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Xing F, Feng J, Lv L, Liu J, Chen X, Sun J, Hu P, Wang K. Altered connectivity between frontal cortex and supplementary motor area in various types of Parkinson's disease. Am J Transl Res 2024; 16:2423-2434. [PMID: 39006296 PMCID: PMC11236641 DOI: 10.62347/gtvb7800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/14/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Tremor-dominant (TD) and postural instability/gait difficulty (PIGD) are common subtypes of Parkinson's disease, each with distinct clinical manifestations and prognoses. The neural mechanisms underlying these subtypes remain unclear. This study aimed to investigate the altered connectivity of the frontal cortex and supplementary motor area (SMA) in different types of Parkinson's disease. METHODS Data of 173 participants, including 41 TD patients, 65 PIGD patients, and 67 healthy controls, were retrospectively analyzed. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI) and clinical assessments. Differences in amplitude of low frequency fluctuation (ALFF), voxel-wise functional connectivity (FC), and functional network connectivity (FNC) among the three groups were compared, followed by partial correlation analysis. RESULTS Compared to healthy controls, the left dorsolateral superior frontal gyrus (DLSFG) ALFF was significantly increased in both PIGD and TD patients. The FC between the left DLSFG and the left SMA, as well as between the left paracentral lobule and the right DLSFG, was significantly decreased. Similarly, the FNC between the visual network and the auditory network was reduced. Compared to TD patients, PIGD patients showed a significantly higher ALFF in the left DLSFG and a notably reduced FC between the left DLSFG and left SMA. Additionally, the FC of the left DLSFG-SMA was inversely correlated with the PIGD score exclusively in PIGD patients. The FNC of the visual-auditory network was inversely associated with the tremor score only in TD patients. CONCLUSION Decreases in the left DLSFG-SMA connectivity may be a key feature of the PIGD subtype, while reduced VN-AUD connectivity may characterize the TD subtype.
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Affiliation(s)
- Fengbo Xing
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Jingjing Feng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Lingling Lv
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Jiaqiu Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Xin Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Jinmei Sun
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science CenterHefei 230088, Anhui, China
- Anhui Institute of Translational MedicineHefei 230000, Anhui, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230000, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical UniversityHefei 230000, Anhui, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric DisordersHefei 230032, Anhui, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental HealthHefei 230000, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science CenterHefei 230088, Anhui, China
- Anhui Institute of Translational MedicineHefei 230000, Anhui, China
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Quattrone A, Calomino C, Sarica A, Caligiuri ME, Bianco MG, Vescio B, Arcuri PP, Buonocore J, De Maria M, Vaccaro MG, Quattrone A. Neuroimaging correlates of postural instability in Parkinson's disease. J Neurol 2024; 271:1910-1920. [PMID: 38108896 DOI: 10.1007/s00415-023-12136-9] [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: 06/21/2023] [Revised: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Postural instability (PI) is a common disabling symptom in Parkinson's disease (PD), but little is known on its pathophysiological basis. OBJECTIVE In this study, we aimed to identify the brain structures associated with PI in PD patients, using different MRI approaches. METHODS We consecutively enrolled 142 PD patients and 45 control subjects. PI was assessed using the MDS-UPDRS-III pull-test item (PT). A whole-brain regression analysis identified brain areas where grey matter (GM) volume correlated with the PT score in PD patients. Voxel-based morphometry (VBM) and Tract-Based Spatial Statistics (TBSS) were also used to compare unsteady (PT ≥ 1) and steady (PT = 0) PD patients. Associations between GM volume in regions of interest (ROI) and several clinical features were then investigated using LASSO regression analysis. RESULTS PI was present in 44.4% of PD patients. The whole-brain approach identified the bilateral inferior frontal gyrus (IFG) and superior temporal gyrus (STG) as the only regions associated with the presence of postural instability. VBM analysis showed reduced GM volume in fronto-temporal areas (superior, middle, medial and inferior frontal gyrus, and STG) in unsteady compared with steady PD patients, and the GM volume of these regions was selectively associated with the PT score and not with any other motor or non-motor symptom. CONCLUSIONS This study demonstrates a significant atrophy of fronto-temporal regions in unsteady PD patients, suggesting that these brain areas may play a role in the pathophysiological mechanisms underlying postural instability in PD. This result paves the way for further studies on postural instability in Parkinsonism.
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Camilla Calomino
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Alessia Sarica
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Giovanna Bianco
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | | | - Pier Paolo Arcuri
- Institute of Radiology, Azienda Ospedaliero-Universitaria Dulbecco, Catanzaro, Italy
| | - Jolanda Buonocore
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Marida De Maria
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy.
