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Silva-Batista C, Liu W, Vitorio R, Stuart S, Quinn JF, Mancini M. The Time Course of Changes in Prefrontal Cortex Activity During Walking in People With Parkinson's Disease. Neurorehabil Neural Repair 2024:15459683241265935. [PMID: 39075890 DOI: 10.1177/15459683241265935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Walking abnormalities in people with Parkinson's disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory, executive control, mainly located in the prefrontal cortex (PFC). Although PFC activity during walking increases in people with PD, the time course of PFC activity during walking and its relationship to clinical or gait characteristics is unknown. OBJECTIVE To identify the time course of PFC activity during walking in people with PD. To investigate whether clinical or gait variables would explain the PFC activity changes. METHODS Thirty-eight people with PD tested OFF medication wore a portable, functional near-infrared spectroscopy (fNIRS) system to record relative PFC activity while walking. Wearable inertial sensors recorded spatiotemporal gait characteristics. Based on the PFC activity (fNIRS) in the late phase of the walking task (final 40 seconds), compared to the early phase (initial 40 seconds), participants were separated into 2 groups: reduced or sustained PFC activity. RESULTS People with PD who reduced PFC activity during walking had less impaired gait (eg, faster gait speed) than those who had a sustained increase in PFC activity (P < .05). Cognitive set-shifting ability explained 18% of the PFC activation in the group with a sustained increase in PFC activity (P = .033). CONCLUSIONS The time course of reduction in PFC activity corresponds to less impaired gait performance in people with PD, while a sustained increase in PFC activity is related to worse cognitive flexibility. Reduction in PFC activity while walking may indicate a less impaired, automatic control of walking.
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Affiliation(s)
- Carla Silva-Batista
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - William Liu
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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Wang X, Fu S, Yoo K, Wang X, Gan L, Zou T, Gao Q, Han H, Yang Z, Hu X, Chen H, Liu D, Li R. Individualized Structural Perturbations on Normative Brain Connectome Restrict Deep Brain Stimulation Outcomes in Parkinson's Disease. Mov Disord 2024. [PMID: 38894532 DOI: 10.1002/mds.29874] [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: 02/02/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) respond to deep brain stimulation (DBS) variably. However, how brain substrates restrict DBS outcomes remains unclear. OBJECTIVE In this article, we aim to identify prognostic brain signatures for explaining the response variability. METHODS We retrospectively investigated a cohort of patients with PD (n = 141) between 2017 and 2022, and defined DBS outcomes as the improvement ratio of clinical motor scores. We used a deviation index to quantify individual perturbations on a reference structural covariance network acquired with preoperative T1-weighted magnetic resonance imaging. The neurobiological perturbations of patients were represented as z scored indices based on the chronological perturbations measured on a group of normal aging adults. RESULTS After applying stringent statistical tests (z > 2.5) and correcting for false discoveries (P < 0.01), we found that accelerated deviations mainly affected the prefrontal cortex, motor strip, limbic system, and cerebellum in PD. Particularly, a negative network within the accelerated deviations, expressed as "more preoperative deviations, less postoperative improvements," could predict DBS outcomes (mean absolute error = 0.09, R2 = 0.15). Moreover, a fusion of personal brain predictors and medical responses significantly improved traditional evaluations of DBS outcomes. Notably, the most important brain predictor, a pathway connecting the cognitive unit (prefrontal cortex) and motor control unit (cerebellum and motor strip), partially mediates DBS outcomes with the age at surgery. CONCLUSIONS Our findings suggest that individual structural perturbations on the cognitive motor control circuit are critical for modulating DBS outcomes. Interventions toward the circuit have the potential for additional clinical improvements. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Xuyang Wang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Kwangsun Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Xiaoyue Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lin Gan
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Ting Zou
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Honghao Han
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Zhenzhe Yang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Huafu Chen
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Rong Li
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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Reilly S, Dhaliwal S, Arshad U, Macerollo A, Husain N, Costa AD. The effects of rivastigmine on neuropsychiatric symptoms in the early stages of Parkinson's disease: A systematic review. Eur J Neurol 2024; 31:e16142. [PMID: 37975761 PMCID: PMC11236000 DOI: 10.1111/ene.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/14/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Neuropsychiatric symptoms including depression, apathy and psychosis occur frequently in patients with Parkinson's disease. A subgroup of patients develop cognitive impairment, which may increase the risk of falls due to reduced attention. The acetylcholinesterase inhibitor rivastigmine is beneficial in Parkinson's disease dementia, but whether the use of rivastigmine is effective earlier in the disease course is unclear. The aim of this systematic review was to assess the evidence for rivastigmine in the treatment of neuropsychiatric symptoms in Parkinson's disease without dementia. METHODS Embase, Medline, PsychINFO, Cochrane CENTRAL, NGLC, National Institute for Health and Care Excellence Evidence and medRxiv.org were searched for studies with terms relating to population (Parkinson's disease) and intervention (rivastigmine). Of 1922 references identified, 358 were duplications. Following title and abstract review, 1331 articles were excluded. After full-text review, nine articles remained. RESULTS Outcomes were heterogenous, therefore, the results are presented in narrative form. The articles included six randomized controlled trials, two open-label trials and one case series. Outcome measures included: time to develop psychosis; frequency of rapid eye movement sleep behaviour disorder (RBD) episodes; apathy; gait variability; falls; cognitive ability; Neuropsychiatric Inventory score; and regional spontaneous brain activity. CONCLUSIONS There is evidence that rivastigmine is beneficial for RBD and apathy in Parkinson's disease patients without dementia. There is high level evidence that rivastigmine reduces falls, which may be due to improved attention. The impact of rivastigmine on psychotic symptoms is less clear, but is supported by current theoretical models which involve acetylcholine dysfunction in the generation of visual hallucinations in Parkinson's disease.
