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Liu J, Kanno S, Iseki C, Kawakami N, Kakinuma K, Katsuse K, Matsubara S, Ota S, Endo K, Takanami K, Osawa SI, Kawaguchi T, Endo H, Mugikura S, Suzuki K. The grasp reflex in patients with idiopathic normal pressure hydrocephalus. J Neurol 2024:10.1007/s00415-024-12341-0. [PMID: 38587636 DOI: 10.1007/s00415-024-12341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the prevalence and intensity of grasp reflexes and to examine changes in these reflexes after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS We enrolled 147 patients with probable iNPH. A standard procedure was used to determine the presence of grasp reflexes, and the intensity of these reflexes was assessed using a four-category classification. Clinical rating scales and their correlation with grasp reflexes were also evaluated. Grasp reflexes were reassessed in 72 patients 1 year after surgery. RESULTS We found that approximately 50.3% of patients with iNPH exhibited a positive grasp reflex. Among these patients, 69% exhibited bilateral positivity, while the remaining patients showed unilateral positivity. Furthermore, the intensity of the grasp reflex was significantly correlated with the severity of gait and with cognitive, urinary, motor, and behavioural symptoms. Surgical interventions led to a reduction (41.7%) or maintenance (30.6%) of the reflex intensity in 72.3% of iNPH patients. The changes in reflex intensity showed significant positive correlations with changes in the number of steps of the Timed Up and Go test and Trail Making Test-A scores but not with changes in total scores on the iNPH Grading Scale. CONCLUSION This retrospective study identified grasp reflexes as a highly prevalent phenomenon in patients with iNPH. These reflexes can assist in evaluating the severity of various symptoms, including cognitive, gait, urinary, motor and emotional symptoms.
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Affiliation(s)
- Junyan Liu
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Chifumi Iseki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Department of Neurology, The University of Tokyo, Tokyo, Japan
| | - Shiho Matsubara
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shoko Ota
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiko Endo
- Department of Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Wei X, Wang S, Zhang M, Yan Y, Wang Z, Wei W, Tuo H, Wang Z. Gait impairment-related axonal degeneration in Parkinson's disease by neurite orientation dispersion and density imaging. NPJ Parkinsons Dis 2024; 10:45. [PMID: 38413647 PMCID: PMC10899173 DOI: 10.1038/s41531-024-00654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Microstructural alterations in the brain networks of Parkinson's disease (PD) patients are correlated with gait impairments. Evaluate microstructural alterations in the white matter (WM) fiber bundle tracts using neurite orientation dispersion and density imaging (NODDI) technique in PD versus healthy controls (HC). In this study, 24 PD patients and 29 HC were recruited. NODDI and high-resolution 3D structural images were acquired for each participant. The NODDI indicators, including the intracellular neurite density index (NDI), orientation dispersion index (ODI), and isotropic volume fraction (ISO), were compared between the two groups. Diffusion-weighted (DW) images were preprocessed using MRtrix 3.0 software and the orientation distribution function to trace the main nerve fiber tracts in PD patients. Quantitative gait and clinical assessment scales were used to compare the medication "ON" and "OFF" states of PD patients. The NDI, ODI, and ISO values of the WM fiber bundles were significantly higher in PD patients compared to HC. Fiber bundles, including the anterior thalamic radiation, corticospinal tract, superior longitudinal fasciculus, forceps major, cingulum, and inferior longitudinal fasciculus, were found to be significantly affected in PD. The NDI changes of PD patients were well correlated with stride lengths in the "ON" state; ODI changes were correlated with the stride time in the "ON" and "OFF" states and ISO changes were correlated with the stride time and cadence in the "ON" state. In conclusion, combination of NODDI technique and gait parameters can help detect gait impairment in PD patients early and accurately.
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Grants
- 82202097 National Natural Science Foundation of China (National Science Foundation of China)
- 82071257 National Natural Science Foundation of China (National Science Foundation of China)
- Beijing Scholars Program is the highest-level talent development program approved by the Beijing Municipal People’s Government. It aims to cultivate a group of scientists, engineers, and renowned experts who are at the forefront of global science and technology, possess innovative capabilities, and have international advanced levels. The program provides intellectual support for the construction of a globally influential science and technology innovation center.
- Beijing Hospitals Authority’ Youth Programme is one of the three major talent development programs, namely "Qingmiao, Dengfeng, Shiming," launched by the Beijing Hospital Management Center in 2015. This program aims to support and cultivate young talents and provide a development platform for the growth of young talents in municipal hospitals through various training initiatives. Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University is a research support fund program for young doctors opened by Capital Medical University, targeting different specialties, colleges, and departments.
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Affiliation(s)
- Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shiya Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingkai Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Yan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Division of Science and Technology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Houzhen Tuo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Frank Y, Levy T, Lozano R, Friedman K, Underwood S, Kostic A, Walker H, Kolevzon A. Gait Abnormalities in Children with Phelan-McDermid Syndrome. J Child Neurol 2023; 38:665-671. [PMID: 37849292 DOI: 10.1177/08830738231204395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Background: Phelan-McDermid syndrome is a genetic disorder caused by haploinsufficiency of the SHANK3 gene on chromosome 22q13.3 and is characterized by autism spectrum disorder, intellectual disability, speech and language abnormalities, hypotonia, and mild dysmorphic features. Early literature in Phelan-McDermid syndrome did not include gait abnormalities as part of the syndrome although recent prospective studies report that the prevalence of gait abnormalities ranges from 55% to 94%. We compared gait abnormalities in individuals with Phelan-McDermid syndrome, idiopathic autism spectrum disorder, and typically developing controls, and explored associations between gait abnormalities, autism spectrum disorder, and intellectual functioning. Method: The study cohort consists of 67 participants between the ages of 3 and 18 years, divided into 3 groups: Phelan-McDermid syndrome (n = 46), idiopathic autism spectrum disorder (n = 11), and typically developing controls (n = 10). Gait was recorded using a video camera and scored across 26 gait features using a "Gait Clinical Observations scale" designed specifically for this study. Results: Gait abnormalities were significantly higher in the Phelan-McDermid syndrome group as compared to idiopathic autism spectrum disorder or typically developing controls. The number of gait abnormalities across groups was also significantly correlated with Intellectual Quotient/Developmental Quotient (IQ/DQ). In analysis of covariance including IQ/DQ, the effect of group was not significant, but the effect of IQ/DQ was significant. Conclusions: Overall differences in gait abnormalities were determined by the degree of intellectual disability, which was significantly higher in Phelan-McDermid syndrome.
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Affiliation(s)
- Yitzchak Frank
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tess Levy
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reymundo Lozano
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kate Friedman
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Slayton Underwood
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Kostic
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Walker
- Health and Behavior Sciences at Teachers College, Columbia University, New York, NY, USA
| | - Alexander Kolevzon
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Manto M, Serrao M, Filippo Castiglia S, Timmann D, Tzvi-Minker E, Pan MK, Kuo SH, Ugawa Y. Neurophysiology of cerebellar ataxias and gait disorders. Clin Neurophysiol Pract 2023; 8:143-160. [PMID: 37593693 PMCID: PMC10429746 DOI: 10.1016/j.cnp.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.
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Affiliation(s)
- Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgium
- Service de Neurologie, CHU-Charleroi, Charleroi, Belgium
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi, 21, 27100 Pavia, Italy
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elinor Tzvi-Minker
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hamburg, Germany
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
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Pourahmad R, Saleki K, Esmaili M, Abdollahi A, Alijanizadeh P, Gholinejad MZ, Banazadeh M, Ahmadi M. Deep brain stimulation (DBS) as a therapeutic approach in gait disorders: What does it bring to the table? IBRO Neurosci Rep 2023; 14:507-513. [PMID: 37304345 PMCID: PMC10248795 DOI: 10.1016/j.ibneur.2023.05.008] [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: 01/20/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Gait deficits are found in various degenerative central nervous system conditions, and are particularly a hallmark of Parkinson's disease (PD). While there is no cure for such neurodegenerative disorders, Levodopa is considered as the standard medication in PD patients. Often times, the therapy of severe PD consists of deep brain stimulation (DBS) of the subthalamic nucleus. Earlier research exploring the effect of gait have reported contradictory results or insufficient efficacy. A change in gait includes various parameters, such as step length, cadence, Double-stance phase duration which may be positively affected by DBS. DBS could also be effective in correcting the levodopa-induced postural sway abnormalities. Moreover, during normal walking, interaction among the subthalamic nucleus and cortex -essential regions which exert a role in locomotion- are coupled. However, during the freezing of gait, the activity is desynchronized. The mechanisms underlying DBS-induced neurobehavioral improvements in such scenarios requires further study. The present review discusses DBS in the context of gait, the benefits associated with DBS compared to standard pharmacotherapy options, and provides insights into future research.
