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Masaki M, Takeuchi M, Kasahara M, Minakawa K, Inagaki Y, Ogawa Y, Sato Y, Yokota M, Maruyama S, Obinata S. Association of activities of daily living, mobility and balance ability, and symptoms of Parkinson's disease with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with Parkinson's disease. J Med Ultrason (2001) 2023; 50:551-560. [PMID: 37646863 DOI: 10.1007/s10396-023-01356-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We examined the association of activities of daily living (ADL), mobility and balance ability, and symptoms of Parkinson's disease (PD) with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with PD. METHODS The subjects were 11 community-dwelling patients with PD. ADL were assessed using the Functional Independence Measure. Mobility capacity was assessed based on measurement of maximal walking speed and timed up-and-go time, while balance ability was evaluated based on measurement of one-legged stance time. The symptoms of PD were assessed based on measurement of the Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale. Muscle thickness (MT) and echo intensity (EI) of the trunk and lower extremity muscles were also measured using an ultrasound imaging device. RESULTS Partial correlation analysis revealed an association between reduced ADL and increased EI of the lumbar erector spinae muscle; reduced mobility capacity and increased EI of the rectus abdominis and gluteus minimus muscles; and reduced balance ability and decreased MT of the lumbar erector spinae muscle and increased EI of the lumbar erector spinae, semitendinosus, and tibialis posterior muscles. Partial correlation analysis also showed an association between symptoms of severe PD and decreased MT of the tibialis anterior muscles and increased EI of the lumbar erector spinae, gluteus minimus, and tibialis posterior muscles. CONCLUSION The properties of the trunk and lower extremity muscles may be critical for ADL, mobility and balance ability, and symptoms of PD in patients with PD.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, 501 Nakaorui-machi, Takasaki, Gunma, 370-0033, Japan.
| | - Moeka Takeuchi
- Department of Rehabilitation, Iwamuro Rehabilitation Hospital, 772-1 Iwamuronsen, Nishikan-ku, Niigata, Niigata, 953-0104, Japan
| | - Maki Kasahara
- Department of Rehabilitation, Tsunoda Hospital, 675-4 Kamishinden, Tamamura-machi, Sawagun, Gunma, 370-1133, Japan
| | - Kota Minakawa
- Tsutsumi Orthopaedic Clinic, 3-8-24 Terauchidonosawa, Akita, Akita, 011-0901, Japan
| | - Yukika Inagaki
- Department of Rehabilitation, Sawarabi Medical Welfare Center, 168-1 Oyagi-machi, Takasaki, Gunma, 370-0072, Japan
| | - Yukine Ogawa
- Department of Rehabilitation, Sannocho Hospital, 5-2-30 Hon-cho, Sanjo, Niigata, 955-0071, Japan
| | - Yoshino Sato
- Suzuki Otolaryngology Clinic, 6-5-37 Meike, Chuo-ku, Niigata, Niigata, 950-0941, Japan
| | - Minori Yokota
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamaga-machi, Aizuwakamatsu, Fukushima, 965-8585, Japan
| | - Seina Maruyama
- Piapupu Sports, 2-11-18 Dekijima, Chuo-ku, Niigata, Niigata, 950-0962, Japan
| | - Shunsuke Obinata
- Department of Rehabilitation, National Hospital Organization Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-ku, Niigata, Niigata, 950-2085, Japan
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Zhu CW, Gu Y, Kociolek AJ, Fernandez KK, Cosentino S, Stern Y. Costs During the Last Five Years of Life for Patients with Clinical and Pathological Confirmed Diagnosis of Lewy Body Dementia and Alzheimer's Disease. J Alzheimers Dis 2023; 92:457-466. [PMID: 36776064 PMCID: PMC10120914 DOI: 10.3233/jad-221021] [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: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life. OBJECTIVE This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed diagnosis. METHODS The study included 58 participants clinically diagnosed with mild dementia at study entry (AD: n = 44, DLB: n = 14) and also had autopsy-confirmed diagnoses of pure AD (n = 32), mixed AD+Lewy body (LB) (n = 5), or pure LB (n = 11). Total Medicare expenditures were compared by clinical and pathology confirmed diagnosis, adjusting for sex, age at death, and patient's cognition, function, comorbidities, and psychiatric and extrapyramidal symptoms. RESULTS When pathology diagnoses were not considered, predicted annualized total Medicare expenditures during the last 5 years of life were similar between clinically diagnosed AD ($7,465±1,098) and DLB ($7,783±1,803). When clinical diagnoses were not considered, predicted expenditures were substantially higher in patients with pathology confirmed mixed AD+LB ($12,005±2,455) than either pure AD ($6,173±941) or pure LB ($4,629±1,968) cases. Considering clinical and pathology diagnosis together, expenditures for patients with clinical DLB and pathology mixed AD+LB ($23,592±3,679) dwarfed other groups. CONCLUSION Medicare expenditures during the last 5 years of life were substantially higher in patients with mixed AD+LB pathology compared to those with pure-AD and pure-LB pathologies, particularly in those clinically diagnosed with DLB. Results highlight the importance of having both clinical and pathology diagnoses in examining healthcare costs.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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Masaki M, Kasahara M, Takeuchi M, Minakawa K, Inagaki Y, Ogawa Y, Sato Y, Yokota M, Maruyama S, Usuki R, Azuma S, Obinata S. Comparison of the mass and amount of intramuscular non-contractile tissue of the trunk and lower extremity muscles between patients with Parkinson’s disease and community-dwelling older adults. Neurol Sci 2022; 43:3629-3640. [DOI: 10.1007/s10072-021-05828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
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Gu Y, Kociolek A, Fernandez KK, Cosentino SA, Zhu CW, Jin Z, Leverenz JB, Stern YB. Clinical Trajectories at the End of Life in Autopsy-Confirmed Dementia Patients With Alzheimer Disease and Lewy Bodies Pathologies. Neurology 2022; 98:e2140-e2149. [PMID: 35379761 PMCID: PMC9169937 DOI: 10.1212/wnl.0000000000200259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, health care decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the 2 most common dementias: Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Using autopsy-confirmed diagnoses, we aimed to examine the disease trajectories in the years before death among patients with dementia with pure AD, pure DLB, or mixed (AD and DLB) pathologies. METHODS The current retrospective longitudinal study included 62 participants with autopsy-confirmed diagnoses of pure AD (n = 34), mixed AD and DLB (AD + DLB; n = 17), or pure DLB (n = 11) from the Predictors 2 Cohort Study, a prospective, clinic-based, cohort of patients with dementia. Generalized estimating equation models, with time zero at death, were used to examine the trajectory of cognition (Folstein Mini-Mental State Examination [MMSE]), function (activities of daily living [ADL]), and Dependence Scale among patients with different autopsy-confirmed diagnosis (pure AD, AD + DLB, and pure DLB). The models were adjusted for age, sex, education, and baseline features including extrapyramidal signs, MMSE, ADL, and Dependence Scale. RESULTS The participants on average received 9.4 ± 4.6 assessments at 6-month intervals during a mean 5.4 ± 2.9 years of follow-up. The 3 groups were similar in both cognition and function status at baseline. Cognition and function were highly correlated among patients with AD + DLB but not in pure AD or pure DLB at baseline. Patients of the 3 groups all declined in both cognition and function but had different trajectories of decline. More specifically, the patients with pure DLB experienced approximately double the rate of both cognitive decline and functional decline than the patients with pure AD, and the mixed pathology group showed double the rate of functional decline as compared to pure AD. DISCUSSION In this longitudinal study, we found that among patients with dementia, those with Lewy body pathology experienced faster cognitive and functional decline than those with pure AD pathology.
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Affiliation(s)
- Yian Gu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH.
