
- Salvatore Maugeri Foundation; Scientific Institute of Telese; Telese Terme BN Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders; Institute of Neurology; University College London (UCL); London UK
| | - Marcello Moccia
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Roberto Allocca
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Valeria Agosti
- University Parthenope; Naples Italy
- IDC-Hermitage-Capodimonte; Naples Italy
| | - Franco Santangelo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Paolo Barone
- Neurodegenerative Diseases Center; Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - Gabriella Santangelo
- IDC-Hermitage-Capodimonte; Naples Italy
- Department of Psychology; Second University of Naples; Caserta Italy
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Shine JM. Electrophysiological insights into freezing in Parkinson's disease. Clin Neurophysiol 2016; 127:2334-6. [PMID: 27178847 DOI: 10.1016/j.clinph.2016.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
Affiliation(s)
- James M Shine
- Department of Psychology, Stanford University, Stanford, CA, USA; Neuroscience Research Australia, The University of New South Wales, Sydney, NSW, Australia.
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Moustafa AA, Phillips J, Kéri S, Misiak B, Frydecka D. On the Complexity of Brain Disorders: A Symptom-Based Approach. Front Comput Neurosci 2016; 10:16. [PMID: 26941635 PMCID: PMC4763073 DOI: 10.3389/fncom.2016.00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/05/2016] [Indexed: 12/27/2022] Open
Abstract
Mounting evidence shows that brain disorders involve multiple and different neural dysfunctions, including regional brain damage, change to cell structure, chemical imbalance, and/or connectivity loss among different brain regions. Understanding the complexity of brain disorders can help us map these neural dysfunctions to different symptom clusters as well as understand subcategories of different brain disorders. Here, we discuss data on the mapping of symptom clusters to different neural dysfunctions using examples from brain disorders such as major depressive disorder (MDD), Parkinson’s disease (PD), schizophrenia, posttraumatic stress disorder (PTSD) and Alzheimer’s disease (AD). In addition, we discuss data on the similarities of symptoms in different disorders. Importantly, computational modeling work may be able to shed light on plausible links between various symptoms and neural damage in brain disorders.
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Affiliation(s)
- Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney UniversitySydney, NSW, Australia; Marcs Institute for Brain and Behavior, Western Sydney UniversitySydney, NSW, Australia
| | - Joseph Phillips
- School of Social Sciences and Psychology, Western Sydney University Sydney, NSW, Australia
| | - Szabolcs Kéri
- Nyírö Gyula Hospital, National Institute of Psychiatry and Addictions Budapest, Hungary
| | - Blazej Misiak
- Department and Clinic of Psychiatry, Wroclaw Medical UniversityWroclaw, Poland; Department of Genetics, Wroclaw Medical UniversityWroclaw, Poland
| | - Dorota Frydecka
- Department and Clinic of Psychiatry, Wroclaw Medical University Wroclaw, Poland
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Freezing of gait in Parkinson's disease is associated with altered functional brain connectivity. Parkinsonism Relat Disord 2015; 24:100-6. [PMID: 26776567 DOI: 10.1016/j.parkreldis.2015.12.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) may develop several gait disturbances during the course of illness and Freezing of gait (FOG) is one of them. Several neuroimaging studies have been conducted to identify the neural correlates of FOG but results have not been uniform. Resting state functional MRI (rs-fMRI) is relatively less explored in PD patients with FOG. This study aims to compare the whole brain resting state connectivity of PD patients with and without FOG using rs-fMRI. METHODS rs-fMRI was obtained for 28 PD patients (15 with and 13 patients without FOG) who were matched for various demographic and clinical characteristics. Seed to voxel analysis was performed at whole brain level and compared between the two groups. RESULTS When compared to patients without FOG, the patients with FOG had reduced functional connectivity across multiple seeds. Major finding was reduced inter-hemispheric connectivity of left parietal opercular cortex with multiple regions of the brain primarily involving the primary somatosensory and auditory areas, which also negatively correlated with the FOGQ scores. CONCLUSION Our findings suggest that alterations in the resting state functional connectivity of the opercular parietal cortex may be one of the substrates of FOG. Reduced interhemispheric connectivity probably is the reason for impairment of control and coordination in bilateral leg movements while walking.
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Sterling NW, Cusumano JP, Shaham N, Piazza SJ, Liu G, Kong L, Du G, Lewis MM, Huang X. Dopaminergic modulation of arm swing during gait among Parkinson's disease patients. JOURNAL OF PARKINSONS DISEASE 2015; 5:141-50. [PMID: 25502948 DOI: 10.3233/jpd-140447] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduced arm swing amplitude, symmetry, and coordination during gait have been reported in Parkinson's disease (PD), but the relationship between dopaminergic depletion and these upper limb gait changes remains unclear. OBJECTIVE We aimed to investigate the effects of dopaminergic drugs on arm swing velocity, symmetry, and coordination in PD. METHODS Forearm angular velocity was recorded in 16 PD and 17 control subjects (Controls) during free walking trials. Angular velocity amplitude of each arm, arm swing asymmetry, and maximum cross-correlation were compared between control and PD groups, and between OFF- and ON-medication states among PD subjects. RESULTS Compared to Controls, PD subjects in the OFF-medication state exhibited lower angular velocity amplitude of the slower- (p = 0.0018), but not faster- (p = 0.2801) swinging arm. In addition, PD subjects demonstrated increased arm swing asymmetry (p = 0.0046) and lower maximum cross-correlation (p = 0.0026). Following dopaminergic treatment, angular velocity amplitude increased in the slower- (p = 0.0182), but not faster- (p = 0.2312) swinging arm among PD subjects. Furthermore, arm swing asymmetry decreased (p = 0.0386), whereas maximum cross-correlation showed no change (p = 0.7436). Pre-drug angular velocity amplitude of the slower-swinging arm was correlated inversely with the change in arm swing asymmetry (R = -0.73824, p = 0.0011). CONCLUSIONS This study provides quantitative evidence that reduced arm swing and symmetry in PD can be modulated by dopaminergic replacement. The lack of modulations of bilateral arm coordination suggests that additional neurotransmitters may also be involved in arm swing changes in PD. Further studies are warranted to investigate the longitudinal trajectory of arm swing dynamics throughout PD progression.
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Affiliation(s)
- Nicholas W Sterling
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph P Cusumano
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Noam Shaham
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guangwei Du
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Radiology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Neurosurgery, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
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Therapy-resistant symptoms in Parkinson’s disease. J Neural Transm (Vienna) 2015; 123:19-30. [DOI: 10.1007/s00702-015-1463-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/15/2015] [Indexed: 12/25/2022]
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