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Affiliation(s)
- Siobhan Reilly
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Usman Arshad
- Pakistan Institute of Living and LearningKarachiPakistan
- The University of ManchesterManchesterUK
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and NeurosurgeryLiverpoolUK
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Nusrat Husain
- The University of ManchesterManchesterUK
- Mersey Care NHS Foundation TrustLiverpoolUK
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Venuto CS, Smith G, Herbst K, Zielinski R, Yung NC, Grosset DG, Dorsey ER, Kieburtz K. Predicting Ambulatory Capacity in Parkinson's Disease to Analyze Progression, Biomarkers, and Trial Design. Mov Disord 2023; 38:1774-1785. [PMID: 37363815 PMCID: PMC10615710 DOI: 10.1002/mds.29519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Parkinson's disease (PD), gait and balance is impaired, relatively resistant to available treatment and associated with falls and disability. Predictive models of ambulatory progression could enhance understanding of gait/balance disturbances and aid in trial design. OBJECTIVES To predict trajectories of ambulatory abilities from baseline clinical data in early PD, relate trajectories to clinical milestones, compare biomarkers, and evaluate trajectories for enrichment of clinical trials. METHODS Data from two multicenter, longitudinal, observational studies were used for model training (Tracking Parkinson's, n = 1598) and external testing (Parkinson's Progression Markers Initiative, n = 407). Models were trained and validated to predict individuals as having a "Progressive" or "Stable" trajectory based on changes of ambulatory capacity scores from the Movement Disorders Society Unified Parkinson's Disease Rating Scale parts II and III. Survival analyses compared time-to-clinical milestones and trial outcomes between predicted trajectories. RESULTS On external evaluation, a support vector machine model predicted Progressive trajectories using baseline clinical data with an accuracy, weighted-F1 (proportionally weighted harmonic mean of precision and sensitivity), and sensitivity/specificity of 0.735, 0.799, and 0.688/0.739, respectively. Over 4 years, the predicted Progressive trajectory was more likely to experience impaired balance, loss of independence, impaired function and cognition. Baseline dopamine transporter imaging and select biomarkers of neurodegeneration were significantly different between predicted trajectory groups. For an 18-month, randomized (1:1) clinical trial, sample size savings up to 30% were possible when enrollment was enriched for the Progressive trajectory versus no enrichment. CONCLUSIONS It is possible to predict ambulatory abilities from clinical data that are associated with meaningful outcomes in people with early PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Charles S. Venuto
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Greta Smith
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Konnor Herbst
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Robert Zielinski
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Biostatistics, Brown University, Providence, RI, USA
| | - Norman C.W. Yung
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Donald G. Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Camicioli R, Morris ME, Pieruccini‐Faria F, Montero‐Odasso M, Son S, Buzaglo D, Hausdorff JM, Nieuwboer A. Prevention of Falls in Parkinson's Disease: Guidelines and Gaps. Mov Disord Clin Pract 2023; 10:1459-1469. [PMID: 37868930 PMCID: PMC10585979 DOI: 10.1002/mdc3.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background People living with Parkinson's disease (PD) have a high risk for falls. Objective To examine gaps in falls prevention targeting people with PD as part of the Task Force on Global Guidelines for Falls in Older Adults. Methods A Delphi consensus process was used to identify specific recommendations for falls in PD. The current narrative review was conducted as educational background with a view to identifying gaps in fall prevention. Results A recent Cochrane review recommended exercises and structured physical activities for PD; however, the types of exercises and activities to recommend and PD subgroups likely to benefit require further consideration. Freezing of gait, reduced gait speed, and a prior history of falls are risk factors for falls in PD and should be incorporated in assessments to identify fall risk and target interventions. Multimodal and multi-domain fall prevention interventions may be beneficial. With advanced or complex PD, balance and strength training should be administered under supervision. Medications, particularly cholinesterase inhibitors, show promise for falls prevention. Identifying how to engage people with PD, their families, and health professionals in falls education and implementation remains a challenge. Barriers to the prevention of falls occur at individual, environmental, policy, and health system levels. Conclusion Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study.
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Affiliation(s)
- Richard Camicioli
- Department of Medicine (Neurology) and Neuroscience and Mental Health InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Meg E. Morris
- La Trobe University, Academic and Research Collaborative in Health & HealthscopeMelbourneVictoriaAustralia
| | - Frederico Pieruccini‐Faria
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Manuel Montero‐Odasso
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Surim Son
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - David Buzaglo
- Center for the Study of Movement, Cognition and Mobility, Neurological InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
- Department of Physical Therapy, Faculty of Medicine, Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- Rush Alzheimer's Disease Center and Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy)KU LeuvenLeuvenBelgium
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Sparrow D, DeMolles D, Dubaz O, Durso R, Rosner B. Design issues in crossover trials involving patients with Parkinson's disease. Front Neurol 2023; 14:1197281. [PMID: 37670777 PMCID: PMC10476358 DOI: 10.3389/fneur.2023.1197281] [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: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023] Open
Abstract
Background and objectives Crossover designs are frequently used to assess treatments for patients with Parkinson's disease. Typically, two-period two-treatment trials include a washout period between the 2 periods and assume that the washout period is sufficiently long to eliminate carryover effects. A complementary strategy might be to jointly model carryover and treatment effects, though this has rarely been done in Parkinson's disease crossover studies. The primary objective of this research is to demonstrate a modeling approach that assesses treatment and carryover effects in one unified mixed model analysis and to examine how it performs in a simulation study and a real data analysis example, as compared to other data analytic approaches used in Parkinson's disease crossover studies. Methods We examined how three different methods of analysis (standard crossover t-test, mixed model with a carryover term included in model statement, and mixed model with no carryover term) performed in a simulation study and illustrated the methods in a real data example in Parkinson's disease. Results The simulation study based on the presence of a carryover effect indicated that mixed models with a carryover term and an unstructured correlation matrix provided unbiased estimates of treatment effect and appropriate type I error. The methods are illustrated in a real data example involving Parkinson's disease. Our literature review revealed that a majority of crossover studies included a washout period but did not assess whether the washout was sufficiently long to eliminate the possibility of carryover. Discussion We recommend using a mixed model with a carryover term and an unstructured correlation matrix to obtain unbiased estimates of treatment effect.