| | - Anton Kociolek
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Kayri K Fernandez
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Stephanie A Cosentino
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Carolyn Wei Zhu
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Zhezhen Jin
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - James B Leverenz
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
| | - Yaakov B Stern
- From the Department of Neurology (Y.G., S.A.C., Y.B.S.), Taub Institute for Research in Alzheimer's Disease and the Aging (Y.G., A.K., K.K.F., S.A.C., Y.B.S.), and Gertrude H. Sergievsky Center (Y.G., S.A.C., Y.B.S.), Columbia University Irving Medical Center; Departments of Epidemiology (Y.G.) and Biostatistics (Z.J.), Columbia University Mailman School of Public Health; Department of Geriatrics and Palliative Care (C.W.Z.), Icahn School of Medicine at Mount Sinai, New York; Geriatrics Research, Education, and Clinical Center (GRECC) (C.W.Z.), James J Peters VA Medical Center, Bronx, NY; and Cleveland Lou Ruvo Center for Brain Health (J.B.L.), Cleveland Clinic, OH
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Kashif M, Ahmad A, Bandpei MAM, Gilani SA, Hanif A, Iram H. Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkinson's disease: a randomized controlled trial. BMC Geriatr 2022; 22:381. [PMID: 35488213 PMCID: PMC9055773 DOI: 10.1186/s12877-022-03035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder, impairing balance and motor function. Virtual reality (VR) and motor imagery (MI) are emerging techniques for rehabilitating people with PD. VR and MI combination have not been studied in PD patients. This study was conducted to investigate the combined effects of VR and MI techniques on the balance, motor function, and activities of daily living (ADLs) of patients with PD. Methods This study was a single-centered, two-armed, parallel-designed randomized controlled trial. A total of 44 patients of either gender who had idiopathic PD were randomly allocated into two groups using lottery methods. Both groups received Physical therapy (PT) treatment, while the experimental group (N: 20) received VR and MI in addition to PT. Both groups received assigned treatment for three days a week on alternate days for 12 weeks. The Unified Parkinson’s Disease Rating Scale (UPDRS) (parts II and III), Berg Balance Scale (BBS), and Activities-specific Balance Confidence (ABC) Scale were used as outcome measures for motor function, balance, and ADLs. The baseline, 6th, and 12th weeks of treatment were assessed, with a 16th week follow-up to measure retention. The data was analysed using SPSS 24. Results The experimental group showed significant improvement in motor function than the control group on the UPDRS part III, with 32.45±3.98 vs. 31.86±4.62 before and 15.05±7.16 vs. 25.52±7.36 at 12-weeks, and a p-value < 0.001. At 12 weeks, the experimental group's BBS scores improved from 38.95±3.23 to 51.36±2.83, with p-value < 0.001. At 12 weeks, the experimental group's balance confidence improved considerably, from 59.26±5.87to 81.01±6.14, with a p-value of < 0.001. The experimental group's ADL scores improved as well, going from 22.00±4.64 to 13.07±4.005 after 12 weeks, with a p-value of < 0.001. Conclusion VR with MI techniques in addition to routine PT significantly improved motor function, balance, and ADLs in PD patients compared to PT alone. Trial registration IRCT20200221046567N1. Date of registration: 01/04/2020
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Affiliation(s)
- Muhammad Kashif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, 1 KM Defence Road, Lahore, 4200, Pakistan. .,Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan.
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, 1 KM Defence Road, Lahore, 4200, Pakistan
| | - Muhammad Ali Mohseni Bandpei
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, 1 KM Defence Road, Lahore, 4200, Pakistan
| | - Syed Amir Gilani
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, 1 KM Defence Road, Lahore, 4200, Pakistan
| | - Asif Hanif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, 1 KM Defence Road, Lahore, 4200, Pakistan
| | - Humaira Iram
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Faisalabad Campus, Faisalabad, Pakistan
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Ma R, Hou Y, Zhang Y, He M, Gao S, Kaudimba KK, Lin K, Jin L, Liu T, Wang R. The Efficacy of Tai Chi and Stretching Exercises Based on a Smartphone Application for Patients With Parkinson's Disease: A Protocol for a Randomized Controlled Trial. Front Neurol 2021; 12:731606. [PMID: 34777200 PMCID: PMC8581180 DOI: 10.3389/fneur.2021.731606] [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: 06/27/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction: Parkinson's disease (PD) is a common neurodegenerative disease that seriously impairs patients' quality of life, and increases the burden of patients and caregivers. Both drugs and exercise can alleviate its motor and non-motor symptoms, improving the quality of life for PD patients. Telehealth, an increasingly popular tool, makes rehabilitation accessible at home, overcoming the inconvenience of traffic and scheduling. Care-PD is a phone application designed for rehabilitation training, which provides Tai Chi and stretching exercises through tutorial videos as well as an online evaluation system. In this protocol, we will explore the efficacy of Tai Chi and stretching exercises as a PD rehabilitation therapy based on the smartphone application Care-PD. Methods and Analysis: A double-blind, parallel randomized controlled trial will be conducted in this study. The recruitment, intervention, and evaluation processes will be implemented through the Care-PD application. Persons with PD will fill out questionnaires on Activities of Daily Living (ADL), upload the latest case report, and sign the informed consent form in the application. Afterward, doctors and researchers will screen and enroll 180 participants who will be randomly (1:1:1) assigned to Tai Chi group, stretching exercises group, or control group. The subjects will participate in a 1-h exercise session three times per week for 12 weeks, ending with another 4 weeks of follow-up study. Each exercise session includes 10 min of warm-up, 45 min of exercise, and 5 min of cool-down. The primary outcomes are Motor Aspects of Experiences of Daily Living and the 39-item Parkinson's disease Questionnaire. The secondary outcomes include the 9-item Wearing-Off Questionnaire, the Freezing of Gait Questionnaire, the Caregiver Strain Index, Non-motor Experiences of Daily Living, ADL, and Morse Fall Scale. All assessments will be performed at baseline, week 12 and 16. Discussion: Care-PD integrates subject recruitment, intervention, and evaluation, providing a new perspective on clinical rehabilitation for persons with PD. This study will evaluate the efficacy of Tai Chi and stretching exercises on patients' quality of life and disease progression based on a smartphone application. We aim to provide a new rehabilitation training platform for persons with PD. Ethics and Dissemination: This study was approved by the Scientific Research Ethics Committee (102772020RT132) of Shanghai University of Sport. Data collection begins after the approval of the ethics committee. The participants must sign an informed consent form before enrollment. The results will be published in relevant journals, seminars, and be disseminated among rehabilitation practitioners and patients with PD. Clinical Trial Registration: Chinese Clinical Trial Registry, identifier [ChiCTR2100042096]. Registered on January 13, 2021.
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Affiliation(s)
- Renyan Ma
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yuning Hou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yiyin Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Muyang He
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Song Gao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | | | - Kaiqing Lin
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Lingjing Jin
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Tiemin Liu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Ru Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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Kociolek AJ, Fernandez KK, Jin Z, Cosentino S, Zhu CW, Gu Y, Stern Y. Extrapyramidal signs and Alzheimer's disease prognosis in a multiethnic, community-based sample of demented elders. Alzheimers Dement 2021; 17:1465-1473. [PMID: 33710771 DOI: 10.1002/alz.12309] [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: 09/09/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations. METHODS One hundred and forty-two multiethnic community-dwelling participants with dementia were selected. Adjusted Cox models were fitted for mortality, cognitive (Mini Mental State Examination ≤10), functional (Blessed Dementia Rating Scale ≥10), and dependency (needs full-time care) endpoints with baseline EPS as predictor. RESULTS Thirty-seven participants (26.06%) had EPS at baseline. EPS predicted more rapid time to death (hazard ratio [HR] = 2.76, 95% confidence interval [CI] = 1.49, 5.42), and functional endpoint (HR = 3.88, 95% CI = 1.75, 8.62) but not cognitive and dependency endpoints. No evidence of interaction by ethnicity, age, sex, education, or apolipoprotein E ε4 polymorphism was found. DISCUSSION Our results partially confirm previous studies on predominantly White, clinic-based samples. Further research is needed to better understand the etiological role of EPS in AD.
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Affiliation(s)
- Anton J Kociolek
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kayri K Fernandez
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yian Gu
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective. World Neurosurg 2020; 139:549-557. [PMID: 32426065 PMCID: PMC7229725 DOI: 10.1016/j.wneu.2020.05.066] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022]
Abstract
Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.
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Taghizadeh G, Martinez-Martin P, Meimandi M, Habibi SAH, Jamali S, Dehmiyani A, Rostami S, Mahmuodi A, Mehdizadeh M, Fereshtehnejad SM. Barthel Index and modified Rankin Scale: Psychometric properties during medication phases in idiopathic Parkinson disease. Ann Phys Rehabil Med 2019; 63:500-504. [PMID: 31816448 DOI: 10.1016/j.rehab.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/04/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. OBJECTIVE This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. METHODS We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test-retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. RESULTS For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test-retest and inter-rater reliability (ICC=0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ=0.51-0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ=0.48-0.82). CONCLUSION The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases.
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Affiliation(s)
- Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Mahsa Meimandi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Sayed Amir Hasan Habibi
- Department of Neurology, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Shamsi Jamali
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Arian Dehmiyani
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Siavash Rostami
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | - Alieh Mahmuodi
- Department of Aging, University of Social Welfare Rehabilitation Sciences, Tehran, Iran
| | - Maryam Mehdizadeh
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Division of Neurology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Ishikuro K, Dougu N, Nukui T, Yamamoto M, Nakatsuji Y, Kuroda S, Matsushita I, Nishimaru H, Araujo MFP, Nishijo H. Effects of Transcranial Direct Current Stimulation (tDCS) Over the Frontal Polar Area on Motor and Executive Functions in Parkinson's Disease; A Pilot Study. Front Aging Neurosci 2018; 10:231. [PMID: 30104971 PMCID: PMC6077209 DOI: 10.3389/fnagi.2018.00231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder with motor and non-motor symptoms due to degeneration of dopaminergic neurons. The current pharmacological treatments induce complications associated with long-term use. However, current stimulation techniques for PD treatment, such as deep brain stimulation (DBS), are too invasive. In this context, non-invasive brain stimulation including transcranial direct current stimulation (tDCS) may be a safe and effective alternative treatment for PD. We previously reported that anodal tDCS over the frontal polar area (FPA) improved motor functions in heathy subjects. Therefore, in the present study, effects of tDCS over the FPA on motor and cognitive functions of PD patients were analyzed. Nine PD patients (3 men and 6 women) participated in this cross over study with three tDCS protocols; anodal, cathodal or sham tDCS over the FPA. Each tDCS protocol was applied for 1 week (5 times/week). Before and after each protocol, motor and cognitive functions of the patients were assessed using Unified PD Rating Scale [UPDRS (part III: motor examination)], Fugl Meyer Assessment set (FMA), Simple Test for Evaluating hand Function (STEF) and Trail Making Test A (TMT-A). The results indicated that anodal stimulation significantly decreased scores of motor disability in UPDRS-III compared with sham and cathodal stimulation, and significantly increased scores of motor functions in FMA compared with sham stimulation. Furthermore, anodal stimulation significantly decreased time to complete a motor task requiring high dexterity in STEF compared with those requiring low and medium levels of dexterity. In addition, anodal stimulation significantly decreased time to complete the TMT-A task, which requires executive functions, compared with sham stimulation. To the best of our knowledge, this is the first clinical research reporting that tDCS over the FPA successfully improved the motor and non-motor functions in PD patients. These findings suggest that tDCS over the FPA might be a useful alternative for the treatment of PD patients.