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Affiliation(s)
- Ramtin Pourahmad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences(SBMU), Tehran, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Arian Abdollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parsa Alijanizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | | | - Mohammad Banazadeh
- Pharmaceutical Sciences and Cosmetic Products Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mona Ahmadi
- Department of Neurology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Walusinski O. From hysteria to gait dementia: History of the concept of astasia-abasia. Rev Neurol (Paris) 2023:S0035-3787(23)00917-7. [PMID: 37030986 DOI: 10.1016/j.neurol.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/04/2022] [Accepted: 12/22/2022] [Indexed: 04/10/2023]
Abstract
Paul Blocq (1860-1896) and his teacher Jean-Martin Charcot (1825-1893) introduced the expression "astasia-abasia" into medical terminology in 1888 to designate a pathology they believed to be caused by hysteria. This condition makes it impossible to remain erect and to walk, whereas the ability to move the legs while lying down remains normal. At the turn of the 20th century, and now almost exclusively, this motor disturbance is recognised as a syndrome with multiple possible organic causes, and now described as "higher-level gait disorder". After briefly mentioning earlier descriptions by other authors, I will review Charcot's Tuesday lessons in 1889 that covered astasia-abasia and elucidated the beginnings of the breakdown into organic aetiologies: medial-frontal and corpus callosum tumors, damage to the cerebellar vermis, lacunar state as described by Pierre Marie (1853-1940), Parkinson's disease, and Parkinson-plus syndrome. The long history of astasia-abasia reveals a cluster of neurologists, often emerging from oblivion herein and all of whom, through the precision of their clinical examinations and their pathophysiological findings, helped advance the understanding of the mechanisms by which human beings are the only erect, constantly bipedal mammals, whether immobile or walking.
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Affiliation(s)
- O Walusinski
- Lauréat de l'Académie nationale de Médecine, 20, rue de Chartres, 28160 Brou, France.
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Carswell C. Idiopathic normal pressure hydrocephalus: historical context and a contemporary guide. Pract Neurol 2023; 23:15-22. [PMID: 36162853 DOI: 10.1136/pn-2021-003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
Idiopathic normal pressure hydrocephalus (NPH) was described in 1965 as a syndrome in which hydrocephalus develops but with a normal cerebrospinal fluid (CSF) pressure, causing shunt-responsive gait apraxia, cognitive impairment and urinary incontinence. Not all patients respond to shunting despite having the clinical syndrome with appropriate radiological features. This has led to considerable debate over subsequent decades regarding idiopathic NPH. It is now understood that asymptomatic communicating hydrocephalus can develop in many healthy older people, and that over time this can develop into a symptomatic state that sometimes responds to CSF shunting, but to a variable extent. This review looks at the historical background of NPH, the use of predictive tests, the current state of clinical evidence for the diagnosis and treatment of idiopathic NPH and the possible underlying causes, to provide a contemporary practical guide for assessing patients with the radiological features of idiopathic NPH.
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Affiliation(s)
- Christopher Carswell
- Imperial College Healthcare NHS Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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8
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Development of a Safe Mobilisation Program to Improve Functional Mobility and Reduce Fall Risk in Older Adults With Cognitive Impairment and Gait Disorders. TOPICS IN GERIATRIC REHABILITATION 2023. [DOI: 10.1097/tgr.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rehabilitation effects in idiopathic normal pressure hydrocephalus: a randomized controlled trial. J Neurol 2023; 270:357-368. [PMID: 36071284 DOI: 10.1007/s00415-022-11362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/30/2022] [Accepted: 08/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. OBJECTIVES This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. METHODS A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. RESULTS A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. CONCLUSIONS DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.
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The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101738. [PMID: 36162707 DOI: 10.1016/j.arr.2022.101738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia. AIM The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia. METHODS Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on 'MoCA', 'MMSE', 'Mini-Cog' (measures) and 'cognition', 'cognitive function', 'cognitive', 'cognitive performance', 'executive function', 'executive process', 'attention', 'memory', 'memory performance' (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants' age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale. RESULTS Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28-0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12-1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22-0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05-0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21-1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12-1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04-2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20-1,18], p = 0.01). CONCLUSION Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.
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Nikaido Y, Urakami H, Okada Y, Kajimoto Y, Ishida N, Kawami Y, Akisue T, Saura R. Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk. Clin Biomech (Bristol, Avon) 2022; 99:105757. [PMID: 36113194 DOI: 10.1016/j.clinbiomech.2022.105757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk. METHODS Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale. FINDINGS Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group. INTERPRETATION Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yuki Kawami
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan; Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Hyogo, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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12
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Wearable and Portable GPS Solutions for Monitoring Mobility in Dementia: A Systematic Review. SENSORS 2022; 22:s22093336. [PMID: 35591026 PMCID: PMC9104067 DOI: 10.3390/s22093336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
Dementia is the most common neurodegenerative disorder globally. Disease progression is marked by declining cognitive function accompanied by changes in mobility. Increased sedentary behaviour and, conversely, wandering and becoming lost are common. Global positioning system (GPS) solutions are increasingly used by caregivers to locate missing people with dementia (PwD) but also offer a non-invasive means of monitoring mobility patterns in PwD. We performed a systematic search across five databases to identify papers published since 2000, where wearable or portable GPS was used to monitor mobility in patients with common dementias or mild cognitive impairment (MCI). Disease and GPS-specific vocabulary were searched singly, and then in combination, identifying 3004 papers. Following deduplication, we screened 1972 papers and retained 17 studies after a full-text review. Only 1/17 studies used a wrist-worn GPS solution, while all others were variously located on the patient. We characterised the studies using a conceptual framework, finding marked heterogeneity in the number and complexity of reported GPS-derived mobility outcomes. Duration was the most frequently reported category of mobility reported (15/17), followed by out of home (14/17), and stop and trajectory (both 10/17). Future research would benefit from greater standardisation and harmonisation of reporting which would enable GPS-derived measures of mobility to be incorporated more robustly into clinical trials.
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13
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Sun Y, Liang S, Yu Y, Yang Y, Lu J, Wu J, Cheng Y, Wang Y, Wu J, Han J, Yu N. Plantar pressure-based temporal analysis of gait disturbance in idiopathic normal pressure hydrocephalus: Indications from a pilot longitudinal study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106691. [PMID: 35176597 DOI: 10.1016/j.cmpb.2022.106691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is a common yet potentially reversible neurodegenerative disease, and gait disturbance is a major symptom. Lots of methodological and clinical work has been conducted on gait disturbance analysis for differential diagnosis, presurgical test, and postsurgery assessment of iNPH. Nevertheless, the verification analysis was mostly lacking for surgery response, and the temporal characteristics of ground reaction force has been rarely investigated. METHODS In this work, we propose that plantar pressure features fundamentally signifies iNPH gait disturbance and improvement after cerebrospinal fluid (CSF) drainage by lumbar puncture tap test as well as surgical shunt implantation. The plantar pressure signals of six iNPH patients and eight healthy controls were collected, and an online database of sixteen healthy controls were used. For patients, data were collected in five periods, which are the baseline before the tap test, 8, 24, and 72 hours after the tap test, and one month after the shunt implantation surgery, respectively. Fast dynamic time warping (DTW) with an improved DTW barycenter averaging (DBA) method was proposed for temporal analysis with the measured and online plantar pressure data. An plantar-pressure variation index (PPVI) was formulated to characterize the temporal dynamic stability of walking. RESULTS The PPVI based on temporal analysis of plantar pressure well discriminated the impaired gait (baseline, 24 and 72 hours after tap test) with the improved gait (8 hours after tap test and follow up after surgery) of the patients. Further, the PPVI was close for the improved gait of the patients and the healthy gait measured in our study as well as in the online database. CONCLUSIONS Plantar pressure-based temporal features are promisingly effective for clinical examination and treatment of iNPH.
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Affiliation(s)
- Yubo Sun
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yang Yu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yuchen Yang
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China
| | - Jingchao Wu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yuanyuan Cheng
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Yue Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Jialing Wu
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin 300350, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China; Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin 300350, China.
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, China; Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin 300350, China.
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Nikaido Y, Okada Y, Urakami H, Ishida N, Akisue T, Kawami Y, Kuroda K, Kajimoto Y, Saura R. Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease. Acta Neurol Scand 2022; 145:215-222. [PMID: 34633069 DOI: 10.1111/ane.13537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yohei Okada
- Graduate School of Health Sciences Kio University Nara Japan
- Neurorehabilitation Research Center of Kio University Nara Japan
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
| | - Yuki Kawami
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
- Department of Physical Therapy, Faculty of Rehabilitation Hyogo Prefectural Rehabilitation Hospital at Nishi‐Harima Hyogo Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine Osaka Medical and Pharmaceutical University Osaka Japan
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15
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Ma R, Zhào H, Wei W, Liu Y, Huang Y. Gait characteristics under single-/dual-task walking conditions in elderly patients with cerebral small vessel disease: Analysis of gait variability, gait asymmetry and bilateral coordination of gait. Gait Posture 2022; 92:65-70. [PMID: 34826695 DOI: 10.1016/j.gaitpost.2021.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dual-task walking (DTW) is common in daily life and represents an ideal paradigm for elucidating gait irregularity. Under single-task walking (STW) and DTW conditions, the symmetric and bilaterally coordinated human gait pattern found in healthy individuals is absent in individuals with neurological ailments such as Parkinson's disease, Alzheimer's disease and post-stroke issues. Cerebral small vessel disease (CSVD) is a neuropathological and radiological issue that has been reported to be associated with cognitive and motor disorders. However, few gait analyses have focused on elderly individuals with CSVD under DTW conditions. RESEARCH QUESTION Are parameters of gait analysis helpful in elucidating gait abnormalities in elderly patients with CSVD under DTW conditions? METHODS A total of 46 elderly patients with CSVD (CSVD group) and 22 healthy, age-matched individuals (HE group) were recruited. Gait data were collected from both groups under STW and DTW conditions. Direct parameters and metrics reflecting gait variability, gait asymmetry, and bilateral coordination of gait in the two groups were compared. RESULTS Under STW conditions, elderly individuals with CSVD showed markedly shorter stride length, were slower, and had higher gait asymmetry (GA) and phase coordination index (PCI) than healthy controls after adjusting for age, sex and level of education. Under DTW conditions, there were statistically significant differences between the two groups in stride time, stride length, cadence, stride time variability, GA and PCI after adjusting for age, sex, and level of education. SIGNIFICANCE Reanalysis-generated parameters, such as gait variability, GA, and PCI, are biomarkers for gait dysfunction in elderly patients with CSVD. In this study, elderly individuals with CVSD showed abnormal gait features under both STW and DTW conditions.