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Affiliation(s)
- David Sparrow
- VA Boston Healthcare System, Boston, MA, United States
- Departments of Medicine and Public Health, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | | | - Ornella Dubaz
- VA Boston Healthcare System, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Raymon Durso
- Departments of Medicine and Public Health, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Bernard Rosner
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Channing Division for Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Tong SY, Wang RW, Li Q, Liu Y, Yao XY, Geng DQ, Gao DS, Ren C. Serum glial cell line-derived neurotrophic factor (GDNF) a potential biomarker of executive function in Parkinson's disease. Front Neurosci 2023; 17:1136499. [PMID: 36908789 PMCID: PMC9995904 DOI: 10.3389/fnins.2023.1136499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Evidence shows that the impairment of executive function (EF) is mainly attributed to the degeneration of frontal-striatal dopamine pathway. Glial cell line-derived neurotrophic factor (GDNF), as the strongest protective neurotrophic factor for dopaminergic neurons (DANs), may play a role in EF to some extent. This study mainly explored the correlation between serum GDNF concentration and EF performance in Parkinson's disease (PD). Methods This study recruited 45 healthy volunteers (health control, HC) and 105 PD patients, including 44 with mild cognitive impairment (PD-MCI), 20 with dementia (PD-D), and 20 with normal cognitive function (PD-N). Neuropsychological tests were performed to evaluate EF (working memory, inhibitory control, and cognitive flexibility), attention, language, memory, and visuospatial function. All subjects were tested for serum GDNF and homovanillic acid (HVA) levels by ELISA and LC-ESI-MS/MS, respectively. Results PD-MCI patients showed impairments in the trail making test (TMT) A (TMT-A), TMT-B, clock drawing test (CDT) and semantic fluency test (SFT), whereas PD-D patients performed worse in most EF tests. With the deterioration of cognitive function, the concentration of serum GDNF and HVA in PD patients decreased. In the PD group, the serum GDNF and HVA levels were negatively correlated with TMT-A (r GDNF = -0.304, P < 0.01; r HVA = -0.334, P < 0.01) and TMT-B (r GDNF = -0.329, P < 0.01; r HVA = -0.323, P < 0.01) scores. Serum GDNF levels were positively correlated with auditory verbal learning test (AVLT-H) (r = 0.252, P < 0.05) and SFT (r = 0.275, P < 0.05) scores. Serum HVA levels showed a positively correlation with digit span test (DST) (r = 0.277, P < 0.01) scores. Stepwise linear regression analysis suggested that serum GDNF and HVA concentrations and UPDRS-III were the influence factors of TMT-A and TMT-B performances in PD patients. Conclusion The decrease of serum GDNF concentration in PD patients was associated with impaired inhibitory control, cognitive flexibility, and attention performances. The changes of GDNF and HVA might synergistically participate in the occurrence and development of executive dysfunction in PD patients.
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Affiliation(s)
- Shu-Yan Tong
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, General Hospital of Xuzhou Mining Group, Xuzhou, Jiangsu, China
| | - Rui-Wen Wang
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qian Li
- Department of Scientific Research, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Yi Liu
- Department of Cell Biology and Neurobiology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao-Yan Yao
- Department of Neurology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - De-Qin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dian-Shuai Gao
- Department of Cell Biology and Neurobiology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chao Ren
- Department of Neurology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China.,Shandong Provincial Innovation and Practice Base for Postdoctors, Yantai Yuhuangding Hospital, Yantai, Shandong, China.,Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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Pooladgar P, Sakhabakhsh M, Taghva A, Soleiman-Meigooni S. Donepezil Beyond Alzheimer's Disease? A Narrative Review of Therapeutic Potentials of Donepezil in Different Diseases. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2022; 21:e128408. [PMID: 36942075 PMCID: PMC10024338 DOI: 10.5812/ijpr-128408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Donepezil hydrochloride is an acetylcholine esterase inhibitor studied and approved to treat Alzheimer's disease (AD). However, this drug can have positive therapeutic potential in treating different conditions, including various neurodegenerative disorders such as other types of dementia, multiple sclerosis, Parkinson's disease, psychiatric and mood disorders, and even infectious diseases. Hence, this study reviewed the therapeutic potential of this drug in treating Alzheimer's and other diseases by reviewing the articles from databases including Web of Science, Scopus, PubMed, Cochrane, and Science Direct. It was shown that donepezil could affect the pathophysiology of these diseases via mechanisms such as increasing the concentration of acetylcholine, modulating local and systemic inflammatory processes, affecting acetylcholine receptors like nicotinic and muscarinic receptors, and activating various cellular signaling via receptors like sigma-1 receptors. Despite many therapeutic potentials, this drug has not yet been approved for treating non-Alzheimer's diseases, and more comprehensive studies are needed.