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Affiliation(s)
- Koji Ishikuro
- Rehabilitation Department, Toyama University Hospital, Toyama, Japan
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Nobuhiro Dougu
- Department of Neuropathic Internal Medicine Neurology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Takamasa Nukui
- Department of Neuropathic Internal Medicine Neurology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mamoru Yamamoto
- Department of Neuropathic Internal Medicine Neurology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yuji Nakatsuji
- Department of Neuropathic Internal Medicine Neurology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Isao Matsushita
- Rehabilitation Department, Toyama University Hospital, Toyama, Japan
| | - Hiroshi Nishimaru
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mariana F. P. Araujo
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Löfgren N, Benka Wallén M, Sorjonen K, Conradsson D, Franzén E. Investigating the Mini-BESTest's construct validity in elderly with Parkinson's disease. Acta Neurol Scand 2017; 135:614-621. [PMID: 27417912 DOI: 10.1111/ane.12640] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Mini-BESTest consists of items relevant to balance deficiencies among people with Parkinson's disease (PwPD). However, the Mini-BESTest's construct validity has been sparsely evaluated in this population. We therefore aimed to investigate the hypotheses that the Mini-BESTest results would be worse among: (i) PwPD compared to healthy controls; (ii) PwPD with moderate compared to mild motor severity; (iii) PwPD with a history of recurrent compared to non-recurrent falls. Moreover, the relationship between the Mini-BESTest and tests of similar and different constructs was expected to be moderate to strong and poor, respectively. MATERIALS AND METHODS One hundred and five PwPD with mild-to-moderate motor severity and 47 healthy controls were included. PwPD were divided into subgroups based on motor severity and fall history. Main outcome measures were the Mini-BESTest, the timed up and go (TUG), and the original Unified Parkinson's Disease Rating Scale, part II (Activities of Daily Living). Independent t-tests and Spearman's rho were used for the analyses. RESULTS The Mini-BESTest results were worse among PwPD compared to controls (P<.001), and among people with moderate motor severity compared to those with mild severity (P<.001). However, no differences were found between recurrent and non-recurrent fallers (P=.096). Spearman's rho showed moderate (ρ=-.470) and poor correlations (ρ=-.211) for convergent (TUG) and divergent validity (UPDRS, part II), respectively. CONCLUSIONS Overall, the Mini-BESTest appears to adequately measure dynamic balance among PwPD with mild-to-moderate severity, although it was unable to distinguish between recurrent and non-recurrent fallers.
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Affiliation(s)
- N. Löfgren
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - M. Benka Wallén
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - K. Sorjonen
- Division of Psychology; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - D. Conradsson
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Functional Area Occupational Therapy & Physiotherapy; Allied Health Professionals Function; Karolinska University Hospital; Stockholm Sweden
| | - E. Franzén
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Functional Area Occupational Therapy & Physiotherapy; Allied Health Professionals Function; Karolinska University Hospital; Stockholm Sweden
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12
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Autonomic and electrocardiographic findings in Parkinson's disease. Auton Neurosci 2017; 205:93-98. [PMID: 28506500 DOI: 10.1016/j.autneu.2017.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 11/22/2022]
Abstract
Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms and signs. Many reports suggest that diminished heart rate variability occurs early, even prior to the cardinal signs of PD. In a longitudinal study of PD, we evaluated whether heart rate variability (HRV) obtained using a 10-second ECG tracing, and the electrocardiographic QT-interval would be associated with PD severity and progression. Subjects were derived from a longitudinal study of 1741 individuals with early, stable PD. The severity of PD was measured using the global statistical test (GST). In a subset, the heart rate corrected QT-interval (QTcB) was calculated for each electrocardiogram (ECG). The HRV was measured for each ECG and then transformed to fit a normal distribution. The baseline analysis included 653 subjects, with 256 completing the 5-year follow up study. There was an association (P<0.05) between QTcB and PD severity in individuals that were taking QT-interval affecting drugs. A longer QT-interval at baseline was associated with more advanced PD at 5years (P<0.05), and greater disease progression over 5years (P<0.05). There was an association between diminished HRV and an orthostatic decrease in standing blood pressure at baseline in individuals with PD (P<0.05). HRV was not associated with PD severity or progression. In conclusion, we were able to detect measurable associations between the QTcB interval and PD severity, PD severity 5years later, and the change in disease over time. However, routine ECG tracings appear inadequate for the evaluation of autonomic function in PD.
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Stern Y, Gu Y, Cosentino S, Azar M, Lawless S, Tatarina O. The Predictors study: Development and baseline characteristics of the Predictors 3 cohort. Alzheimers Dement 2017; 13:20-27. [PMID: 27219818 PMCID: PMC5118195 DOI: 10.1016/j.jalz.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/18/2016] [Accepted: 04/09/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Predictors study was designed to predict the length of time to major disease outcomes in Alzheimer's disease (AD) patients. Here, we describe the development of a new, Predictors 3, cohort. METHODS Patients with prevalent or incident AD and individuals at-risk for developing AD were selected from the North Manhattan community and followed annually with instruments comparable to those used in the original two Predictors cohorts. RESULTS The original Predictors cohorts were clinic based and racially/ethnically homogenous (94% white, 6% black; 3% Hispanic). In contrast, the 274 elders in this cohort are community-based and ethnically diverse (39% white, 40% black, 21% other; 78% Hispanic). Confirming previous observations, psychotic features were associated with poorer function and mental status and extrapyramidal signs with poorer function. DISCUSSION This new cohort will allow us to test observations made in our original clinic-based cohorts in patients that may be more representative of the general community.
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Affiliation(s)
- Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oksana Tatarina
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Shulman LM, Armstrong M, Ellis T, Gruber-Baldini A, Horak F, Nieuwboer A, Parashos S, Post B, Rogers M, Siderowf A, Goetz CG, Schrag A, Stebbins GT, Martinez-Martin P. Disability Rating Scales in Parkinson's Disease: Critique and Recommendations. Mov Disord 2016; 31:1455-1465. [DOI: 10.1002/mds.26649] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lisa M. Shulman
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Melissa Armstrong
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Terry Ellis
- Department of Physical Therapy & Athletic Training; Boston University; Boston Massachusetts USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Fay Horak
- Department of Neurology; Oregon Health and Science University and Portland VA Medical System; Portland Oregon USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science; KU Leuven-University of Leuven; Heverlee Belgium
| | | | - Bart Post
- Department of Neurology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mark Rogers
- Department of Physical Therapy & Rehabilitation; University of Maryland School of Medicine; Baltimore Maryland USA
| | | | | | - Anette Schrag
- UCL Institute of Neurology; University College London; UK
| | - Glenn T. Stebbins
- Department of Neurology; Rush University Medical Center; Chicago USA
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED; Carlos III Institute of Health; Madrid Spain
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Martínez-Martín P, Rojo-Abuin JM, Rodríguez-Violante M, Serrano-Dueñas M, Garretto N, Martínez-Castrillo JC, Arillo VC, Fernández W, Chaná-Cuevas P, Arakaki T, Alvarez M, Ibañez IP, Rodríguez-Blázquez C, Chaudhuri KR, Merello M. Analysis of four scales for global severity evaluation in Parkinson's disease. NPJ PARKINSONS DISEASE 2016; 2:16007. [PMID: 28725695 PMCID: PMC5516587 DOI: 10.1038/npjparkd.2016.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 01/01/2023]
Abstract
Global evaluations of Parkinson’s disease (PD) severity are available, but their concordance and accuracy have not been previously tested. The present international, cross-sectional study was aimed at determining the agreement level among four global scales for PD (Hoehn and Yahr, HY; Clinical Global Impression of Severity, CGIS; Clinical Impression of Severity Index, CISI-PD; and Patient Global Impression of Severity, PGIS) and identifying which of them better correlates with itemized PD assessments. Assessments included additional scales for evaluation of the movement impairment, disability, affective disorders, and quality of life. Spearman correlation coefficients, weighted and generalized kappa, and Kendall’s concordance coefficient were used. Four hundred thirty three PD patients, 66% in HY stages 2 or 3, mean disease duration 8.8 years, were analyzed. Correlation between the global scales ranged from 0.60 (HY with PGIS) to 0.91 (CGIS with CISI-PD). Kendall’s coefficient of concordance resulted 0.76 (P<0.0001). HY and CISI-PD showed the highest association with age, disease duration, and levodopa-equivalent daily dose, and CISI-PD with measures of PD manifestations, disability, and quality of life. PGIS and CISI-PD correlated similarly with anxiety and depression scores. The lowest agreement in classifying patients as mild, moderate, or severe was observed between PGIS and HY or CISI-PD (58%) and the highest between CGIS and CISI-PD (84.3%). The four PD global severity scales agree moderately to strongly among them; clinician-based ratings estimate PD severity, as established by other measures, better than PGIS; and the CISI-PD showed the highest association with measures of impairment, disability, and quality of life.