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Affiliation(s)
- Rui Ma
- Department of Neurology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China; Department of Neurology, Emergency General Hospital, Beijing, 100028, China.
| | - Hóngyi Zhào
- Department of Neurology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China; Department of Neurology, NO 984 Hospital of PLA, Beijing, 100094, China.
| | - Wei Wei
- Department of Neurology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
| | - Yu Liu
- Department of Neurology, NO 984 Hospital of PLA, Beijing, 100094, China.
| | - Yonghua Huang
- Department of Neurology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
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16
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Proposal for a Normal Pressure Hydrocephalus Syndrome Center of Excellence. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Zhang W, Low LF, Gwynn JD, Beveridge AH, Harper E, Mills N, Clemson L. A Safe Mobilisation Program to Improve Functional Mobility and Reduce Fall Risks in Cognitively Impaired Older Adults with Higher Level Gait Disorders: A Pilot Study. Dement Geriatr Cogn Disord 2021; 50:364-371. [PMID: 34569524 DOI: 10.1159/000519055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between gait and cognition, and their combined impact on postural stability may underlie the increased fall risk in older adults with dementia. However, there are few interventions to improve functional mobility and reduce fall risks in people with cognitive impairment. OBJECTIVES This study aims to investigate the feasibility and acceptability of a Safe Mobilisation Program for cognitively impaired older adults with higher level gait disorders. It also explores the potential effectiveness of the program on mobility and fall risks. METHODS Fifteen community-dwelling older adults participated in a 3-week pre-post intervention study. They were trained to take steady steps in transfers and mobilization using errorless learning and spaced retrieval teaching techniques. RESULTS The intervention program was feasible, all the participants completed the program and were able to mobilize safely. The program was acceptable and participants reported an increase in safety awareness, improvement in confidence while transferring and mobilising, and better quality of life. There was a trend of improvement in Falls Efficacy Scale-international (FES-I), 360° turn and Tinetti Performance Oriented Mobility Assessment (POMA), which may indicate improvement in balance and mobility. CONCLUSION The Safe Mobilisation Program was feasible and acceptable in older adults with cognitive impairment and gait disorders and warrants further evaluation.
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Affiliation(s)
- Weihong Zhang
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Occupational Therapy, Wolper Jewish Hospital, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Josephine Diana Gwynn
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Harry Beveridge
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Elizabeth Harper
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nicholas Mills
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Huang HC, Chen CM, Lu MK, Liu BL, Li CI, Chen JC, Wang GJ, Lin HC, Duann JR, Tsai CH. Gait-Related Brain Activation During Motor Imagery of Complex and Simple Ambulation in Parkinson's Disease With Freezing of Gait. Front Aging Neurosci 2021; 13:731332. [PMID: 34630069 PMCID: PMC8492994 DOI: 10.3389/fnagi.2021.731332] [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: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Freezing of gait (FOG) in Parkinson's disease (PD) is a devastating clinical phenomenon that has a detrimental impact on patients. It tends to be triggered more often during turning (complex) than during forwarding straight (simple) walking. The neural mechanism underlying this phenomenon remains unclear and requires further elucidation. Objective: To investigate the differences in cerebral functional magnetic resonance imaging responses between PD patients with and without FOG during explicitly video-guided motor imagery (MI) of various complex (normal, freezing) and simple (normal, freezing) walking conditions. Methods: We recruited 34 PD patients, namely, 20 with FOG and 14 without FOG, and 15 normal controls. Participants underwent video-guided MI of turning and straight walking, with and without freezing, while their brain blood oxygen level-dependent (BOLD) activities were measured. Gait analysis was performed. Results: While comparing FOG turning with FOG straight walking, freezers showed higher activation of the superior occipital gyrus, left precentral gyrus, and right postcentral gyrus compared with non-freezers. Normal controls also manifest similar findings compared with non-freezers, except no difference was noted in occipital gyrus activity between the two groups. Freezers also displayed a higher effect size in the locomotor regions than non-freezers during imagery of normal turning. Conclusions: Our findings suggest that freezers require a higher drive of cortical and locomotion regions to overcome the overinhibition of the pathways in freezers than in non-freezers. Compared with simple walking, increased dorsal visual pathway and deep locomotion region activities might play pivotal roles in tackling FOG in freezers during complex walking.
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Affiliation(s)
- Hui-Chun Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Bey-Ling Liu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Cheng Chen
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Guei-Jane Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Education, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Chon-Haw Tsai
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
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19
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Nikaido Y, Urakami H, Akisue T, Okada Y, Kawami Y, Ishida N, Kuroda K, Ohno H, Kajimoto Y, Saura R. Perceived and actual changes in gait balance after CSF shunting in idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2021; 144:21-28. [PMID: 33754339 DOI: 10.1111/ane.13421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated the perceived and actual changes in gait and balance function immediately after cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH), including those with mild cases. MATERIALS AND METHODS Ninety-nine iNPH patients were assessed using the timed Up and Go (TUG) and Functional Gait Assessment (FGA) before and 1-week after CSF shunting and their perceived changes were assessed on a Global Rate of Change (GRC) scale. Minimal clinically important differences (MCIDs) were calculated using a receiver operating characteristic (ROC) curve method using GRC scores. RESULTS In all patients (n = 99), the TUG value postoperatively was significantly faster than the preoperative value (difference; 3.1 ± 4.6 s, p < 0.001), and the postoperative FGA score was significantly better than the preoperative score (difference; 3.8 ± 3.3 points, p < 0.001). In the TUG <15 s group (n = 51), the postoperative FGA score was significantly improved (difference; 3.3 ± 2.9 points, p < 0.001), whereas the TUG value was only slightly improved (difference; 0.6 ± 1.6 s, p = 0.008). The ROC curve MCIDs of GRC ≥2 points, which is the recommended level of improvement, were 1.7 s (16.5%) for the TUG and 4 points (20.0%) for the FGA in all patients (n = 99) and the TUG <15 s group (n = 51). CONCLUSIONS FGA can be used to confirm treatment effects, including perceived and actual changes after CSF shunting, in patients with mild iNPH. Our results can help clinicians to determine the clinical significance of improvements in gait and balance function immediately after CSF shunting in individual patients with iNPH.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation Osaka Medical College Hospital Osaka Japan
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation Osaka Medical College Hospital Osaka Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science Graduate School of Health Sciences Kobe University Kobe Japan
| | - Yohei Okada
- Graduate School of Health Sciences Kio University Nara Japan
- Neurorehabilitation Research Center of Kio University Nara Japan
| | - Yuki Kawami
- Department of Rehabilitation Science Graduate School of Health Sciences Kobe University Kobe Japan
- Department of Physical Therapy Faculty of Rehabilitation Hyogo Prefectural Rehabilitation Hospital at Nishi‐Harima Hyogo Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation Osaka Medical College Hospital Osaka Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation Osaka Medical College Hospital Osaka Japan
| | - Hiroshi Ohno
- Clinical Department of Rehabilitation Osaka Medical College Hospital Osaka Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery Division of Surgery Osaka Medical College Osaka Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine Division of Comprehensive Medicine Osaka Medical College Osaka Japan
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20
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Ellmers TJ, Kal EC, Richardson JK, Young WR. Short-latency inhibition mitigates the relationship between conscious movement processing and overly cautious gait. Age Ageing 2021; 50:830-837. [PMID: 33951155 PMCID: PMC8099234 DOI: 10.1093/ageing/afaa230] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Overly cautious gait is common in older adults. This is characterised by excessively slow gait, shortened steps, broadened base of support and increased double limb support. The current study sought to (1) evaluate if overly cautious gait is associated with attempts to consciously process walking movements, and (2) explore whether an individual's ability to rapidly inhibit a dominant motor response serves to mitigate this relationship. METHODS A total of 50 older adults walked at a self-selected pace on an instrumented walkway containing two raised wooden obstacles (height = 23 cm). Trait conscious movement processing was measured with the Movement-Specific Reinvestment Scale. Short-latency inhibitory function was assessed using a validated electronic go/no-go ruler catch protocol. We used linear regressions to explore the relationship between these variables and gait parameters indicative of overly cautious gait. RESULTS When controlling for general cognitive function (MoCA), and functional balance (Berg Balance Scale), the interaction between trait conscious movement processing and short-latency inhibition capacity significantly predicted gait velocity, step length and double limb support. Specifically, older adults with higher trait conscious movement processing and poorer inhibition were more likely to exhibit gait characteristics indicative of cautious gait (i.e. reduced velocity, shorter step lengths and increased double limb support). Neither conscious movement processing nor inhibition independently predicted gait performance. CONCLUSION The combination of excessive movement processing tendencies and poor short-latency inhibitory capacity was associated with dysfunctional or 'overly cautious' gait. It is therefore plausible that improvement in either factor may lead to improved gait and reduced fall risk.