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Affiliation(s)
- Parham Pooladgar
- Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Sakhabakhsh
- Head of Department of Neurology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Arsia Taghva
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Moreira-Neto A, Ugrinowitsch C, Coelho DB, de Lima-Pardini AC, Barbosa ER, Teixeira LA, Amaro E, Horak FB, Mancini M, Nucci MP, Silva-Batista C. Freezing of gait, gait initiation, and gait automaticity share a similar neural substrate in Parkinson's disease. Hum Mov Sci 2022; 86:103018. [DOI: 10.1016/j.humov.2022.103018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
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Huang CY, Chen YA, Wu RM, Hwang IS. Dual-task walking improvement with enhanced kinesthetic awareness in Parkinson’s disease with mild gait impairment: EEG connectivity and clinical implication. Front Aging Neurosci 2022; 14:1041378. [DOI: 10.3389/fnagi.2022.1041378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
Due to basal ganglia dysfunction, short step length is a common gait impairment in Parkinson’s disease (PD), especially in a dual-task walking. Here, we use electroencephalography (EEG) functional connectivity to investigate neural mechanisms of a stride awareness strategy that could improve dual-task walking in PD. Eighteen individuals with PD who had mild gait impairment walked at self-paced speed while keeping two interlocking rings from touching each other. During the dual-task walking trial, the participants received or did not receive awareness instruction to take big steps. Gait parameters, ring-touching time, and EEG connectivity in the alpha and beta bands were analyzed. With stride awareness, individuals with PD exhibited greater gait velocity and step length, along with a significantly lower mean EEG connectivity strength in the beta band. The awareness-related changes in the EEG connectivity strength of the beta band positively correlated with the awareness-related changes in gait velocity, cadence, and step length, but negatively correlated with the awareness-related change in step-length variability. The smaller reduction in beta connectivity strength was associated with greater improvement in locomotion control with stride awareness. This study is the first to reveal that a stride awareness strategy modulates the beta band oscillatory network and is related to walking efficacy in individuals with PD in a dual-task condition.
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Vitório R, Morris R, Das J, Walker R, Mancini M, Stuart S. Brain activity response to cues during gait in Parkinson’s disease: A study protocol. PLoS One 2022; 17:e0275894. [PMID: 36395190 PMCID: PMC9671304 DOI: 10.1371/journal.pone.0275894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson’s disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cueing are also unknown. This trial aims to: (i) determine brain activity response to cue stimulus (internal, visual, auditory or tactile) when walking in PD and; (ii) examine changes in brain activity to cues at different stages of PD. This ongoing single-site study uses an exploratory observational design, with laboratory application of cues for gait deficit. A total of 80 people with PD who meet the inclusion criteria will be enrolled. Participants are split into groups dependent on their disease stage (classified with the Hoehn and Yahr (H&Y) scale); n = 20 H&YI; n = 30 H&YII; n = 30 H&YIII. Within the H&Y stage II and III groups, we will also ensure recruitment of a sub-group of 15 individuals with FOG within each group. Participants perform walking tasks under several conditions: baseline walking without cues; randomized cued walking conditions [internal and external (visual, auditory and tactile) cues]. A combined functional near-infrared spectroscopy and electroencephalography system quantifies cortical brain activity while walking. Inertial sensors are used to assess gait. Primary outcome measures are cue-related changes in cortical brain activity while walking, including the relative change in cortical HbO2 and the power spectral densities at alpha (8-13Hz), beta (13-30Hz), delta (0.5-4Hz), theta (4-8Hz) and gamma (30-40Hz) frequency bandwidths. Secondary outcome measures are cue-related changes in spatiotemporal gait characteristics. Findings will enhance our understanding about the cortical responses to different cueing strategies and how they are influenced by PD progression and FOG status. This trial is registered at clinicaltrials.gov (NCT04863560; April 28, 2021, https://clinicaltrials.gov/ct2/show/NCT04863560).
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Affiliation(s)
- Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne, United Kingdom
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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12
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The effect of galvanic vestibular stimulation on postural balance in Parkinson's disease: A systematic review and meta-analysis. J Neurol Sci 2022; 442:120414. [PMID: 36116217 DOI: 10.1016/j.jns.2022.120414] [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: 03/24/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
People with Parkinson's disease (PD) develop postural imbalance and falls. Galvanic Vestibular Stimulation (GVS) may potentially improve postural balance in humans and hence reduce falls in PD. This systematic review and meta-analysis investigate the effects of GVS on postural balance in PD. Six separate databases and research registers were searched for cross-over design trials that evaluated the effects of GVS on postural balance in PD. We used standardized mean difference (Hedges' g) as a measure of effect size in all studies. We screened 223 studies, evaluated 14, of which five qualified for the meta-analysis. Among n = 40 patients in five studies (range n = 5 to 13), using a fixed effects model we found an effect size estimate of g = 0.43 (p < 0.001, 95% CI [0.29,0.57]). However, the test for residual heterogeneity was significant (p < 0.001), thus we used a random effects model and found a pooled effect size estimate of 0.62 (p > 0.05, 95% CI [- 0.17, 1.41], I2 = 96.21%). Egger's test was not significant and thus trim and funnel plot indicated no bias. To reduce heterogeneity, we performed sensitivity analysis and by removing one outlier study (n = 7 patients), we found an effect size estimate of 0.16 (p < 0.05, 95% CI [0.01, 0.31], I2 = 0%). Our meta-analysis found GVS has a favourable effect on postural balance in PD patients, but due to limited literature and inconsistent methodologies, this favourable effect must be interpreted with caution.