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Affiliation(s)
- Pablo Martínez-Martín
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Jose Manuel Rojo-Abuin
- Department of Statistics, Centre of Human and Social Sciences, Spanish Council for Scientific Research, Madrid, Spain
| | | | - Marcos Serrano-Dueñas
- Movement Disorder and Biostatistics Units, Neurological Service, Carlos Andrade Marín Hospital and Medicine Faculty, Pontifical Catholic University of Ecuador, Quito, Ecuador
| | - Nélida Garretto
- Department of Neurology, Hospital Ramos Mejia, Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | | | - Víctor Campos Arillo
- Movement Disorders Unit, Department of Neuroscience, Hospital Xanit International, Benalmádena (Málaga), Spain
| | - William Fernández
- Movement Disorders Unit, Department of Neurology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Pedro Chaná-Cuevas
- CETRAM, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
| | - Tomoko Arakaki
- Department of Neurology, Hospital Ramos Mejia, Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Mario Alvarez
- Department of Movement Disorders and Neurodegeneration, CIREN, La Habana, Havana, Cuba
| | - Ivonne Pedroso Ibañez
- Department of Movement Disorders and Neurodegeneration, CIREN, La Habana, Havana, Cuba
| | | | - Kallol Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, King's College, London, UK
| | - Marcelo Merello
- Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Murray LL, Rutledge S. Reading comprehension in Parkinson's disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:S246-S258. [PMID: 24686432 DOI: 10.1044/2014_ajslp-13-0087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results. METHOD Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning. RESULT The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group. CONCLUSION Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.
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Tanner CM, Meng CC, Ravina B, Lang A, Kurlan R, Marek K, Oakes D, Seibyl J, Flagg E, Gauger L, Guest DD, Goetz CG, Kieburtz K, DiEuliis D, Fahn S, Elliott RA, Shoulson I. A practical approach to remote longitudinal follow-up of Parkinson's disease: the FOUND study. Mov Disord 2014; 29:743-9. [PMID: 24515275 DOI: 10.1002/mds.25814] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/24/2013] [Accepted: 12/30/2013] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to examine a remote method for maintaining long-term contact with Parkinson's disease (PD) patients participating in clinical studies. Long-term follow-up of PD patients is needed to fill critical information gaps on progression, biomarkers, and treatment. Prospective in-person assessment can be costly and may be impossible for some patients. Remote assessment using mail and telephone contact may be a practical follow-up method. Patients enrolled in the multi-center Longitudinal and Biomarker Study in Parkinson's Disease (LABS-PD) in-person follow-up study in 2006 were invited to enroll in Follow-up of Persons With Neurologic Diseases (FOUND), which is overseen by a single center under a separate, central institutional review board protocol. FOUND uses mailed questionnaires and telephone interviews to assess PD status. FOUND follow-up continued when LABS-PD in-person visits ended in 2011. Retention and agreement between remote and in-person assessments were determined. In total, 422 of 499 (84.5%) of eligible patients volunteered, AND 96% of participants were retained. Of 60 patients who withdrew consent from LABS-PD, 51 were retained in FOUND. Of 341 patients who were active in LABS-PD, 340 were retained in FOUND (99.7%) when the in-person visits ceased. Exact agreement between remote and in-person assessments was ≥ 80% for diagnosis, disease features (eg, dyskinesias), and PD medication. Correlation between expert-rated and self-reported Unified Parkinson's Disease Rating Scale and Movement Disorder Society Unified Parkinson's Disease Rating Scale, which were examined at times separated by several months, was moderate or substantial for most items. Retention was excellent using remote follow-up of research participants with PD, providing a safety net when combined with in-person visits, and also is effective as a stand-alone assessment method, providing a useful alternative when in-person evaluation is not feasible.
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Affiliation(s)
- Caroline M Tanner
- Clinical Research, The Parkinson's Institute, Sunnyvale, California, USA; Department of Health Research and Policy, Stanford University, Palo Alto, California, USA
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Martinez-Martin P, Rodriguez-Blazquez C, Frades-Payo B. Specific patient-reported outcome measures for Parkinson’s disease: analysis and applications. Expert Rev Pharmacoecon Outcomes Res 2014; 8:401-18. [DOI: 10.1586/14737167.8.4.401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Rodriguez-Blazquez C, Rojo-Abuin JM, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A, Garretto N, Gershanik O, Kurtis MM, Martinez-Castrillo JC, Mendoza-Rodriguez A, Moore HP, Rodriguez-Violante M, Singer C, Tilley BC, Huang J, Stebbins GT, Goetz CG, Martinez-Martin P. The MDS-UPDRS Part II (motor experiences of daily living) resulted useful for assessment of disability in Parkinson's disease. Parkinsonism Relat Disord 2013; 19:889-93. [PMID: 23791519 DOI: 10.1016/j.parkreldis.2013.05.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/24/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the motor experiences of daily living section of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS M-EDL) for assessing disability in PD patients; to determine the association between disability and quality of life; and to identify cut-off score ranges for no, mild, moderate and severe disability with this measure. METHODS International, observational, cross-sectional study of 435 PD patients, assessed with: MDS-UPDRS, Hoehn and Yahr staging, Rapid Assessment of Disability Scale, Clinical Impression of Severity Index for PD, Parkinson's Disease Questionnaire-8 and EQ-5D. Descriptive statistics, Spearman's rank correlation coefficients, Kruskal-Wallis test for group comparisons, ordinal logistic regression analysis for setting cut-off values and a step-wise multiple linear regression model were calculated. RESULTS MDS-UPDRS M-EDL correlated 0.70-0.80 with other disability measures, and -0.46 to 0.74 with quality of life scales. Scores significantly increased with higher disease duration and severity (p < 0.001). Cut-off values for the M-EDL were: 0-2 points, no disability; 3-16, mild; 17-31, moderate; and 32 points or more, severe. Linear regression analysis identified the MDS-UPDRS nM-EDL section as the main determinant of M-EDL, followed by the rest of MDS-UPDRS sections (explained variance: 59%). CONCLUSIONS MDS-UPDRS M-EDL proved to be useful for assessing disability in PD.
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Gerzeli S, Cavallo MC, Caprari F, Ponzi P. Analisi dei costi della stimolazione cerebrale profonda (DBS) nella malattia di Parkinson: uno studio osservazionale su pazienti italiani. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Little M, Wicks P, Vaughan T, Pentland A. Quantifying short-term dynamics of Parkinson's disease using self-reported symptom data from an Internet social network. J Med Internet Res 2013; 15:e20. [PMID: 23343503 PMCID: PMC3636067 DOI: 10.2196/jmir.2112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 09/24/2012] [Accepted: 10/26/2012] [Indexed: 11/25/2022] Open
Abstract
Background Parkinson’s disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this. Objective To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson’s Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years. Methods Online self-reported data was validated against the gold standard Parkinson’s Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of fluctuations versus time since diagnosis was modeled by using a gamma generalized linear model. Results Distributions of ages at diagnosis and UPDRS in the PLM and PD-DOC databases were broadly consistent. The PLM patients were systematically younger than the PD-DOC patients and showed increased symptom severity in the PD off state. The average fluctuation in symptoms (UPDRS Parts I and II) was 2.6 points at the time of diagnosis, rising to 5.9 points 16 years after diagnosis. This fluctuation exceeds the estimated minimal and moderate clinically important differences, respectively. Not all patients conformed to the current clinical picture of gradual, smooth changes: many patients had regimes where symptom severity varied in an unpredictable manner, or underwent large rapid changes in an otherwise more stable progression. Conclusions This information about short-term PD symptom dynamics contributes new scientific understanding about the disease progression, currently very costly to obtain without self-administered Internet-based reporting. This understanding should have implications for the optimization of clinical trials into new treatments and for the choice of treatment decision timescales.
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Affiliation(s)
- Max Little
- Human Dynamics Group, Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, United States.
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Seidel SE, Tilley BC, Huang P, Palesch YY, Bergmann KJ, Goetz CG, Swearingen CJ. Subject-investigator reproducibility of the Unified Parkinson's Disease Rating Scale. Parkinsonism Relat Disord 2011; 18:230-3. [PMID: 22018910 DOI: 10.1016/j.parkreldis.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/04/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the subject-investigator agreement on the Unified Parkinson's Disease Rating Scale (UPDRS) subsections I and II. METHODS Subject-investigator agreement was estimated at baseline and endpoint by Kappa statistics for individual items and concordance correlations for subscale totals using data from two NIH Exploratory Trials in Parkinson's Disease studies. RESULTS All but two questions had moderate subject-investigator agreement at baseline and endpoint. Participants consistently rated their disease activity worse that investigators. CONCLUSION UPDRS self-administration produces similar results to investigator-administration. Although slightly elevated, UPDRS self-administration can be accommodated in a clinical trial setting.