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Affiliation(s)
- Toby J Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, UK
- Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Elmar C Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK
- Centre for Cognitive Neuroscience, Brunel University London, UK
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, USA
| | - William R Young
- School of Sport and Health Sciences, University of Exeter, UK
- College of Health, Medicine and Life Sciences, Brunel University London, UK
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21
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Todisco M, Zangaglia R, Minafra B, Pisano P, Trifirò G, Bossert I, Pozzi NG, Brumberg J, Ceravolo R, Isaias IU, Fasano A, Pacchetti C. Clinical Outcome and Striatal Dopaminergic Function After Shunt Surgery in Patients With Idiopathic Normal Pressure Hydrocephalus. Neurology 2021; 96:e2861-e2873. [PMID: 33893195 DOI: 10.1212/wnl.0000000000012064] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine changes in clinical features and striatal dopamine reuptake transporter (DAT) density after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS Participants with probable iNPH were assessed at baseline by means of clinical rating scales, brain MRI, and SPECT with [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (FP-CIT). Levodopa responsiveness was also evaluated. Patients who did or did not undergo lumboperitoneal shunt were clinically followed up and repeated SPECT after 2 years. RESULTS We enrolled 115 patients with iNPH. Of 102 patients without significant levodopa response and no signs of atypical parkinsonism, 92 underwent FP-CIT SPECT (58 also at follow-up) and 59 underwent surgery. We identified a disequilibrium subtype (phenotype 1) and a locomotor subtype (phenotype 2) of higher-level gait disorder. Gait impairment correlated with caudate DAT density in both phenotypes, whereas parkinsonian signs correlated with putamen and caudate DAT binding in patients with phenotype 2, who showed more severe symptoms and lower striatal DAT density. Gait and caudate DAT binding improved in both phenotypes after surgery (p < 0.01). Parkinsonism and putamen DAT density improved in shunted patients with phenotype 2 (p < 0.001). Conversely, gait, parkinsonian signs, and striatal DAT binding worsened in patients who declined surgery (p < 0.01). CONCLUSIONS This prospective interventional study highlights the pathophysiologic relevance of striatal dopaminergic dysfunction in the motor phenotypic expression of iNPH. Absence of levodopa responsiveness, shunt-responsive parkinsonism, and postsurgery improvement of striatal DAT density are findings that corroborate the notion of a reversible striatal dysfunction in a subset of patients with iNPH.
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Affiliation(s)
- Massimiliano Todisco
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Roberta Zangaglia
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Brigida Minafra
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Patrizia Pisano
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Giuseppe Trifirò
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Irene Bossert
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Nicoló Gabriele Pozzi
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Joachim Brumberg
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Roberto Ceravolo
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Ioannis Ugo Isaias
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Alfonso Fasano
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada
| | - Claudio Pacchetti
- From the Parkinson's Disease and Movement Disorders Unit (M.T., R.Z., B.M., N.G.P., C.P.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (M.T.), University of Pavia; Neurosurgery Unit (P.P.), IRCCS San Matteo Foundation; Nuclear Medicine Unit (G.T., I.B.), Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy; Neurology Department (N.G.P., I.U.I.), University Hospital and Julius Maximilian University of Würzburg; Nuclear Medicine Department (J.B.), University Hospital Würzburg, Germany; Unit of Neurology, Department of Clinical and Experimental Medicine (R.C.), University of Pisa, Italy; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic (A.F.), Toronto Western Hospital, University Health Network; Division of Neurology (A.F.), University of Toronto; Krembil Brain Institute (A.F.); and Center for Advancing Neurotechnological Innovation to Application (CRANIA) (A.F.), Toronto, Canada.
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Bertuccelli M, Verheyen K, Hallemans A, Sander JW, Ragona F, Bisiacchi P, Masiero S, Del Felice A. Deconstructing Dravet syndrome neurocognitive development: A scoping review. Epilepsia 2021; 62:874-887. [PMID: 33646591 DOI: 10.1111/epi.16844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
Dravet syndrome (DS) is a rare severe epilepsy syndrome associated with slowed psychomotor development and behavioral disorders from the second year onward in a previously seemingly normal child. Among cognitive impairments, visuospatial, sensorimotor integration, and expressive language deficits are consistently reported. There have been independent hypotheses to deconstruct the typical cognitive development in DS (dorsal stream vulnerability, cerebellar-like pattern, sensorimotor integration deficit), but an encompassing framework is still lacking. We performed a scoping review of existing evidence to map the current understanding of DS cognitive and behavioral developmental profiles and to summarize the evidence on suggested frameworks. We searched PubMed, Scopus, PsycInfo, and MEDLINE to identify reports focusing on cognitive deficits and/or behavioral abnormalities in DS published between 1978 and March 15, 2020. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Twenty-one reports were selected and tabulated by three independent reviewers based on predefined data extraction and eligibility forms. Eighteen reports provided assessments of global intelligence quotients with variable degrees of cognitive impairment. Eleven reports analyzed single subitems contribution to global cognitive scores: these reports showed consistently larger impairment in performance scales compared to verbal ones. Studies assessing specific cognitive functions demonstrated deterioration of early visual processing, fine and gross motor abilities, visuomotor and auditory-motor integration, spatial processing, visuo-attentive abilities, executive functions, and expressive language. Behavioral abnormalities, reported from 14 studies, highlighted autistic-like traits and attention and hyperactivity disorders, slightly improving with age. The cognitive profile in DS and some behavioral and motor abnormalities may be enclosed within a unified theoretical framework of the three main hypotheses advanced: a pervasive sensorimotor integration deficit, encompassing an occipito-parietofrontal circuit (dorsal stream) dysfunction and a coexistent cerebellar deficit.
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Affiliation(s)
- Margherita Bertuccelli
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Karen Verheyen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,MOVANT, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Josemir W Sander
- University College London Queen Square Institute of Neurology, National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico Foundation Neurological Institute C. Besta, Milano, Italy
| | - Patrizia Bisiacchi
- Padova Neuroscience Center, University of Padova, Padova, Italy.,Department of General Psychology, University of Padova, Padova, Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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23
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Choi M, Ahn N, Park J, Kim K. 12-Week Exercise Training of Knee Joint and Squat Movement Improves Gait Ability in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041515. [PMID: 33562705 PMCID: PMC7915473 DOI: 10.3390/ijerph18041515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
This study analyzed the effects of an exercise training program consisting of a knee joint complex exercise device (leg-link system) with digitally controlled active motion function and squat movement on physical fitness and gait ability of elderly women aged 70 or above. Fifty four (54) elderly women aged 70 or above were divided into three groups as control group (n = 18), aerobic training group (n = 18), and combined training group with resistance and aerobic exercise (n = 18). Health-related physical fitness, gait ability-related physical fitness, and the temporal and spatial parameters of gait ability were compared. The health-related physical fitness after the 12-week training was not significantly altered in control group, whereas combined training group showed significant increase in all factors (p < 0.05) and aerobic training group showed significant increase (p < 0.05) only in the physical efficiency index. The gait ability-related physical fitness and all items of the temporal and spatial parameters of gait were found to have significantly increased (p < 0.05) in combined training group after the 12-week exercise training; however, in aerobic training group, only the factors related to muscular endurance and balance showed significant increase (p < 0.05). This study suggested that the exercise training consisting of knee joint complex exercise with digitally controlled active motion function and squat exercise for strengthening lower extremities and core muscles had positive effects on enhancing the ambulatory competence in elderly women.
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24
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Heß T, Milani TL, Meixensberger J, Krause M. Postural performance and plantar cutaneous vibration perception in patients with idiopathic normal pressure hydrocephalus. Heliyon 2021; 7:e05811. [PMID: 33458441 PMCID: PMC7797513 DOI: 10.1016/j.heliyon.2020.e05811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/22/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate whether impaired plantar cutaneous vibration perception contributes to postural disturbance in idiopathic normal pressure hydrocephalus (iNPH). Methods Three different groups were tested: iNPH-patients (iNPH), iNPH-patients after surgical shunt therapy (iNPH shunt), and healthy subjects (HS). Postural performance was quantified during quiescent stance on a pressure distribution platform. Vibration perception threshold (VPT) was measured using a modified vibration exciter to apply stimuli to the plantar foot. Results Regarding postural performance, iNPH showed significantly higher values for all investigated center of pressure (COP)-parameters compared to HS, which suggests impaired postural control. Shunted patients presented a tendency towards better postural control in contrast to non-shunted patients. VPTs did not differ significantly between all investigated groups, which suggests comparable plantar cutaneous vibration perception. Conclusion Patients with iNPH suffer from poor postural stability, whereas shunting tends to affect postural performance positively. Plantar cutaneous vibration perception seems to be comparable between all investigated study groups. Consequently, postural disturbance in iNPH cannot clearly be ascribed to defective plantar cutaneous input.