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13
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Zhang X, Fan W, Yu H, Li L, Chen Z, Guan Q. Single- and dual-task gait performance and their diagnostic value in early-stage Parkinson's disease. Front Neurol 2022; 13:974985. [PMID: 36313494 PMCID: PMC9615249 DOI: 10.3389/fneur.2022.974985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gait parameters are considered potential diagnostic markers of Parkinson's disease (PD). We aimed to 1) assess the gait impairment in early-stage PD and its related factors in the single-task (ST) and dual-task (DT) walking tests and 2) evaluate and compare the diagnostic value of gait parameters for early-stage PD under ST and DT conditions. Methods A total of 97 early-stage PD patients and 41 healthy controls (HC) were enrolled at Hwa Mei hospital. Gait parameters were gathered and compared between the two groups in the ST and DT walking test, controlling for covariates. Utilizing the receiver operating characteristic curve, diagnostic parameters were investigated. Results In the ST walking test, significantly altered gait patterns could be observed in early-stage PD patients in all domains of gait, except for asymmetry (P < 0.05). Compared to the ST walking test, the early-stage PD group performed poorly in the DT walking test in the pace, rhythm, variability and postural control domain (P < 0.05). Older, heavier subjects, as well as those with lower height, lower level of education and lower gait velocity, were found to have a poorer gait performance (P < 0.05). Stride length (AUC = 0.823, sensitivity, 68.0%; specificity, 85.4%; P < 0.001) and heel strike angle (AUC = 0.796, sensitivity, 71.1%; specificity, 80.5%; P < 0.001) could distinguish early-stage PD patients from HCs with moderate accuracy, independent of covariates. The diagnostic accuracy of gait parameters under ST conditions were statistically noninferior to those under DT conditions(P>0.05). Combining all gait parameters with diagnostic values under ST and DT walking test, the predictive power significantly increased with an AUC of 0.924 (sensitivity, 85.4%; specificity, 92.7%; P < 0.001). Conclusion Gait patterns altered in patients with early-stage PD but the gait symmetry remained preserved. Stride length and heel strike angle were the two most prominent gait parameters of altered gait in early-stage of PD that could serve as diagnostic markers of early-stage PD. Our findings are helpful to understand the gait pattern of early-stage PD and its related factors and can be conducive to the development of new diagnostic tools for early-stage PD.
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Affiliation(s)
| | | | | | | | - Zhaoying Chen
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qiongfeng Guan
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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14
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Kang SH, Kim J, Lee J, Koh SB. Mild cognitive impairment is associated with poor gait performance in patients with Parkinson’s disease. Front Aging Neurosci 2022; 14:1003595. [PMID: 36268193 PMCID: PMC9577227 DOI: 10.3389/fnagi.2022.1003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Cognitive impairment may be commonly accompanied by gait disturbance in patients with Parkinson’s disease (PD). However, it is still controversial whether gait disturbance is associated with mild cognitive impairment (MCI) and which cognitive function has a more important effect on specific gait parameter. Our objective was to investigate the association of gait parameters with MCI and the correlation between performance on comprehensive neuropsychological tests and gait parameters in PD patients. We enrolled 257 patients with de novo PD (111 PD-normal cognition and 146 PD-MCI). All patients underwent comprehensive neuropsychological tests and gait evaluation using the GAITRite system. We used logistic regression analysis and partial correlation to identify the association between gait parameters and MCI and correlations between neuropsychological performance and gait parameters. Gait velocity (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.97−0.99) and stride length (OR = 0.98; 95% CI = 0.97−0.99) were associated with MCI in patients with PD. Specifically, gait velocity, stride length, and double support ratio were only associated with attention and frontal-executive function performance in patients with PD. Our findings provide insight into the relationship between gait disturbance and MCI in patients with PD. Furthermore, the evaluation of gait disturbance is necessary for PD patients with cognitive impairment.
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15
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Ragothaman A, Mancini M, Nutt JG, Fair DA, Miranda-Dominguez O, Horak FB. Resting state functional networks predict different aspects of postural control in Parkinson's disease. Gait Posture 2022; 97:122-129. [PMID: 35931013 DOI: 10.1016/j.gaitpost.2022.07.003] [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: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder causing postural control impairments. Postural control involves multiple domains, such as control of postural sway in stance, automatic postural responses (APRs) and anticipatory postural adjustments (APAs). We hypothesize that impairments in each postural domain is associated with resting-state functional connectivity (rsFC), accounted by predictive modeling and that cortical and cerebellar networks would predict postural control in people with PD (PwPD). OBJECTIVE To determine whether rsFC can predict three domains of postural control independently in PwPD and older adults (OA) based on predictive accuracy of models. METHODS The cohort consisted of 65 PwPD (67.7 +8.1 age) tested in their OFF-state and 42 OA (69.7 +8.2 age). Six body-worn, inertial sensors measured postural sway area while standing on foam, step length of APRs to a backward push-and-release perturbation, and magnitude of lateral APAs prior to voluntary gait initiation. Resting state-fMRI data was reported on 384 regions of interest that were grouped into 13 functional brain networks. Associations between rsFC and postural metrics were characterized using predictive modeling, with an independent training (n = 67) and validation (n = 40) dataset. Models were trained in the training sample and performance of the best model was validated in the independent test dataset. RESULTS rsFC of different brain networks predicted each domain of postural control in PD: Frontoparietal and Ventral Attention rsFC for APAs; Cerebellar-Subcortical and Visual rsFC and Auditory and Cerebellar-Subcortical rsFC for APRs; Ventral Attention and Ventral Multimodal rsFC for postural sway. In OA, CinguloOpercular and Somatomotor rsFC predicted APAs. CONCLUSIONS Our findings suggest that cortical networks predict postural control in PD and there is little overlap in brain network connectivities that predict different domains of postural control, given the rsFC methodology used. PwPD use different cortical networks for APAs compared to OA.
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Affiliation(s)
| | - Martina Mancini
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA; Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain (MIDB), University of Minnesota, Minneapolis, MN 55455, USA; Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN 55455, USA; Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239, USA
| | - Oscar Miranda-Dominguez
- Masonic Institute for the Developing Brain (MIDB), University of Minnesota, Minneapolis, MN 55455, USA; Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Fay B Horak
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA; Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA.