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Affiliation(s)
- Sydney E Seidel
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA
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Bladh S, Nilsson MH, Hariz GM, Westergren A, Hobart J, Hagell P. Psychometric performance of a generic walking scale (Walk-12G) in multiple sclerosis and Parkinson's disease. J Neurol 2011; 259:729-38. [PMID: 21956376 DOI: 10.1007/s00415-011-6254-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/09/2011] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
Abstract
Walking difficulties are common in neurological and other disorders, as well as among the elderly. There is a need for reliable and valid instruments for measuring walking difficulties in everyday life since existing gait tests are clinician rated and focus on situation specific capacity. The Walk-12G was adapted from the 12-item multiple sclerosis walking scale as a generic patient-reported rating scale for walking difficulties in everyday life. The aim of this study is to examine the psychometric properties of the Walk-12G in people with multiple sclerosis (MS) and Parkinson's disease (PD). The Walk-12G was translated into Swedish and evaluated qualitatively among 25 people with and without various neurological and other conditions. Postal survey (MS, n = 199; PD, n = 189) and clinical (PD, n = 36) data were used to test its psychometric properties. Respondents considered the Walk-12G relevant and easy to use. Mean completion time was 3.5 min. Data completeness was good (<5% missing item responses) and tests of scaling assumptions supported summing item scores to a total score (corrected item-total correlations >0.6). Coefficient alpha and test-retest reliabilities were >0.9, and standard errors of measurement were 2.3-2.8. Construct validity was supported by correlations in accordance with a priori expectations. Results are similar to those with previous Walk-12G versions, indicating that scale adaptation was successful. Data suggest that the Walk-12G meets rating scale criteria for clinical trials, making it a valuable complement to available gait tests. Further studies involving other samples and application of modern psychometric methods are warranted to examine the scale in more detail.
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Affiliation(s)
- Stina Bladh
- Department of Health Sciences, Lund University, Lund, Sweden
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Dahodwala N, Karlawish J, Siderowf A, Duda JE, Mandell DS. Delayed Parkinson's disease diagnosis among African-Americans: the role of reporting of disability. Neuroepidemiology 2011; 36:150-4. [PMID: 21508648 DOI: 10.1159/000324935] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 01/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Racial differences in the observed prevalence of Parkinson's disease (PD) may be due to delayed diagnosis among African-Americans. We sought to compare the stage at which African-American and white PD patients present for healthcare, and determine whether perception of disability accounts for racial differences. METHODS Using records of veterans with newly diagnosed PD at the Philadelphia Veterans Affairs Medical Center, we calculated differences in reporting of symptoms as the difference in z-scores on the Unified Parkinson Disease Rating Scale part 2 (disability) and part 3 (motor impairment). Ordinal logistic regression was used to determine predictors of stage at diagnosis. RESULTS African-American (n = 16) and white (n = 58) veterans with a mean age of 70.1 years were identified. African-Americans presented at a later PD stage than whites (median Hoehn + Yahr stage 2.5 vs. 2.0, p = 0.02) and were more likely to under-report disability relative to motor impairment (81 vs. 40%, p < 0.01). Multivariate analysis showed that under-reporting of disability accounted for much of the effect of race on stage of diagnosis. CONCLUSIONS Under-reporting of disability among African-Americans may account for later stages of PD diagnosis than whites. This study begins to explain the mechanisms underlying observed racial disparities in PD.
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Affiliation(s)
- Nabila Dahodwala
- Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA.
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Frost E, Tripoliti E, Hariz MI, Pring T, Limousin P. Self-perception of speech changes in patients with Parkinson's disease following deep brain stimulation of the subthalamic nucleus. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:399-404. [PMID: 20602580 DOI: 10.3109/17549507.2010.497560] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves the motor difficulties experienced by patients with Parkinson's disease (PD); however, the effects on speech are variable. In this study, patients rated their current post-surgery speech difficulties using the Voice Handicap Index (VHI) and used the same measure to retrospectively rate their pre-surgery speech. Scores pre- and post-surgery were also available on the UPDRS-III, and the patients' intelligibility was assessed by an independent listener. A control group of non-surgical patients with PD (medical group) also completed the VHI for comparison. VHI scores deteriorated equally in the two groups. However, the variability of the change scores in the surgical group was significantly greater than in the medical group. The correlation between the changes in the VHI and UPDRS scores for the surgical group was not significant. Correlations between the VHI scores and intelligibility were significant both before and after surgery, suggesting that patients accurately perceive their difficulties. The findings confirm the variability in the speech difficulties of patients following STN-DBS. The patients' ability to use the VHI offers a means of assessing the effects of their speech on their quality-of-life, and may be clinically useful post-STN-DBS.
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Nilsson MH, Hariz GM, Wictorin K, Miller M, Forsgren L, Hagell P. Development and testing of a self administered version of the Freezing of Gait Questionnaire. BMC Neurol 2010; 10:85. [PMID: 20863392 PMCID: PMC2955563 DOI: 10.1186/1471-2377-10-85] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/23/2010] [Indexed: 11/17/2022] Open
Abstract
Background The Freezing of Gait Questionnaire (FOGQ) was developed in response to the difficulties of observing and quantifying freezing of gait (FOG) clinically as well as in laboratory settings. However, as the FOGQ is a clinician-administered patient-reported rating scale it cannot be used in postal surveys. Here we report the development and measurement properties of a self-administered version of the FOGQ (FOGQsa). Methods A clinical sample and a postal survey sample of non-demented people with Parkinson's disease (PD; total n = 225) completed the FOGQsa and questionnaires concerning physical functioning (PF) and fall-related self efficacy (FES). Additional questions (No/Yes) regarded previous falls and whether they were afraid of falling. The clinical sample was also assessed with the Unified PD Rating Scale (UPDRS). Thirty-five participants completed FOGQsa and were also assessed with the original version (FOGQ) in a clinical interview. Results There were no differences (P = 0.12) between FOGQ (median, 10; q1-q3, 2-14) and FOGQsa (median, 8; 2-14) scores. The Spearman (rs) and intra-class correlations between the two were 0.92 and 0.91 (95% CI, 0.82-0.95), respectively. For FOGQsa, corrected item-total correlations ranged between 0.68-0.89. Reliability was 0.93 (95% CI, 0.91-0.94). FOGQsa scores correlated strongest with UPDRS Item 14 (Freezing; rs, 0.76) and with FES (rs, -0.74). The weakest correlation was found with age (rs, 0.14). Fallers scored significantly (p < 0.001) higher on FOGQsa compared to non-fallers, median scores 8 (q1-q3, 4-14) versus 2 (0-7). Those expressing a fear of falling scored higher (p < 0.001) than those who did not, median scores 2 (0-7) versus 6 (2-14). Conclusions The present findings indicate that the FOGQsa is as reliable and valid as the original interview administered FOGQ version. This has important clinical implications when investigating FOG in large scale studies.
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Affiliation(s)
- Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.
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Abstract
OBJECTIVE This investigation sought to examine the potential moderating influence of heightened anxiety on working memory in Parkinson disease (PD) patients. Further, we wanted to determine whether this moderating influence of anxiety differentially affects PD patients with left hemibody (LBH) versus right hemibody (RHB) onset of motor symptoms. BACKGROUND Research has examined the neurocognitive effects of depression in PD. However, a paucity of research has examined the effects of heightened anxiety in PD. We predicted that LHB PD patients with heightened anxiety would perform worse on a measure of working memory than RHB PD patients. METHOD A total of 59 PD patients completed the state-trait anxiety inventory and were also administered the digit span subtest of the Wechsler Memory Scale-III. RESULTS The results supported the hypotheses, indicating that the LHB PD patients with heightened anxiety performed significantly worse than the RHB PD patients with heightened anxiety and the LHB PD patients with low anxiety. CONCLUSIONS These findings suggest that left hemibody onset PD patients may experience more disability in their activities of daily living. Future research should explore whether differences also exist between PD patients with and without the diagnosed anxiety disorders.
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Abstract
Parkinson disease (PD) is a progressive neurologic condition that causes motor and nonmotor manifestations. Treatment provides symptomatic benefit but no current treatment has been proven to slow disease progression. Research studies of PD require a means of rating the severity of disease by measurement of motor manifestations, assessment of ability to perform daily functional activities, and symptomatic response to medication. The most common rating scales are the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr staging, and the Schwab and England rating of activities of daily living. Each of these rating scales are described, including detailed instructions on how to implement these ratings. Although these are the most widely applied rating scales of PD, there are still substantial limitations to these scales that must be considered when using them for research. Finally, some common applications of these scales are described.
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Affiliation(s)
- Joel S Perlmutter
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Evatt ML, Chaudhuri KR, Chou KL, Cubo E, Hinson V, Kompoliti K, Yang C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG. Dysautonomia rating scales in Parkinson's disease: sialorrhea, dysphagia, and constipation--critique and recommendations by movement disorders task force on rating scales for Parkinson's disease. Mov Disord 2009; 24:635-46. [PMID: 19205066 DOI: 10.1002/mds.22260] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Upper and lower gastrointestinal dysautonomia symptoms (GIDS)--sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met "Recommended" criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically.