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Affiliation(s)
- Tobias Heß
- Chemnitz University of Technology, Department of Human Locomotion, Chemnitz, Germany
| | - Thomas L Milani
- Chemnitz University of Technology, Department of Human Locomotion, Chemnitz, Germany
| | | | - Matthias Krause
- University Hospital, Department of Neurosurgery, Leipzig, Germany
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25
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Pozzi NG, Brumberg J, Todisco M, Minafra B, Zangaglia R, Bossert I, Trifirò G, Ceravolo R, Vitali P, Isaias IU, Fasano A, Pacchetti C. Striatal Dopamine Deficit and Motor Impairment in Idiopathic Normal Pressure Hydrocephalus. Mov Disord 2020; 36:124-132. [PMID: 33151012 DOI: 10.1002/mds.28366] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus can present with parkinsonism. However, abnormalities of the striatal dopamine reuptake transporter are unclear. OBJECTIVES To explore presence and features of striatal dopaminergic deficit in subjects with idiopathic normal pressure hydrocephalus as compared to Parkinson's disease (PD) patients and healthy controls. METHODS We investigated 50 subjects with idiopathic normal pressure hydrocephalus, 25 with PD, and 40 healthy controls. All participants underwent [123 I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane and single-photon emission computed tomography to quantify the striatal dopamine reuptake transporter binding. All subjects with idiopathic normal pressure hydrocephalus underwent a levodopa (l-dopa) challenge test and magnetic resonance imaging to evaluate ventriculomegaly and white matter changes. Gait, cognition, balance, and continence were assessed with the Idiopathic Normal Pressure Hydrocephalus Rating Scale, and parkinsonism with the motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale. All patients completed a 2-year follow-up. RESULTS A total of 62% of patients with idiopathic normal pressure hydrocephalus featured a reduced striatal dopamine reuptake transporter binding, which correlated with the severity of parkinsonism but not with features of ventriculomegaly or white matter changes. Unlike PD, this dopaminergic deficit in idiopathic normal pressure hydrocephalus was more symmetric and prominent in the caudate nucleus. CONCLUSIONS Subjects with idiopathic normal pressure hydrocephalus can present a reduction of striatal dopamine reuptake transporter binding, which is consistent with the severity of parkinsonism and qualitatively differs from that found in PD patients. Longitudinal interventional studies are needed to prove a role for striatal dopamine reuptake transporter deficit in the pathophysiology of idiopathic normal pressure hydrocephalus. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicoló Gabriele Pozzi
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.,Neurology Department, University Hospital and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Joachim Brumberg
- Nuclear Medicine Department, University Hospital Würzburg, Würzburg, Germany
| | - Massimiliano Todisco
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Irene Bossert
- Nuclear Medicine Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Giuseppe Trifirò
- Nuclear Medicine Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Vitali
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Ioannis Ugo Isaias
- Neurology Department, University Hospital and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
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26
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Bonvegna S, Straccia G, Golfrè Andreasi N, Elia AE, Marucci G, Di Bella D, Cilia R, Eleopra R. Parkinsonism and Nigrostriatal Damage Secondary to
CSF1R
‐Related Primary Microgliopathy. Mov Disord 2020; 35:2360-2362. [DOI: 10.1002/mds.28290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Salvatore Bonvegna
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giulia Straccia
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
- Department of Medical Sciences and Advanced Surgery University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Antonio Emanuele Elia
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Gianluca Marucci
- Neuropathology Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Daniela Di Bella
- Unit of Medical Genetics and Neurogenetics Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
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27
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Onder H. Corticobasal Degeneration Misdiagnosed As Musculoskeletal Disease: A Challenging Diagnosis of Higher-Level Gait Disease. J Neurosci Rural Pract 2020; 11:640-642. [PMID: 33144804 PMCID: PMC7595797 DOI: 10.1055/s-0040-1716773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gait disorders are common in the elderly as there are various causes of neurological and non-neurological conditions. On the other hand, most of the gait parameters do change with advancing age which is identified as age-related physiological changes in gait. At this point, the discrimination between age-related physiological changes and gait disorders may be strictly challenging. After identifying gait as an abnormal pattern, classification of it and making the responsible pathophysiology also require high-level expertise in this regard. Herein, we present a rare patient with corticobasal degeneration (CBD) who had admitted initially due to complaints of gait problems. Over a long time, the patient had received the misdiagnosis of gait abnormality due to musculoskeletal problems by multiple physicians. However, the detailed neurological exam showed a higher level gait disorder (HLGD). Further investigations at this point yielded the diagnosis of CBD.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey
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28
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[Diagnosis and treatment of vascular dementia]. Z Gerontol Geriatr 2020; 53:687-698. [PMID: 32975634 DOI: 10.1007/s00391-020-01786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/28/2020] [Indexed: 01/26/2023]
Abstract
Vascular dementias (VD, due to the various expressions of VD the plural form is used) are the second most common form of dementia after Alzheimer's dementia. These dementias play an important role especially in geriatric patients. They can occur due to acute events (e.g. stroke) and due to slowly progressive cerebrovascular damage. This article focuses on VD due to cortical and strategic infarcts, microangiopathic infarcts with lacunae as well as intracerebral bleeding. In addition to the clinical description and radiological findings, a special focus is on education, prevention and rehabilitation aspects.
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Clark DJ, Chatterjee SA, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ. Combining Frontal Transcranial Direct Current Stimulation With Walking Rehabilitation to Enhance Mobility and Executive Function: A Pilot Clinical Trial. Neuromodulation 2020; 24:950-959. [PMID: 32808403 DOI: 10.1111/ner.13250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This pilot study assessed whether frontal lobe transcranial direct current stimulation (tDCS) combined with complex walking rehabilitation is feasible, safe, and shows preliminary efficacy for improving walking and executive function. MATERIALS AND METHODS Participants were randomized to one of the following 18-session interventions: active tDCS and rehabilitation with complex walking tasks (Active/Complex); sham tDCS and rehabilitation with complex walking tasks (Sham/Complex); or sham tDCS and rehabilitation with typical walking (Sham/Typical). Active tDCS was delivered over F3 (cathode) and F4 (anode) scalp locations for 20 min at 2 mA intensity. Outcome measures included tests of walking function, executive function, and prefrontal activity measured by functional near infrared spectroscopy. RESULTS Ninety percent of participants completed the intervention protocol successfully. tDCS side effects of tingling or burning sensations were low (average rating less than two out of 10). All groups demonstrated gains in walking performance based on within-group effect sizes (d ≥ 0.50) for one or more assessments. The Sham/Typical group showed the greatest gains for walking based on between-group effect sizes. For executive function, the Active/Complex group showed the greatest gains based on moderate to large between-group effect sizes (d = 0.52-1.11). Functional near-infrared spectroscopy (fNIRS) findings suggest improved prefrontal cortical activity during walking. CONCLUSIONS Eighteen sessions of walking rehabilitation combined with tDCS is a feasible and safe intervention for older adults. Preliminary effects size data indicate a potential improvement in executive function by adding frontal tDCS to walking rehabilitation. This study justifies future larger clinical trials to better understand the benefits of combining tDCS with walking rehabilitation.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Sudeshna A Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jared W Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Paige E Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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Sacheli LM, Zapparoli L, Bonandrini R, Preti M, Pelosi C, Sconfienza LM, Banfi G, Paulesu E. How aging affects the premotor control of lower limb movements in simulated gait. Hum Brain Mapp 2020; 41:1889-1903. [PMID: 31922648 PMCID: PMC7267909 DOI: 10.1002/hbm.24919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/19/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
Gait control becomes more demanding in healthy older adults, yet what cognitive or motor process leads to this age-related change is unknown. The present study aimed to investigate whether it might depend on specific decay in the quality of gait motor representation and/or a more general reduction in the efficiency of lower limb motor control. Younger and older healthy participants performed in fMRI a virtual walking paradigm that combines motor imagery (MI) of walking and standing on the spot with the presence (Dynamic Motor Imagery condition, DMI) or absence (pure MI condition) of overtly executed ankle dorsiflexion. Gait imagery was aided by the concomitant observation of moving videos simulating a stroll in the park from a first-person perspective. Behaviorally, older participants showed no sign of evident depletion in the quality of gait motor representations, and absence of between-group differences in the neural correlates of MI. However, while younger participants showed increased frontoparietal activity during DMI, older participants displayed stronger activation of premotor areas when controlling the pure execution of ankle dorsiflexion, regardless of the imagery task. These data suggest that reduced automaticity of lower limb motor control in healthy older subjects leads to the recruitment of additional premotor resources even in the absence of basic gait functional disabilities.