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16
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The Anti-Parkinson Potential of Gingko biloba-Supplement Mitigates Cortico-Cerebellar Degeneration and Neuropathobiological Alterations via Inflammatory and Apoptotic Mediators in Mice. Neurochem Res 2022; 47:2211-2229. [DOI: 10.1007/s11064-022-03600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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17
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Bardakan MM, Fink GR, Zapparoli L, Bottini G, Paulesu E, Weiss PH. Imaging the neural underpinnings of freezing of gait in Parkinson’s disease. NEUROIMAGE: CLINICAL 2022; 35:103123. [PMID: 35917720 PMCID: PMC9421505 DOI: 10.1016/j.nicl.2022.103123] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
Review of recent (after 2012) imaging studies on Parkinsonian freezing of gait. Virtual reality studies report functional decoupling of cortico-striatal circuits. Motor imagery studies reveal increased recruitment of parieto-occipital regions. fNIRS studies converge on reporting higher activity within prefrontal regions. Imaging findings support pathophysiological models of freezing of gait.
Freezing of gait (FoG) is a paroxysmal and sporadic gait impairment that severely affects PD patients’ quality of life. This review summarizes current neuroimaging investigations that characterize the neural underpinnings of FoG in PD. The review presents and discusses the latest advances across multiple methodological domains that shed light on structural correlates, connectivity changes, and activation patterns associated with the different pathophysiological models of FoG in PD. Resting-state fMRI studies mainly report cortico-striatal decoupling and disruptions in connectivity along the dorsal stream of visuomotor processing, thus supporting the ‘interference’ and the ‘perceptual dysfunction’ models of FoG. Task-based MRI studies employing virtual reality and motor imagery paradigms reveal a disruption in functional connectivity between cortical and subcortical regions and an increased recruitment of parieto-occipital regions, thus corroborating the ‘interference’ and ‘perceptual dysfunction’ models of FoG. The main findings of fNIRS studies of actual gait primarily reveal increased recruitment of frontal areas during gait, supporting the ‘executive dysfunction’ model of FoG. Finally, we discuss how identifying the neural substrates of FoG may open new avenues to develop efficient treatment strategies.
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18
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Cholinesterase inhibitors for gait, balance, and fall in Parkinson disease: a meta-analysis. NPJ Parkinsons Dis 2021; 7:103. [PMID: 34824258 PMCID: PMC8617004 DOI: 10.1038/s41531-021-00251-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/04/2021] [Indexed: 11/08/2022] Open
Abstract
Gait disturbance and imbalance are the major symptoms of Parkinson disease (PD), with fall being the most undesirable consequence. However, few effective evidence-based treatments are available for alleviating these symptoms and preventing falls. Cholinesterase inhibitors (ChEIs) are a well-established treatment for PD dementia with possible impacts on gait, balance, and fall reduction. The present study involved a meta-analysis of randomized controlled trials (RCTs) to investigate the effects of ChEIs on gait, balance, and fall in patients with PD. We searched for studies using the PubMed, Embase, and Web of Science databases. The major outcomes were effects on gait parameters, balance, and fall. This study was registered with PROSPERO (CRD42021254733). Five RCTs were included in the present meta-analysis. ChEIs did not significantly increase gait speed in PD patients (mean difference [MD]: 0.03 m/s, 95% confidence interval [CI]: -0.02 to 0.07, p = 0.29). However, ChEI treatment significantly decreased step or stride variability during the single task (standard MD: -0.43, 95% CI = -0.79 to -0.06, p = 0.02). Regarding fall and balance, trending but nonsignificant beneficial effects were observed with ChEI treatment. In conclusion, although ChEI treatment did not significantly improve gait speed and reduce fall, it can significantly reduce step or stride variability. Considering that gait disorder is a challenging issue in patients with PD and that ChEIs are generally tolerable, the present meta-analysis may provide more evidence for the benefit of ChEIs on PD gait disturbance as an alternative treatment consideration.
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19
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Stuart S, Wagner J, Makeig S, Mancini M. Brain Activity Response to Visual Cues for Gait Impairment in Parkinson's Disease: An EEG Study. Neurorehabil Neural Repair 2021; 35:996-1009. [PMID: 34505536 PMCID: PMC8593320 DOI: 10.1177/15459683211041317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background. Gait impairments are common in Parkinson's disease (PD) and increase falls risk. Visual cues can improve gait in PD, particularly freezing of gait (FOG), but mechanisms involved in visual cue response are unknown. This study aimed to examine brain activity in response to visual cues in people with PD who do (PD+FOG) and do not report FOG (PD-FOG) and explore relationships between attention, brain activity and gait. Methods. Mobile EEG measured brain activity during gait in 20 healthy older adults and 43 PD participants (n=22 PD+FOG, n=21 PD-FOG). Participants walked for 2-minutes with and without visual cues (transverse lines to step over). We report power spectral density (PSD) in Delta (1-4 Hz), Theta (4-7 Hz), Alpha (8-12 Hz), Beta (14-24 Hz) and Gamma (30-50 Hz) bands within clusters of similarly brain localized independent component sources. Results. PSDs within the parietal and occipital lobes were altered when walking with visual cues in PD, particularly in PD+FOG. Between group, differences suggested that parietal sources in PD, particularly with PD+FOG, had larger activity compared to healthy older adults when walking. Within group, visual cues altered brain activity in PD, particularly in PD+FOG, within visual processing brain regions. In PD participants, brain activity differences with cues correlated with gait improvements, and in PD+FOG those with worse attention required more visual attentional processing (reduced alpha PSD) in the occipital lobe. Conclusions. Visual cues improve gait and influence brain activity during walking in PD, particularly in PD+FOG. Findings may allow development of more effective therapeutics.