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Affiliation(s)
- Marian L Evatt
- Section of Movement Disorders, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
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Harrison MB, Wylie SA, Frysinger RC, Patrie JT, Huss DS, Currie LJ, Wooten GF. UPDRS activity of daily living score as a marker of Parkinson's disease progression. Mov Disord 2009; 24:224-30. [PMID: 18951537 DOI: 10.1002/mds.22335] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The activities of daily living (ADL) subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) captures the impact of Parkinson's disease (PD) on daily function and may be less affected than other subsections by variability associated with drug cycle and motor fluctuations. We examined UPDRS mentation, ADL and motor subscores in 888 patients with idiopathic PD. Multiple linear regression analyses determined the association between disease duration and UPDRS subscores as a function of medication status at examination and in a subset of patients with multiple examinations. Independent of medication status and across cross-sectional and longitudinal analyses, ADL subscores showed a stronger and more stable association with disease duration than other UPDRS subscores after adjusting for age of disease onset. The association between disease duration and the motor subscore depended on medication status. The strong association between ADL subscore and disease duration in PD suggests that this measure may serve as a better marker of disease progression than signs and symptoms assessed in other UPDRS sections.
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Affiliation(s)
- Madaline B Harrison
- Department of Neurology, University of Virginia, Charlottesville, Virginia 22903, USA.
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31
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Leentjens AF, Koester J, Fruh B, Shephard DTS, Barone P, Houben JJ. The effect of pramipexole on mood and motivational symptoms in parkinson's disease: A meta-analysis of placebo-controlled studies. Clin Ther 2009; 31:89-98. [DOI: 10.1016/j.clinthera.2009.01.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
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Alberici A, Bonato C, Calabria M, Agosti C, Zanetti O, Miniussi C, Padovani A, Rossini PM, Borroni B. The contribution of TMS to frontotemporal dementia variants. Acta Neurol Scand 2008; 118:275-80. [PMID: 18397363 DOI: 10.1111/j.1600-0404.2008.01017.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Frontotemporal lobar degeneration (FTLD) includes different heterogeneous conditions mainly characterized by personality changes and cognitive deficits in language and executive functions; movement disorders have also been associated with FTLD. The present study aimed to measure the primary motor cortex (M1) inhibitory and facilitatory functions in patients affected by FTLD. MATERIALS AND METHODS The study included 17 FTLD patients, 8 age-matched healthy controls and 8 Alzheimer's disease (AD) patients. Transcranial magnetic stimulation (TMS) was used to study intracortical inhibition (ICI) and facilitation (ICF) by using a double-pulse paradigm. RESULTS FTLD patients were comparable with controls and AD patients for ICI and ICF. Corticobasal degeneration (CBD) patients presented significant reduced inhibition at ISI3; moreover two out of seven CBD patients had only ipsilateral responses. DISCUSSION The present study reveals a selective impairment of M1 ICI inhibitory response in CBD, which may help in distinguishing among the FTLD clinical spectrum.
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Affiliation(s)
- A Alberici
- Department of Neurological Sciences, University of Brescia, Italy.
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Borroni B, Turla M, Bertasi V, Agosti C, Gilberti N, Padovani A. Cognitive and behavioral assessment in the early stages of neurodegenerative extrapyramidal syndromes. Arch Gerontol Geriatr 2008; 47:53-61. [PMID: 17765337 DOI: 10.1016/j.archger.2007.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 07/05/2007] [Accepted: 07/11/2007] [Indexed: 11/18/2022]
Abstract
Parkinson's disease (PD), Dementia with Lewy Bodies (DLB), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration Syndrome (CBDS) are the most common neurodegenerative extrapyramidal syndromes. Beyond motor symptoms, cognitive dysfunctions and behavioral disturbances are reported. Neuropsychological and neuropsychiatry features in the early stages, however, are under-investigated, and few comparison studies are available yet. The aim of the present study was to evaluate the cognitive and behavioral profile in the early stages of neurodegenerative extrapyramidal syndromes. Thirty-nine PD, 27 DLB, 16 CBDS, and 24 PSP were recruited. Groups were matched for global cognitive and motor impairment. The overall sample showed a common neuropsychological core characterized by visuospatial deficits. Although in the early stage of the disease, a high presence of behavioral disturbances was detected, depression and anxiety were the most common disorders, followed by apathy and sleep disturbances. The observation of overlapping clinical entities points the attention on the need of adjunctive diagnostic markers for early differential diagnosis.
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Affiliation(s)
- B Borroni
- Neurology Unit, Department of Medical Sciences, University of Brescia, Piazza Spedali Civili 1, I-25125 Brescia, Italy.
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Fernandez HH, Aarsland D, Fénelon G, Friedman JH, Marsh L, Tröster AI, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG. Scales to assess psychosis in Parkinson's disease: Critique and recommendations. Mov Disord 2008; 23:484-500. [DOI: 10.1002/mds.21875] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schrag A, Barone P, Brown RG, Leentjens AFG, McDonald WM, Starkstein S, Weintraub D, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG. Depression rating scales in Parkinson's disease: critique and recommendations. Mov Disord 2007; 22:1077-92. [PMID: 17394234 PMCID: PMC2040268 DOI: 10.1002/mds.21333] [Citation(s) in RCA: 443] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Depression is a common comorbid condition in Parkinson's disease (PD) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. As several rating scales have been used to assess depression in PD (dPD), the Movement Disorder Society commissioned a task force to assess their clinimetric properties and make clinical recommendations regarding their use. A systematic literature review was conducted to explore the use of depression scales in PD and determine which scales should be selected for this review. The scales reviewed were the Beck Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Geriatric Depression Scale (GDS), Montgomery-Asberg Depression Rating Scale (MADRS), Unified Parkinson's Disease Rating Scale (UPDRS) Part I, Cornell Scale for the Assessment of Depression in Dementia (CSDD), and the Center for Epidemiologic Studies Depression Scale (CES-D). Seven clinical researchers with clinical and research experience in the assessment of dPD were assigned to review the scales using a structured format. The most appropriate scale is dependent on the clinical or research goal. However, observer-rated scales are preferred if the study or clinical situation permits. For screening purposes, the HAM-D, BDI, HADS, MADRS, and GDS are valid in dPD. The CES-D and CSDD are alternative instruments that need validation in dPD. For measurement of severity of depressive symptoms, the Ham-D, MADRS, BDI, and SDS scales are recommended. Further studies are needed to validate the CSDD, which could be particularly useful for the assessment of severity of dPD in patients with comorbid dementia. To account for overlapping motor and nonmotor symptoms of depression, adjusted instrument cutoff scores may be needed for dPD, and scales to assess severity of motor symptoms (e.g., UPDRS) should also be included to help adjust for confounding factors. The HADS and the GDS include limited motor symptom assessment and may, therefore, be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression. The complex and time-consuming task of developing a new scale to measure depression specifically for patients with PD is currently not warranted.
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Affiliation(s)
- Anette Schrag
- University Department of Clinical Neurosciences, Royal Free and University College Medical School, London, UK.
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Abstract
A significant number of patients with Parkinson's disease (PD) experience sialorrhea. This problem can cause social embarrassment, and because saliva pools in the mouth, may lead to aspiration pneumonia. Sialorrhea in PD is thought to be caused by impaired or infrequent swallowing, rather than hypersecretion. Oral medications, botulinum toxin injections, surgical interventions, radiotherapy, speech therapy, and trials of devices may be used to treat sialorrhea in PD, but few controlled trials have been published. This article reviews current knowledge regarding the frequency, etiology, assessment, and treatment of sialorrhea in PD.
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Affiliation(s)
- Kelvin L Chou
- Department of Clinical Neurosciences, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Borroni B, Grassi M, Agosti C, Paghera B, Alberici A, Di Luca M, Perani D, Padovani A. Latent profile analysis in frontotemporal lobar degeneration and related disorders: clinical presentation and SPECT functional correlates. BMC Neurol 2007; 7:9. [PMID: 17506892 PMCID: PMC1884173 DOI: 10.1186/1471-2377-7-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 05/16/2007] [Indexed: 12/12/2022] Open
Abstract
Background Frontotemporal Lobar Degeneration (FTLD) thus recently renamed, refers to a spectrum of heterogeneous conditions. This same heterogeneity of presentation represents the major methodological limit for the correct evaluation of clinical designation and brain functional correlates. At present, no study has investigated clinical clusters due to specific cognitive and behavioural disturbances beyond current clinical criteria. The aim of this study was to identify clinical FTLD presentation, based on cognitive and behavioural profile, and to define their SPECT functional correlations. Methods Ninety-seven FTLD patients entered the study. A clinical evaluation and standardised assessment were preformed, as well as a brain SPECT perfusion imaging study. Latent Profile Analysis on clinical, neuropsychological, and behavioural data was performed. Voxel-basis analysis of SPECT data was computed. Results Three specific clusters were identified and named "pseudomanic behaviour" (LC1), "cognitive" (LC2), and "pseudodepressed behaviour" (LC3) endophenotypes. These endophenotypes showed a comparable hypoperfusion in left temporal lobe, but a specific pattern involving: medial and orbitobasal frontal cortex in LC1, subcortical brain region in LC2, and right dorsolateral frontal cortex and insula in LC3. Conclusion These findings provide evidence that specific functional-cluster symptom relationship can be delineated in FTLD patients by a standardised assessment. The understanding of the different functional correlates of clinical presentations will hopefully lead to the possibility of individuating diagnostic and treatment algorithms.