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Affiliation(s)
- Lucia Maria Sacheli
- Psychology Department & Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura Zapparoli
- Psychology Department & Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Rolando Bonandrini
- Psychology Department & Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Matteo Preti
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Catia Pelosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,University Vita e Salute San Raffaele, Milan, Italy
| | - Eraldo Paulesu
- Psychology Department & Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Pieruccini‐Faria F, Sarquis‐Adamson Y, Anton‐Rodrigo I, Noguerón‐García A, Bray NW, Camicioli R, Muir‐Hunter SW, Speechley M, McIlroy B, Montero‐Odasso M. Mapping Associations Between Gait Decline and Fall Risk in Mild Cognitive Impairment. J Am Geriatr Soc 2019; 68:576-584. [DOI: 10.1111/jgs.16265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Frederico Pieruccini‐Faria
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
| | - Yanina Sarquis‐Adamson
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
| | - Ivan Anton‐Rodrigo
- Department of Geriatric MedicineMatia Fundazioa, Hospital Ricardo Bermingham San Sebastian Spain
| | | | - Nick W. Bray
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
| | - Richard Camicioli
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Susan W. Muir‐Hunter
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Mark Speechley
- Department of Epidemiology and BiostatisticsUniversity of Western Ontario London Ontario Canada
| | - Bill McIlroy
- Department of KinesiologyUniversity of Waterloo Waterloo Ontario Canada
| | - Manuel Montero‐Odasso
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
- Division of Neurology, Department of MedicineUniversity of Alberta Edmonton Alberta Canada
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Isaacs AM, Williams MA, Hamilton MG. Current Update on Treatment Strategies for Idiopathic Normal Pressure Hydrocephalus. Curr Treat Options Neurol 2019; 21:65. [PMID: 31792620 DOI: 10.1007/s11940-019-0604-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Idiopathic normal pressure hydrocephalus (iNPH) is a surgically treatable neurological disorder of the elderly population that is characterized by abnormal ventricular enlargement due to cerebrospinal fluid (CSF) accumulation and gait disturbance, cognitive impairment, or urinary incontinence. The objective of this review is to present the current diagnostic and treatment approaches for iNPH and to discuss some of the postoperative modalities that complement positive surgical outcomes. RECENT FINDINGS Although historically reported patient outcomes following iNPH surgery were dismal and highly variable, recent advances in terms of better understanding of the iNPH disease process, better standardization of iNPH diagnostic and treatment processes arising from the adoption of clinical guidelines for diagnosis, treatment and in research methodologies, and availability of long-term follow-up data, have helped reduce the variations to a much improved 73 to 96% reported good outcomes. With careful evaluation, good patient selection, and advanced surgical techniques, iNPH can be surgically treated to return patients close to their pre-iNPH functional status. Institution of an interdisciplinary effort to rehabilitate patients following surgery may help augment their recovery.
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Affiliation(s)
- Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA.,Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Williams
- Adult and Transitional Hydrocephalus and CSF Disorders, Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark G Hamilton
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada. .,Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Foothills Medical Centre - 12th Floor, Neurosurgery, 1403 - 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
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Feigl T, Roth D, Gradl S, Wirth M, Latoschik ME, Eskofier BM, Philippsen M, Mutschler C. Sick Moves! Motion Parameters as Indicators of Simulator Sickness. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2019; 25:3146-3157. [PMID: 31425036 DOI: 10.1109/tvcg.2019.2932224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We explore motion parameters, more specifically gait parameters, as an objective indicator to assess simulator sickness in Virtual Reality (VR). We discuss the potential relationships between simulator sickness, immersion, and presence. We used two different camera pose (position and orientation) estimation methods for the evaluation of motion tasks in a large-scale VR environment: a simple model and an optimized model that allows for a more accurate and natural mapping of human senses. Participants performed multiple motion tasks (walking, balancing, running) in three conditions: a physical reality baseline condition, a VR condition with the simple model, and a VR condition with the optimized model. We compared these conditions with regard to the resulting sickness and gait, as well as the perceived presence in the VR conditions. The subjective measures confirmed that the optimized pose estimation model reduces simulator sickness and increases the perceived presence. The results further show that both models affect the gait parameters and simulator sickness, which is why we further investigated a classification approach that deals with non-linear correlation dependencies between gait parameters and simulator sickness. We argue that our approach could be used to assess and predict simulator sickness based on human gait parameters and we provide implications for future research.
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Nikaido Y, Kajimoto Y, Akisue T, Urakami H, Kawami Y, Kuroda K, Ohno H, Saura R. Dynamic Balance Measurements Can Differentiate Patients Who Fall From Patients Who Do Not Fall in Patients With Idiopathic Normal Pressure Hydrocephalus. Arch Phys Med Rehabil 2019; 100:1458-1466. [DOI: 10.1016/j.apmr.2019.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 11/28/2022]
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35
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Luo L, Andrews H, Alcalay RN, Poyraz FC, Boehme AK, Goldman JG, Xie T, Tuite P, Henchcliffe C, Hogarth P, Amara AW, Frank S, Sutherland M, Kopil C, Naito A, Kang UJ. Motor phenotype classification in moderate to advanced PD in BioFIND study. Parkinsonism Relat Disord 2019; 65:178-183. [PMID: 31255537 DOI: 10.1016/j.parkreldis.2019.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/17/2019] [Accepted: 06/22/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Three motor phenotypes have been described in PD: postural instability and gait difficulty (PIGD) dominant, tremor-dominant (TD), and indeterminate (IND) subtype. These phenotypes have been associated with different cognitive trajectories, motor outcomes, and biomarkers profiles. However, whether motor subtype classifications change with treatment and disease progression is not well established. METHODS To evaluate motor subtype ratio changes, we used the chi-square test for the off and on state motor subtypes for 115 PD participants in the BioFIND study and used repeated-measures analyses to evaluate longitudinal changes in 162 PD participants with five-year follow-up in the PPMI study. RESULTS PIGD and TD subtypes in moderate to advanced PD participants change with dopaminergic agents. For those who shifted subtypes, improvement in tremor accounted for the transition of 15 (25.4%) TD participants, while the lack of tremor improvement along with minimal changes in PIGD score resulted in changes for eight (19.0%) PIGD individuals. Analyses of PPMI data revealed that all three subgroups had a significant decrease in subtype ratio with disease progression and a significant decline in subtype ratio occurred only in the TD subgroup with dopaminergic agents. The impact of dopaminergic medication effect on subtype shift for each visit was also more notable with disease advancement. CONCLUSIONS Motor subtypes are not fixed but change with progression of the disease and with treatment. Improvement in tremor was the main contributor to motor phenotype transitions in the BioFIND cohort. A more stable classification system for subtypes based on underlying biological differences is desirable.
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Affiliation(s)
- Lan Luo
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Howard Andrews
- Department of Biostatistics, Columbia University, New York, USA
| | - Roy N Alcalay
- Divison of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, USA
| | - Fernanda Carvalho Poyraz
- Divison of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, USA
| | - Amelia K Boehme
- Department of Neurology, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer G Goldman
- Parkinson Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Tao Xie
- Parkinson Disease and Movement Disorder Program, Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Paul Tuite
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Penelope Hogarth
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel Frank
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret Sutherland
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, USA
| | - Anna Naito
- The Michael J. Fox Foundation for Parkinson's Research, New York, USA
| | - Un Jung Kang
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, NYU Langone Health, New York, NY, USA.
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36
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Nikaido Y, Urakami H, Akisue T, Okada Y, Katsuta N, Kawami Y, Ikeji T, Kuroda K, Hinoshita T, Ohno H, Kajimoto Y, Saura R. Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2019; 183:105385. [PMID: 31207457 DOI: 10.1016/j.clineuro.2019.105385] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The factors influencing falls in idiopathic normal pressure hydrocephalus (iNPH) remain unclear, although iNPH-associated gait and balance disturbances can lead to an increased risk of falls. This study aimed to investigate the associations among fall status, gait variability, balance function in iNPH, and to identify fall-related factors in iNPH. PATIENTS AND METHODS Sixty-three patients with iNPH with a positive cerebrospinal fluid tap test result according to the iNPH diagnosis criteria participated in this prospective cross-sectional study. Patients were assessed using the 10-meter walk test (10MWT), the Functional Gait Assessment (FGA), the Berg Balance Scale (BBS), and the isometric quadriceps strength (QS). We also investigated each patient's history of falls in the past 6 months. Gait variability was measured using a triaxial accelerometer attached to the patient's torso at the L3 vertebra level during the 10MWT. RESULTS Fall status correlated significantly with gait variability (measured as the coefficient of variation; CV) in step time and movement trajectory amplitude (i.e., center of mass movement) in the medial/lateral (ML) and vertical (VT) directions, with balance function as assessed by FGA and BBS scores. In contrast, QS was not correlated with fall status. The independent variables associated with the risk of falling were step time CV, FGA score, and age. CONCLUSION The factors associated with the risk of falling in iNPH were aging and gait-balance instability, particularly temporal gait variability and dynamic balance dysfunction. Our results may enable physicians to identify the patients with iNPH who are at risk of falling and implement suitable prevention strategies.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan.