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Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS foundation trust, North Tyneside, UK
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Johanna Wagner
- Swartz Center for Computational Neuroscience, Institute for Neural Computation (INC), University of California San Diego, San Diego, CA, USA
| | - Scott Makeig
- Swartz Center for Computational Neuroscience, Institute for Neural Computation (INC), University of California San Diego, San Diego, CA, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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Pasquini J, Brooks DJ, Pavese N. The Cholinergic Brain in Parkinson's Disease. Mov Disord Clin Pract 2021; 8:1012-1026. [PMID: 34631936 DOI: 10.1002/mdc3.13319] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The central cholinergic system includes the basal forebrain nuclei, mainly projecting to the cortex, the mesopontine tegmental nuclei, mainly projecting to the thalamus and subcortical structures, and other groups of projecting neurons and interneurons. This system regulates many functions of human behavior such as cognition, locomotion, and sleep. In Parkinson's disease (PD), disruption of central cholinergic transmission has been associated with cognitive decline, gait problems, freezing of gait (FOG), falls, REM sleep behavior disorder (RBD), neuropsychiatric manifestations, and olfactory dysfunction. Neuropathological and neuroimaging evidence suggests that basal forebrain pathology occurs simultaneously with nigrostriatal denervation, whereas pathology in the pontine nuclei may occur before the onset of motor symptoms. These studies have also detailed the clinical implications of cholinergic dysfunction in PD. Degeneration of basal forebrain nuclei and consequential cortical cholinergic denervation are associated with and may predict the subsequent development of cognitive decline and neuropsychiatric symptoms. Gait problems, FOG, and falls are associated with a complex dysfunction of both pontine and basal forebrain nuclei. Olfactory impairment is associated with cholinergic denervation of the limbic archicortex, specifically hippocampus and amygdala. Available evidence suggests that cholinergic dysfunction, alongside failure of the dopaminergic and other neurotransmitters systems, contributes to the generation of a specific set of clinical manifestations. Therefore, a "cholinergic phenotype" can be identified in people presenting with cognitive decline, falls, and RBD. In this review, we will summarize the organization of the central cholinergic system and the clinical correlates of cholinergic dysfunction in PD.
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Affiliation(s)
- Jacopo Pasquini
- Department of Pathophysiology and Transplantation University of Milan Milan Italy.,Clinical Ageing Research Unit Newcastle University Newcastle upon Tyne United Kingdom
| | - David J Brooks
- Positron Emission Tomography Centre Newcastle University Newcastle upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
| | - Nicola Pavese
- Clinical Ageing Research Unit Newcastle University Newcastle upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
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21
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Albin RL, Müller MLTM, Bohnen NI, Spino C, Sarter M, Koeppe RA, Szpara A, Kim K, Lustig C, Dauer WT. α4β2 * Nicotinic Cholinergic Receptor Target Engagement in Parkinson Disease Gait-Balance Disorders. Ann Neurol 2021; 90:130-142. [PMID: 33977560 DOI: 10.1002/ana.26102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Attentional deficits following degeneration of brain cholinergic systems contribute to gait-balance deficits in Parkinson disease (PD). As a step toward assessing whether α4β2* nicotinic acetylcholine receptor (nAChR) stimulation improves gait-balance function, we assessed target engagement of the α4β2* nAChR partial agonist varenicline. METHODS Nondemented PD participants with cholinergic deficits were identified with [18 F]fluoroethoxybenzovesamicol positron emission tomography (PET). α4β2* nAChR occupancy after subacute oral varenicline treatment was measured with [18 F]flubatine PET. With a dose selected from the nAChR occupancy experiment, varenicline effects on gait, balance, and cognition were assessed in a double-masked placebo-controlled crossover study. Primary endpoints were normal pace gait speed and a measure of postural stability. RESULTS Varenicline doses (0.25mg per day, 0.25mg twice daily [b.i.d.], 0.5mg b.i.d., and 1.0mg b.i.d.) produced 60 to 70% receptor occupancy. We selected 0.5mg orally b.i.d for the crossover study. Thirty-three participants completed the crossover study with excellent tolerability. Varenicline had no significant impact on the postural stability measure and caused slower normal pace gait speed. Varenicline narrowed the difference in normal pace gait speed between dual task and no dual task gait conditions, reduced dual task cost, and improved sustained attention test performance. We obtained identical conclusions in 28 participants with treatment compliance confirmed by plasma varenicline measurements. INTERPRETATION Varenicline occupied α4β2* nicotinic acetylcholine receptors, was tolerated well, enhanced attention, and altered gait performance. These results are consistent with target engagement. α4β2* agonists may be worth further evaluation for mitigation of gait and balance disorders in PD. ANN NEUROL 2021;90:130-142.