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Affiliation(s)
- Barbara Borroni
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - Mario Grassi
- Department of Health Sciences, Section of Medical Statistics & Epidemiology, University of Pavia, Pavia, Italy
| | - Chiara Agosti
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | | | - Antonella Alberici
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
| | - Monica Di Luca
- Centre of Excellence for Neurodegenerative Disorders and Department of Pharmacological Sciences, University of Milan, Milan, Italy
| | - Daniela Perani
- Vita Salute San Raffaele University and IRCCS H San Raffaele, IBFN-CNR, Milan, Italy
| | - Alessandro Padovani
- Center for Aging Brain and Dementia, Department of Neurology, University of Brescia, Brescia, Italy
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Martínez‐Martín P, Cubo E. Scales to measure parkinsonism. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:289-327. [DOI: 10.1016/s0072-9752(07)83012-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Martinez-Martin P, Prieto L, Forjaz MJ. Longitudinal metric properties of disability rating scales for Parkinson's disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2006; 9:386-93. [PMID: 17076869 DOI: 10.1111/j.1524-4733.2006.00131.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES This study analyzes the longitudinal metric attributes of three Parkinson's disease (PD) disability scales, taking Hoehn and Yahr (HY) staging as the reference measure of PD progression. METHODS A sample of 87 PD patients was assessed during regular medical visits, using the HY, the Unified Parkinson's Disease Rating Scale--Activities of Daily Living Section (UPDRS-ADL), the Schwab and England Scale (SES), and the Intermediate Scale for Assessment of PD (ISAPD), across a follow-up period of 2.6 +/- 1.0 years. RESULTS The following cross-sectional attributes were analyzed, at baseline and again on conclusion of the study: floor and ceiling effects, convergent validity, reliability, and standard error of measurement, all of which were found to be adequate. Longitudinal reproducibility values (intraclass correlation coefficient) were 0.81 (ISAPD) to 0.84 (UPDRS-ADL). Insofar as longitudinal validity was concerned, the change scores of the three disability scales correlated significantly with the HY change score, absolute value r = 0.33 to 0.45, P < 0.003. Slightly lower values were found when taking the annual rate of change, absolute value r = 0.20 to 0.36. The three scales were acceptable, even though there were small differences among them. The "minimal clinically important difference" proposed for these scales is: SES, -6; UPDRS-ADL, +2; ISAPD, +1.5 points. CONCLUSIONS The three scales proved adequate for longitudinal assessment of PD disability. UPDRS-ADL was more precise and ISAPD more consistent. Magnitude of change and correlation with change in HY were slightly higher with the ISAPD. Effect size and standardized response mean for the minimal change in HY were higher for the UPDRS-ADL.
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Affiliation(s)
- Pablo Martinez-Martin
- Unit of Neuroepidemiology, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Dickson JM, Grünewald RA. Somatic symptom progression in idiopathic Parkinson's disease. Parkinsonism Relat Disord 2005; 10:487-92. [PMID: 15542009 DOI: 10.1016/j.parkreldis.2004.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Revised: 01/08/2004] [Accepted: 05/11/2004] [Indexed: 01/23/2023]
Abstract
The substantia nigra (SN) pars compacta is arranged somatotopically. Symptoms of idiopathic Parkinson's disease (IPD) are caused by a lesion in this nucleus, which spreads in a stereotyped spatio-temporal pattern during the course of the disease. We investigated the order of somatic symptom progression in a group of 30 patients with IPD to determine if progression of symptoms was consistent with ordered spread of pathology through the SN pars compacta. Thirty outpatients with IPD were interviewed retrospectively about the progression of their symptoms using a semi-structured questionnaire. All the patients experienced somatic symptom progression in one of two distinct patterns, which was dependent on the location of the initial symptom. The typical pattern of progression for patients with lower limb onset was: (i) foot, (ii) leg, (iii) arm, (iv) hand, (v) face, (vi) voice and (vii) swallowing. For patients whose first symptom was in the upper limb progression to the face and lower limbs occurred roughly simultaneously or sequentially, with the typical pattern of progression: (i) hand/arm, (ii) foot/leg and face, (iii) speech and (iv) swallowing. These patterns of disease progression may reflect two distinct patterns of neuropathology within the SN pars compacta. Although the sample size was relatively small, this is the first time this phenomenon has been described in a full-length article.
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Affiliation(s)
- Jon M Dickson
- Academic Neurology Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Nyholm D, Kowalski J, Aquilonius SM. Wireless real-time electronic data capture for self-assessment of motor function and quality of life in Parkinson's disease. Mov Disord 2004; 19:446-51. [PMID: 15077243 DOI: 10.1002/mds.10690] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Frequent assessment of the symptoms in Parkinson's disease (PD) is important in both clinical and experimental settings, especially when motor fluctuations are present. Patient diaries are increasingly used in studies, allowing patients to stay in their home environments. However, traditional paper diaries may not reflect reality because of a lack in compliance or retrospective data entries. This study presents a comparison between paper diaries and a new method, real-time data capture with a hand-held computer (electronic diary). Twenty patients with PD diagnosed at least 5 years previously were randomly assigned to use either a paper diary or an electronic diary on 8 days during 1 month. Questions were answered every 2 hours over a 12-hour period on each day. Median compliance was 88% with the electronic diary and 98% with the paper diary, although strict compliance to the scheduled times by patients using the paper diary was 78%. Neither age nor earlier experience with computers affected the patient's ability to use the electronic diary. Electronic diaries can be used for self-assessment of PD symptoms. The real-time feature provides fast access to clean data with knowledge of true compliance.
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Affiliation(s)
- Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden.
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Martínez-Martín P, Benito-León J, Alonso F, Catalán MJ, Pondal M, Tobías A, Zamarbide I. Patients', doctors', and caregivers' assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov Disord 2004; 18:985-92. [PMID: 14502665 DOI: 10.1002/mds.10479] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This multicenter study sought to analyze the validity and reliability of the Unified Parkinson's Disease Rating Scale (UPDRS)-section 2 (Activities of Daily Living, ADL) as applied by patients and caregivers. Sixty pairs of PD patients-caregivers were enrolled for study purposes. Neurologists used a set of scales to determine disease severity and patients' functional state. Patients and caregivers used adapted versions of the UPDRS-section 2 in tandem with other measures. Wilcoxon and Mann-Whitney tests, weighted kappa, intraclass and Spearman's correlation coefficients, as well as multivariate linear regression models were applied. On the whole, PD patient self-assessment and caregiver evaluation of patients' disability showed close concordance with neurologists' ratings. Correlation between caregiver ratings and clinical evaluation tended to be slightly lower than that for patient-based self-assessment. Depression showed a positive correlation with disability and had a nonsystematic influence on UPDRS-section 2 (ADL) scores. As expected, there was a significant correlation between perceived disability and health-related quality of life measures. Caregiver burden did not reduce the level of agreement with neurologists as to the overall rating of any given patient's disability. In PD, UPDRS-section 2-based assessment of disability by patients themselves and caregivers is a valid and reliable outcome.
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Affiliation(s)
- Pablo Martínez-Martín
- National Center for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain.
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Leritz E, Loftis C, Crucian G, Friedman W, Bowers D. Self-Awareness of Deficits in Parkinson Disease. Clin Neuropsychol 2004; 18:352-61. [PMID: 15739807 DOI: 10.1080/1385404049052412] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anosognosia is an unawareness or denial of deficits. While it has mainly been associated with damage to cortical brain regions, anosognosia has also been reported in patients with subcortical brain disease. The present study investigated whether anosognosia is a feature of Parkinson disease. Forty-eight Parkinson disease patients with predominantly left- (N = 16) or right-sided (N = 32) motor symptoms who eventually underwent right or left pallidotomies, and 48 individuals identified as caregivers completed questionnaires rating severity of PD. There was no discrepancy in report between patients and caregivers as a function of pallidotomy side. However, as a group, patients rated themselves as significantly less impaired on 2 measures of activities of daily living, indicating that basal ganglia dysfunction may alter insight into severity of illness. Patients and caregivers in the left-symptom PD group differed significantly on selected measures of functional independence. This suggests the potential interaction of laterality and handedness. The importance of future investigations in PD patients with more severe cognitive impairment is stressed.
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Affiliation(s)
- Elizabeth Leritz
- Department of Clinical and Health Psychology, University of Florida Brain Institute, Gainesville, FL, USA.
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Goetz CG, LeWitt PA, Weidenman M. Standardized training tools for the UPDRS activities of daily living scale: Newly available teaching program. Mov Disord 2003; 18:1455-8. [PMID: 14673881 DOI: 10.1002/mds.10591] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) is the most widely used scale for evaluation of clinical impairment in PD. Whereas the motor section has been studied intensively for clinimetric properties and has an associated training tape, the Activities of Daily Living (ADL) section has been studied less rigorously. In preparation for a multicenter study that planned to use the UPDRS ADL score as an outcome, the authors reviewed the UPDRS ADL scale and designed a teaching program to provide a uniform technique for data acquisition without changing any wording of the primary scale. The teaching program is composed of four components: overall guidelines, clarifying points, recommended strategies, and a teaching videotape. The videotape shows examples of interviewers assessing each ADL item with patients of different disability levels and provides a complete ADL assessment of a single patient. Systematic training and utilization of this teaching program offer the potential for more uniformity in results of ADL assessments conducted in clinical practice and multicenter, international studies of PD. The written materials and videotape belong to the Movement Disorder Society and are available by contacting the MDS central office.