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; Graduate School of Health Science, Kio University, Nara, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yohei Okada
- Graduate School of Health Science, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Naoya Katsuta
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan
| | - Yuki Kawami
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan; Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Hyogo, Japan
| | - Takuya Ikeji
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan
| | - Tetsuya Hinoshita
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan
| | - Hiroshi Ohno
- Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery, Osaka Medical College, Osaka, Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical College, Osaka, Japan
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Aoki Y, Kazui H, Pascual-Marqui RD, Ishii R, Yoshiyama K, Kanemoto H, Suzuki Y, Sato S, Azuma S, Suehiro T, Matsumoto T, Hata M, Canuet L, Iwase M, Ikeda M. EEG Resting-State Networks Responsible for Gait Disturbance Features in Idiopathic Normal Pressure Hydrocephalus. Clin EEG Neurosci 2019; 50:210-218. [PMID: 30417664 DOI: 10.1177/1550059418812156] [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] [Indexed: 01/28/2023]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric disease characterized by gait disturbance, cognitive dysfunction, and urinary incontinence that affects a large population of elderly people. These symptoms, especially gait disturbance, can potentially be improved by cerebrospinal fluid (CSF) drainage, which is more effective if performed at an early stage of the disease. However, the neurophysiological mechanisms of these symptoms and their recovery by CSF drainage are poorly understood. In this study, using exact low-resolution brain electromagnetic tomography-independent component analysis (eLORETA-ICA) with electroencephalography (EEG) data, we assessed activities of five EEG resting-state networks (EEG-RSNs) in 58 iNPH patients before and after drainage of CSF by lumbar puncture (CSF tapping). In addition, we assessed correlations of changes in these five EEG-RSNs activities with CSF tapping-induced changes in iNPH symptoms. The results reveal that compared with 80 healthy controls, iNPH patients had significantly decreased activities in the occipital alpha rhythm, visual perception network, and self-referential network before CSF tapping. Furthermore, CSF tapping-induced changes in occipital alpha activity correlated with changes in postural sway and frontal lobe function. Changes in visual perception network activity correlated with changes in gait speed. In addition, changes in memory perception network activity correlated with changes in Parkinsonian gait features. These results indicate a recruitment of cognitive networks in gait control, and involvement of the occipital alpha activity in cognitive dysfunction in iNPH patients. Based on these findings, eLORETA-ICA with EEG data can be considered a noninvasive, useful tool for detection of EEG-RSN activities and for understanding the neurophysiological mechanisms underlying this disease.
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Affiliation(s)
- Yasunori Aoki
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.,2 Department of Psychiatry, Nippon Life Hospital, Osaka, Japan
| | - Hiroaki Kazui
- 3 Department of Neuropsychiatry, Kochi University, Kochi, Japan
| | - Roberto D Pascual-Marqui
- 4 The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland.,5 Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Ryouhei Ishii
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kenji Yoshiyama
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hideki Kanemoto
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.,6 Department of Psychiatry, Mizuma Hospital, Osaka, Japan.,7 Cognitive Reserve Research Center, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | - Yukiko Suzuki
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shunsuke Sato
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shingo Azuma
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Suehiro
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Matsumoto
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masahiro Hata
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Leonides Canuet
- 8 Department of Clinical Psychology and Psychobiology, La Laguna University, Tenerife, Spain
| | - Masao Iwase
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Manabu Ikeda
- 1 Department of Psychiatry, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Onder H, Buyuk F. Gait Dyspraxia due to Right Occipital Infarct. J Mov Disord 2019; 12:54-56. [PMID: 30732434 PMCID: PMC6369384 DOI: 10.14802/jmd.18033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Halil Onder
- Neurology Clinic, Yozgat City Hospital, Yozgat, Turkey
| | - Ferda Buyuk
- Physical Therapy and Rehabilitation, Yozgat City Hospital, Yozgat, Turkey
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Tichenor S, Yaruss JS. A Phenomenological Analysis of the Experience of Stuttering. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1180-1194. [PMID: 30347062 DOI: 10.1044/2018_ajslp-odc11-17-0192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/27/2018] [Indexed: 05/14/2023]
Abstract
PURPOSE Stuttering behaviors and moments of stuttering are typically defined by what a listener perceives. This study evaluated participants' perceptions of their own experience of moments of stuttering. METHOD Thirteen adults who stutter participated in a phenomenological qualitative study examining their experience of moments of stuttering. Analysis yielded several common themes and subthemes culminating in an essential structure describing the shared experience. RESULTS Speakers experience anticipation and react in action and nonaction ways. Many speakers experience a loss of control that relates to a lack of a well-formed speech plan or agency. The experience of moments of stuttering changes through therapy, over time, with self-help, and across situations. Many speakers experience so-called typical stuttering behaviors as reactions rather than direct consequences of trying to speak. Interactions with listeners can affect the experience of stuttering. CONCLUSION Although research recognizes that the experience of the stuttering disorder involves more than just speech behaviors, people who stutter experience stuttering behaviors in time as involving more than just the disruption in speech. This finding has implications for both the theoretical understanding of stuttering and the clinical evaluation and treatment of the stuttering disorder.
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40
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Postural control before and after cerebrospinal fluid shunt surgery in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2018; 172:46-50. [DOI: 10.1016/j.clineuro.2018.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/17/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022]
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41
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Sacheli LM, Zapparoli L, Preti M, De Santis C, Pelosi C, Ursino N, Zerbi A, Stucovitz E, Banfi G, Paulesu E. A functional limitation to the lower limbs affects the neural bases of motor imagery of gait. NEUROIMAGE-CLINICAL 2018; 20:177-187. [PMID: 30094167 PMCID: PMC6072647 DOI: 10.1016/j.nicl.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 02/04/2023]
Abstract
Studies on athletes or neurological patients with motor disorders have shown a close link between motor experience and motor imagery skills. Here we evaluated whether a functional limitation due to a musculoskeletal disorder has an impact on the ability to mentally rehearse the motor patterns of walking, an overlearned and highly automatic behaviour. We assessed the behavioural performance (measured through mental chronometry tasks) and the neural signatures of motor imagery of gait in patients with chronic knee arthrosis and in age-matched, healthy controls. During fMRI, participants observed (i) stationary or (ii) moving videos of a path in a park shown in the first-person perspective: they were asked to imagine themselves (i) standing on or (ii) walking along the path, as if the camera were “their own eyes” (gait imagery (GI) task). In half of the trials, participants performed a dynamic gait imagery (DGI) task by combining foot movements with GI. Behavioural tests revealed a lower degree of isochrony between imagined and performed walking in the patients, indicating impairment in the ability to mentally rehearse gait motor patterns. Moreover, fMRI showed widespread hypoactivation during GI in motor planning (premotor and parietal) brain regions, the brainstem, and the cerebellum. Crucially, the performance of DGI had a modulatory effect on the patients and enhanced activation of the posterior parietal, brainstem, and cerebellar regions that the healthy controls recruited during the GI task. These findings show that functional limitations of peripheral origin may impact on gait motor representations, providing a rationale for cognitive rehabilitation protocols in patients with gait disorders of orthopaedic nature. The DGI task may be a suitable tool in this respect. Patients with chronic knee arthrosis show impairment in gait motor imagery Impairment is selective for gait and paralleled by hypoactivation in premotor areas Peripheral limitation of lower limb movements affects central gait motor control Dynamic motor imagery favours the recruitment of a motor strategy during imagery Mental motor training might help to restore gait control in orthopaedic patients
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Affiliation(s)
- Lucia Maria Sacheli
- University of Milano-Bicocca, Department of Psychology and Milan Center for Neuroscience (NeuroMI), Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy.
| | - Laura Zapparoli
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Matteo Preti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Carlo De Santis
- University of Milano-Bicocca, Department of Psychology and Milan Center for Neuroscience (NeuroMI), Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Catia Pelosi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Alberto Zerbi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Elena Stucovitz
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy; University Vita e Salute San Raffaele, Milan, Italy
| | - Eraldo Paulesu
- University of Milano-Bicocca, Department of Psychology and Milan Center for Neuroscience (NeuroMI), Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy.
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42
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Allali G, Kern I, Laidet M, Armand S, Assal F. Parkinsonism is a Phenotypical Signature of Amyloidopathy in Patients with Gait Disorders. J Alzheimers Dis 2018; 63:1373-1381. [DOI: 10.3233/jad-171055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Ilse Kern
- Department of Genetics, Laboratory Medicine and Pathology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Magali Laidet
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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43
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Rektor I, Bohnen NI, Korczyn AD, Gryb V, Kumar H, Kramberger MG, de Leeuw FE, Pirtošek Z, Rektorová I, Schlesinger I, Slawek J, Valkovič P, Veselý B. An updated diagnostic approach to subtype definition of vascular parkinsonism - Recommendations from an expert working group. Parkinsonism Relat Disord 2018; 49:9-16. [PMID: 29310988 PMCID: PMC5857227 DOI: 10.1016/j.parkreldis.2017.12.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 11/25/2022]
Abstract
This expert working group report proposes an updated approach to subtype definition of vascular parkinsonism (VaP) based on a review of the existing literature. The persistent lack of consensus on clear terminology and inconsistent conceptual definition of VaP formed the impetus for the current expert recommendation report. The updated diagnostic approach intends to provide a comprehensive tool for clinical practice. The preamble for this initiative is that VaP can be diagnosed in individual patients with possible prognostic and therapeutic consequences and therefore should be recognized as a clinical entity. The diagnosis of VaP is based on the presence of clinical parkinsonism, with variable motor and non-motor signs that are corroborated by clinical, anatomic or imaging findings of cerebrovascular disease. Three VaP subtypes are presented: (1) The acute or subacute post-stroke VaP subtype presents with acute or subacute onset of parkinsonism, which is typically asymmetric and responds to dopaminergic drugs; (2) The more frequent insidious onset VaP subtype presents with progressive parkinsonism with prominent postural instability, gait impairment, corticospinal, cerebellar, pseudobulbar, cognitive and urinary symptoms and poor responsiveness to dopaminergic drugs. A higher-level gait disorder occurs frequently as a dominant manifestation in the clinical spectrum of insidious onset VaP, and (3) With the emergence of molecular imaging biomarkers in clinical practice, our diagnostic approach also allows for the recognition of mixed or overlapping syndromes of VaP with Parkinson's disease or other neurodegenerative parkinsonisms. Directions for future research are also discussed.