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Affiliation(s)
- Roger L Albin
- Neurology Service and GRECC, VAAAHS, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI.,University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,University of Michigan Parkinson's Foundation Research Center of Excellence, Ann Arbor, MI
| | - Martijn L T M Müller
- University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,University of Michigan Parkinson's Foundation Research Center of Excellence, Ann Arbor, MI.,Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nicolaas I Bohnen
- Neurology Service and GRECC, VAAAHS, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI.,University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,University of Michigan Parkinson's Foundation Research Center of Excellence, Ann Arbor, MI.,Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Cathie Spino
- University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Martin Sarter
- University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Ashley Szpara
- Department of Neurology, University of Michigan, Ann Arbor, MI.,University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI
| | - Kamin Kim
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Cindy Lustig
- University of Michigan Parkinson's Foundation Research Center of Excellence, Ann Arbor, MI.,Department of Psychology, University of Michigan, Ann Arbor, MI
| | - William T Dauer
- Neurology Service and GRECC, VAAAHS, Ann Arbor, MI.,Department of Neurology, University of Michigan, Ann Arbor, MI.,University of Michigan Morris K. Udall Parkinson's Disease Research Center of Excellence, Ann Arbor, MI.,Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX.,Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX.,Peter J. O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX
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22
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Vitorio R, Stuart S, Giritharan A, Quinn J, Nutt JG, Mancini M. Changes in prefrontal cortical activity and turning in response to dopaminergic and cholinergic therapy in Parkinson's disease: A randomized cross-over trial. Parkinsonism Relat Disord 2021; 86:10-14. [PMID: 33813359 DOI: 10.1016/j.parkreldis.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cholinergic dysfunction contributes to mobility deficits in Parkinson's disease (PD). People with PD rely on limited prefrontal executive-attentional resources for the control of locomotion, including turning. Cortical and behavioral responses to cholinergic augmentation during turning remains unclear. We examined prefrontal cortex (PFC) activity while turning-in-place and spatiotemporal measures of turns in response to usual dopaminergic medication and adjunct cholinergic augmentation. METHODS This study consisted of a single-site, randomized, double-blind crossover trial. Twenty PD participants were assessed in the levodopa-off state and then randomized to either levodopa + donepezil (5 mg) or levodopa + placebo treatments for two weeks followed by a 2-week washout before crossover. The primary outcome was change from off state in PFC activity while turning-in-place (assessed with functional near-infrared spectroscopy). Secondary outcomes were changes in spatiotemporal turning measures (assessed with body-worn inertial measurement units) and accuracy in the secondary task. RESULTS Nineteen participants completed the trial. While levodopa + placebo had no effect on PFC activity when turning-in-place with a dual-task, levodopa + donepezil led to a large reduction in PFC activity (effect size, -0.82). Spatiotemporal measures of turning improved with both treatments, with slightly greater effect sizes observed for levodopa + donepezil. Additionally, the accuracy in the concurrent cognitive task improved only with levodopa + donepezil (effect size, 0.63). CONCLUSION The addition of cholinergic therapy with donepezil (5 mg/day for 2 weeks) to standard dopaminergic therapy reduced the burden on prefrontal executive-attentional resources while turning with a dual-task and improved secondary task accuracy and turning.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Andrew Giritharan
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Joseph Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.
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23
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Deficiency of Biogenic Amines Modulates the Activity of Hypoglossal Nerve in the Reserpine Model of Parkinson's Disease. Cells 2021; 10:cells10030531. [PMID: 33801475 PMCID: PMC8001069 DOI: 10.3390/cells10030531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
The underlying cause of respiratory impairments appearing in Parkinson's disease (PD) is still far from being elucidated. To better understand the pathogenesis of respiratory disorders appearing in PD, we studied hypoglossal (HG) and phrenic (PHR) motoneuron dysfunction in a rat model evoked with reserpine administration. After reserpine, a decrease in the baseline amplitude and minute HG activity was noted, and no depressive phase of the hypoxic ventilatory response was observed. The pre-inspiratory time of HG activity along with the ratio of pre-inspiratory time to total respiratory cycle time and the ratio of pre-inspiratory to inspiratory amplitude were significantly reduced during normoxia, hypoxia, and recovery compared to sham rats. We suggest that the massive depletion of not only dopamine, but above all noradrenaline and serotonin in the brainstem observed in our study, has an impact on the pre-inspiratory activity of the HG. The shortening of the pre-inspiratory activity of the HG in the reserpine model may indicate a serious problem with maintaining the correct diameter of the upper airways in the preparation phase for inspiratory effort and explain the development of obstructive sleep apnea in some PD patients. Therapies involving the supplementation of amine depletion other than dopamine should be considered.
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24
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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25
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Ranchet M, Hoang I, Cheminon M, Derollepot R, Devos H, Perrey S, Luauté J, Danaila T, Paire-Ficout L. Changes in Prefrontal Cortical Activity During Walking and Cognitive Functions Among Patients With Parkinson's Disease. Front Neurol 2020; 11:601686. [PMID: 33362703 PMCID: PMC7758480 DOI: 10.3389/fneur.2020.601686] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Walking becomes more and more degraded as Parkinson's Disease (PD) progresses. Previous research examined factors contributing to this deterioration. Among them, changes in brain cortical activity during walking have been less studied in this clinical population. Objectives: This study aimed to: (1) investigate changes in dorsolateral prefrontal cortex (DLPFC) activation during usual walking and dual-task walking conditions in patients with PD; (2) examine the association between cortical activity and behavioral/cognitive outcomes; and (3) explore which factors best predict increased activation of the DLPFC during usual walking. Methods: Eighteen patients with early stage PD and 18 controls performed 4 conditions: (1) standing while subtracting, (2) usual walking, (3) walking while counting forward, and (4) walking while subtracting. Cortical activity in DLPFC, assessed by changes in oxy-hemoglobin (ΔHbO2) and deoxy-hemoglobin (ΔHbR), was measured using functional near infrared spectroscopy (fNIRS). Gait performance was recorded using wearables sensors. Cognition was also assessed using neuropsychological tests, including the Trail Making Test (TMT). Results: DLPFC activity was higher in patients compared to controls during both usual walking and walking while subtracting conditions. Patients had impaired walking performance compared to controls only during walking while subtracting task. Moderate-to-strong correlations between ΔHbO2 and coefficients of variation of all gait parameters were found for usual walking and during walking while counting forward conditions. Part-B of TMT predicted 21% of the variance of ΔHbO2 during usual walking after adjustment for group status. Conclusions: The increased DLPFC activity in patients during usual walking suggests a potential compensation for executive deficits. Understanding changes in DLPFC activity during walking may have implications for rehabilitation of gait in patients with PD.
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Affiliation(s)
- Maud Ranchet
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Isabelle Hoang
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Maxime Cheminon
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France
| | | | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Stephane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mînes Ales, Montpellier, France
| | - Jacques Luauté
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France.,Inserm UMR-S 1028, CNRS UMR 529, ImpAct, Center de Recherche en Neurosciences de Lyon, Université Lyon-1, Bron, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Teodor Danaila
- Center de Neurosciences Cognitives, Service de Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
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