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Affiliation(s)
- Christopher G Goetz
- Department of Neurological Sciences, Rush University, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois, USA.
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Abstract
The Movement Disorder Society Task Force for Rating Scales for Parkinson's Disease prepared a critique of the Unified Parkinson's Disease Rating Scale (UPDRS). Strengths of the UPDRS include its wide utilization, its application across the clinical spectrum of PD, its nearly comprehensive coverage of motor symptoms, and its clinimetric properties, including reliability and validity. Weaknesses include several ambiguities in the written text, inadequate instructions for raters, some metric flaws, and the absence of screening questions on several important non-motor aspects of PD. The Task Force recommends that the MDS sponsor the development of a new version of the UPDRS and encourage efforts to establish its clinimetric properties, especially addressing the need to define a Minimal Clinically Relevant Difference and a Minimal Clinically Relevant Incremental Difference, as well as testing its correlation with the current UPDRS. If developed, the new scale should be culturally unbiased and be tested in different racial, gender, and age-groups. Future goals should include the definition of UPDRS scores with confidence intervals that correlate with clinically pertinent designations, "minimal," "mild," "moderate," and "severe" PD. Whereas the presence of non-motor components of PD can be identified with screening questions, a new version of the UPDRS should include an official appendix that includes other, more detailed, and optionally used scales to determine severity of these impairments.
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Kieburtz K. Designing neuroprotection trials in Parkinson's disease. Ann Neurol 2003; 53 Suppl 3:S100-7; discussion S107-9. [PMID: 12666102 DOI: 10.1002/ana.10484] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A major goal of the neuroscience community is to develop neuroprotective treatment strategies that will slow or forestall the progression of Parkinson's disease, one of the most common adult-onset neurodegenerative disorders, affecting approximately 1 million people in North America. Although prior research to identify neuroprotective interventions has not been conclusive, recent advances in the understanding of the pathogenesis of Parkinson's disease, including the development of relevant animal models, provide the opportunity for rational clinical trials to assess neuroprotective treatments.
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Affiliation(s)
- Karl Kieburtz
- University of Rochester Medical Center, Rochester, NY 14620, USA.
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Cordato NJ, Pantelis C, Halliday GM, Velakoulis D, Wood SJ, Stuart GW, Currie J, Soo M, Olivieri G, Broe GA, Morris JGL. Frontal atrophy correlates with behavioural changes in progressive supranuclear palsy. Brain 2002; 125:789-800. [PMID: 11912112 DOI: 10.1093/brain/awf082] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Regional brain volumes were measured in 21 patients with progressive supranuclear palsy (PSP), 17 patients with Parkinson's disease and 23 controls using 3D MRI-based volumetry. Cortical, subcortical and ventricular volume measures were correlated with global indices of motor disability and cognitive disturbance. All MRI measures, including hippocampal volume, were preserved in Parkinson's disease. Patients with PSP could be distinguished from both Parkinson's disease and controls by whole brain volume loss, ventricular dilatation and disproportionate atrophy of the frontal cortex. Caudate nucleus volume loss additionally differentiated PSP from controls, but was modest in severity and proportionate to whole brain volume loss. The present study identifies disease-specific differences in the topography of brain atrophy between PSP and Parkinson's disease, and has potential implications for the in vivo radiological differentiation of these two disorders. In PSP, the variance in frontal grey matter volume related to measures of behavioural disturbance, confirming the use of behavioural tests for ante-mortem case differentiation and suggesting that intrinsic cortical deficits contribute to these clinical disturbances.
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Affiliation(s)
- N J Cordato
- Department of Neurology, Westmead Hospital, Westmead, NSW 2145, Australia.
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Goetz CG, Leurgans S, Raman R. Placebo-associated improvements in motor function: comparison of subjective and objective sections of the UPDRS in early Parkinson's disease. Mov Disord 2002; 17:283-8. [PMID: 11921113 DOI: 10.1002/mds.10024] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Unified Parkinson's Disease Rating Scale (UPDRS) is primarily composed of an investigator-derived objective rating of motor function and a patient-derived assessment of activities of daily living (ADL). Using a stringent definition of placebo effect, we examined the frequency, temporal development, and stability of improvements during placebo treatment over 6 months in a large placebo-controlled trial of deprenyl and tocopherol in early Parkinson's disease (DATATOP). One hundred ninety-nine subjects received placebo treatment in the randomized, multicenter, placebo-controlled DATATOP study. We compared the baseline UPDRS motor section scores with follow-up scores at 4, 13, and 26 weeks. Placebo-associated improvement was defined as an improvement over baseline score in motor UPDRS of at least 50% or a change in at least two motor items at any one visit by two or more points. Seventeen percent of the 185 subjects who qualified for analysis met the placebo response criteria. The group prevalence of response was steady (7% to 10%) at any one visit without a marked predominance of an early study effect. Older subjects with more motor impairment at baseline were most likely to show a placebo-associated improvement. ADL scores were low throughout the study, and ADL improvements did not identify the subjects with objectively defined placebo-associated improvement. Prominent improvements in investigator-derived objective measures of Parkinson's disease motor impairment occur during clinical trials, including one that was not aimed at showing improved short-term efficacy. Although the notion of placebo effect often implies patient-based perceptions, we found subjective changes to be infrequent in placebo-treated patients, suggesting that either: (1) the placebo effect was rater-driven; (2) the ADL questionnaire is insensitive to transient but objectively demonstrable motor changes; or (3) that the objective changes, albeit major, are within the realm of natural variation in the UPDRS motor scale from visit to visit.
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Affiliation(s)
- Christopher G Goetz
- Department of Neurological Sciences Rush University, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA.
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Marinus J, Visser M, Stiggelbout AM, Rabey JM, Bonuccelli U, Kraus PH, van Hilten JBJ. Activity-based diary for Parkinson's disease. Clin Neuropharmacol 2002; 25:43-50. [PMID: 11852296 DOI: 10.1097/00002826-200201000-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to develop a Parkinson's disease diary that evaluates a patient's difficulties in performing activities as a substitute for the amount of "on"- and "off"-time and to assess its clinimetric qualities. In this study, 84 patients with Parkinson's disease kept a diary for 2 or 3 periods of 5 days. Daily, five items were recorded across 11 time periods. Patients simultaneously recorded "on-off" in the traditional way. The diary was easily understood, and median recording time was 5-10 minutes a day. Clinimetric analysis showed that the diary could be reduced successfully to 3 days, in which five items (walking, transfers, manual activities, dyskinesias, and sleep) with four response options (no, slight, moderate, and severe difficulty) were assessed seven times daily. Sumscores of the first three items accurately predicted being "on" or "off" in 93% of the cases, making separate scoring of "on" and "off" unnecessary. The diary was internally consistent and showed good reproducibility. Construct validity with external measures was adequate, and comparisons between patients grouped by disease severity and by degree of fluctuations revealed significant differences in the expected directions. Taken together, this Parkinson's disease diary has a sound clinimetric basis, provides information on the extent of perceived disability, and thereby accurately reflects the severity of "off"-periods and the variability of motor fluctuations.
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Affiliation(s)
- Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Pal PK, Samii A, Kishore A, Schulzer M, Mak E, Yardley S, Turnbull IM, Calne DB. Long term outcome of unilateral pallidotomy: follow up of 15 patients for 3 years. J Neurol Neurosurg Psychiatry 2000; 69:337-44. [PMID: 10945808 PMCID: PMC1737095 DOI: 10.1136/jnnp.69.3.337] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES With the advent of new antiparkinsonian drug therapy and promising results from subthalamic and pallidal stimulation, this study evaluated the long term efficacy of unilateral pallidotomy, a technique which has gained popularity over the past decade for the management of advanced Parkinson's disease. METHODS The 15 patients reported here are part of the original cohort of 24 patients who underwent posteroventral pallidotomy for motor fluctuations and disabling dyskinesias 3 years ago as part of a prospective study. Evaluation scales included the unified Parkinson's disease rating scale, the Goetz dyskinesia scale, and the Purdue pegboard test. RESULTS When compared with the prepallidotomy scores, the reduction in the limb dyskinesias and off state tremor scores persisted on the side contralateral to pallidotomy at the end of 3 years (dyskinesias were reduced by 64% (p<0.01) and tremor by 63% (p<0.05). Other measures tended to deteriorate. The dosage of antiparkinsonian medications did not change significantly from 3 months prepallidotomy to 3 years postpallidotomy. CONCLUSIONS Although unilateral pallidotomy is useful in controlling the contralateral dyskinesias and tremor 3 years after surgery, all other early benefits disappear and activities of daily living continue to worsen.
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Affiliation(s)
- P K Pal
- Neurodegenerative Disorders Centre, M 36 Purdy Pavilion, Vancouver Hospital and Health Sciences Centre, 2221 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
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