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Affiliation(s)
- Ivan Rektor
- Masaryk University, Central European Institute of Technology - CEITEC, Neuroscience Centre and Movement Disorders Centre, Brno, Czech Republic.
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, and Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Amos D Korczyn
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Viktoria Gryb
- Ivano-Frankivsk Medical University, Department of Neurology and Neurosurgery, Ivano-Frankivsk Regional Hospital, Vascular Neurology Department, Ivano-Frankivsk, Ukraine
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | | | - Frank-Erik de Leeuw
- Radboud University Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience Department of Neurology, Nijmegen, The Netherlands
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Rektorová
- Masaryk University, Central European Institute of Technology - CEITEC, Neuroscience Centre and Movement Disorders Centre, Brno, Czech Republic
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Jaroslaw Slawek
- Neurology Department, St. Adalbert Hospital, Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
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Nikaido Y, Akisue T, Kajimoto Y, Tucker A, Kawami Y, Urakami H, Iwai Y, Sato H, Nishiguchi T, Hinoshita T, Kuroda K, Ohno H, Saura R. Postural instability differences between idiopathic normal pressure hydrocephalus and Parkinson’s disease. Clin Neurol Neurosurg 2018; 165:103-107. [DOI: 10.1016/j.clineuro.2018.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/26/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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45
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Nonnekes J, Goselink RJM, Růžička E, Fasano A, Nutt JG, Bloem BR. Neurological disorders of gait, balance and posture: a sign-based approach. Nat Rev Neurol 2018; 14:183-189. [DOI: 10.1038/nrneurol.2017.178] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Application and Interpretation of Functional Outcome Measures for Testing Individuals With Cognitive Impairment. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Espay AJ, Da Prat GA, Dwivedi AK, Rodriguez-Porcel F, Vaughan JE, Rosso M, Devoto JL, Duker AP, Masellis M, Smith CD, Mandybur GT, Merola A, Lang AE. Deconstructing normal pressure hydrocephalus: Ventriculomegaly as early sign of neurodegeneration. Ann Neurol 2017; 82:503-513. [PMID: 28892572 DOI: 10.1002/ana.25046] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/01/2017] [Indexed: 12/27/2022]
Abstract
Idiopathic normal pressure hydrocephalus (NPH) remains both oversuspected on clinical grounds and underconfirmed when based on immediate and sustained response to cerebrospinal fluid diversion. Poor long-term postshunt benefits and findings of neurodegenerative pathology in most patients with adequate follow-up suggest that hydrocephalic disorders appearing in late adulthood may often result from initially unapparent parenchymal abnormalities. We critically review the NPH literature, highlighting the near universal lack of blinding and controls, absence of specific clinical, imaging, or pathological features, and ongoing dependence for diagnostic confirmation on variable cutoffs of gait response to bedside fluid-drainage testing. We also summarize our long-term institutional experience, in which postshunt benefits in patients with initial diagnosis of idiopathic NPH persist in only 32% of patients at 36 months, with known revised diagnosis in over 25% (Alzheimer's disease, dementia with Lewy bodies, and progressive supranuclear palsy). We postulate that previously reported NPH cases with "dual" pathology (ie, developing a "second" disorder) more likely represent ventriculomegalic presentations of selected neurodegenerative disorders in which benefits from shunting may be short-lived, with a consequently unfavorable risk-benefit ratio. Ann Neurol 2017;82:503-513.
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Gustavo A Da Prat
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH.,Sanatorio de la Trinidad Mitre, Departamento de Neurologia, Ciudad de Buenos Aires, Argentina
| | - Alok K Dwivedi
- Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), El Paso, TX
| | - Federico Rodriguez-Porcel
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Jennifer E Vaughan
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Michela Rosso
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Johnna L Devoto
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Andrew P Duker
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Mario Masellis
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, University of Toronto, and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Charles D Smith
- Departments of Neurology and Radiology, Magnetic Resonance Imaging & Spectroscopy Center, University of Kentucky, Lexington, KY
| | - George T Mandybur
- Mayfield Clinic, Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Anthony E Lang
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, ON, Canada
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48
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Peterová K, Brožová H, Klempíř J, Lišková I, Bezdicek O, Ridzoň P, Vaněčková M, Zakharov S, Pelclová D, Miovský M, Růžička E. Gait and Balance Impairment after Acute Methanol Poisoning. Basic Clin Pharmacol Toxicol 2017; 122:176-182. [DOI: 10.1111/bcpt.12853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kamila Peterová
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Hana Brožová
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Jiří Klempíř
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Irena Lišková
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Ondřej Bezdicek
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Petr Ridzoň
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
- Department of Neurology; Thomayer Hospital; Prague Czech Republic
| | - Manuela Vaněčková
- Department of Radiology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Sergej Zakharov
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Daniela Pelclová
- Department of Occupational Medicine; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Michal Miovský
- Department of Addictology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
| | - Evžen Růžička
- Department of Neurology; Charles University; First Faculty of Medicine and General University Hospital; Prague Czech Republic
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49
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Sacheli LM, Zapparoli L, De Santis C, Preti M, Pelosi C, Ursino N, Zerbi A, Banfi G, Paulesu E. Mental steps: Differential activation of internal pacemakers in motor imagery and in mental imitation of gait. Hum Brain Mapp 2017; 38:5195-5216. [PMID: 28731517 DOI: 10.1002/hbm.23725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Gait imagery and gait observation can boost the recovery of locomotion dysfunctions; yet, a neurologically justified rationale for their clinical application is lacking as much as a direct comparison of their neural correlates. Using functional magnetic resonance imaging, we measured the neural correlates of explicit motor imagery of gait during observation of in-motion videos shot in a park with a steady cam (Virtual Walking task). In a 2 × 2 factorial design, we assessed the modulatory effect of gait observation and of foot movement execution on the neural correlates of the Virtual Walking task: in half of the trials, the participants were asked to mentally imitate a human model shown while walking along the same route (mental imitation condition); moreover, for half of all the trials, the participants also performed rhythmic ankle dorsiflexion as a proxy for stepping movements. We found that, beyond the areas associated with the execution of lower limb movements (the paracentral lobule, the supplementary motor area, and the cerebellum), gait imagery also recruited dorsal premotor and posterior parietal areas known to contribute to the adaptation of walking patterns to environmental cues. When compared with mental imitation, motor imagery recruited a more extensive network, including a brainstem area compatible with the human mesencephalic locomotor region (MLR). Reduced activation of the MLR in mental imitation indicates that this more visually guided task poses less demand on subcortical structures crucial for internally generated gait patterns. This finding may explain why patients with subcortical degeneration benefit from rehabilitation protocols based on gait observation. Hum Brain Mapp 38:5195-5216, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucia Maria Sacheli
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Laura Zapparoli
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Carlo De Santis
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Matteo Preti
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Catia Pelosi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Alberto Zerbi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy.,University Vita e Salute San Raffaele, Milan, Italy
| | - Eraldo Paulesu
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
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50
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Higuma M, Sanjo N, Mitoma H, Yoneyama M, Yokota T. Whole-Day Gait Monitoring in Patients with Alzheimer's Disease: A Relationship between Attention and Gait Cycle. J Alzheimers Dis Rep 2017; 1:1-8. [PMID: 30480224 PMCID: PMC6159725 DOI: 10.3233/adr-170001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Gait impairment in patients with Alzheimer's disease (AD) and its relationship with cognitive function has been described, but reports of gait analysis in AD in daily living are limited. Objective: To investigate whether gait pattern of patients with AD in daily living is associated with cognitive function. Methods: Gait was recorded in 24 patients with AD and 9 healthy controls (HC) for 24 hours by using a portable gait rhythmogram. Mean gait cycle and gait acceleration were compared between the AD and HC groups. For the AD group, these gait metrics were assessed for correlations with cognitive function, as determined by the Mini Mental State Examination and Wechsler Memory Scale-Revised (WMS-R). Results: Although both gait parameters were not different between the patients with AD and HC, gait cycle in patients with AD was positively correlated with attention/concentration scores on the WMS-R (r = 0.578), and not with memory function. Patients with AD with attention scores as high as HC displayed a longer gait cycle than both HC (p = 0.048) and patients with AD with lower attention scores (p = 0.011). The patients with AD with lower attention scores showed a similar gait cycle with HC (p = 0.994). Conclusion: Patients with AD with impaired attentional function walk with faster gait cycle comparable to HC in daily living walking, which was unexpected based on previous gait analysis in clinical settings. This result probably reflects diminished consciousness to either the environment or instability of gait in the patients with AD with impaired attention.
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Affiliation(s)
- Maya Higuma
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | | | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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