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Huang X, Dong K, Gan C, Xu Z, Lei D, Dong X, Liu H, Chen X. Effect of Rhythmically Cued Exercise Interventions on Functions in Patients With Parkinson Disease: A Meta-Analysis. Phys Ther 2024; 104:pzad158. [PMID: 37962936 DOI: 10.1093/ptj/pzad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The purpose of this review was to investigate the efficacy of rhythmically cued exercise interventions on motor function, cognition, and mental state in patients with Parkinson disease. METHODS PubMed, Cochrane Database, Web of Science, Embase, and CINAHL were searched June 15, 2023. Original studies investigating the efficacy of rhythmically cued exercise interventions on the functions of patients with Parkinson disease were included. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. The protocol was registered in PROSPERO (CRD42022371203). RESULTS A total of 38 original studies involving 1486 participants were included. Rhythmically cued exercise interventions demonstrated superior effects on motor function compared to exercise therapy without rhythm (standardized mean difference [SMD] = -0.31). However, no significant improvements were observed in cognition and mental state. Overall, significant improvements were observed in motor examination (SMD = -0.61), Timed "Up & Go" Test (mean difference [MD] = -0.91), activities of daily living (SMD = -0.49), balance (SMD = 0.59), walking velocity (MD = 0.06), step length (MD = 2.65), and stride length (MD = 0.04) following rhythmically cued exercise interventions. No significant improvements were observed in freezing of gait and cadence. Assessment of publication bias showed no significant evidence of publication bias. Meta-regression analyses revealed a significant association between treatment duration and improvement in motor function. Furthermore, adverse events and dropout rates did not significantly differ between the 2 groups. CONCLUSION Rhythmically cued exercise interventions are effective in improving motor function in the early to middle stages of Parkinson disease. More than 10 weeks of intervention yielded better results. However, these interventions do not have a significant impact on cognition and mental states. Importantly, rhythmically cued exercise interventions are safe and well tolerated. Large-scale trials are needed for further confirmation. IMPACT This study contributes to the development of safe and reliable home rehabilitation programs, aiming to enhance the quality of life for patients with Parkinson disease.
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Affiliation(s)
- Xin Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ke Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Gan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinghua Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hanjun Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xi Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Hu ZD, Zhu SG, Huang JF, Chen JY, Huang SS, Liu RP, Chen ZL, Ma LL, Zhang X, Wang JY. Carpets with visual cues can improve gait in Parkinson's disease patients: may be independent of executive function. Eur J Med Res 2023; 28:530. [PMID: 37974270 PMCID: PMC10652558 DOI: 10.1186/s40001-023-01472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Gait impairment is common in Parkinson's disease (PD) patients, which greatly reduces their quality of life. Executive dysfunction is associated with gait impairment. Compensatory strategies, including visual cues, have been shown to be effective in improving PD gait. In this study, we aimed to understand whether carpets with visual cues could improve PD gait, and how the improvement varies across patients with different executive function state. METHODS We designed carpets with chessboard and stripe cues. A total of 65 Chinese PD patients were recruited. Movement Disorder Society Unified Parkinson's Disease Rating Scale, L-dopa equivalent daily dosage, Hoehn & Yahr stage, Frontal Assessment Battery, Mini Mental State Examination Scale, Hamilton Anxiety Scale, and Hamilton Depression Scale were evaluated. Gait parameters including stride length, gait speed and fall risk were recorded by a wearable electronic device. RESULTS The stride length and gait speed were significantly improved and the fall risk was significantly mitigated when PD patients walked on carpets with chessboard and stripe patterns. Further analysis showed the amelioration of gait parameters was independent of executive dysfunction. CONCLUSIONS Our study demonstrates that carpets with visual cues can improve the gait of PD patients even in those with mild executive dysfunction.
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Affiliation(s)
- Ze-Di Hu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Guo Zhu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jie-Fan Huang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jin-Yu Chen
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Shi Huang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong-Pei Liu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhu-Ling Chen
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lu-Lu Ma
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiong Zhang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jian-Yong Wang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Bower AE, Crisomia SJ, Chung JW, Martello JP, Burciu RG. Free water imaging unravels unique patterns of longitudinal structural brain changes in Parkinson's disease subtypes. Front Neurol 2023; 14:1278065. [PMID: 37965163 PMCID: PMC10642764 DOI: 10.3389/fneur.2023.1278065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Research shows that individuals with Parkinson's disease (PD) who have a postural instability and gait difficulties (PIGD) subtype have a faster disease progression compared to those with a tremor dominant (TD) subtype. Nevertheless, our understanding of the structural brain changes contributing to these clinical differences remains limited, primarily because many brain imaging techniques are only capable of detecting changes in the later stages of the disease. Objective Free water (FW) has emerged as a robust progression marker in several studies, showing increased values in the posterior substantia nigra that predict symptom worsening. Here, we examined longitudinal FW changes in TD and PIGD across multiple brain regions. Methods Participants were TD and PIGD enrolled in the Parkinson's Progression Marker Initiative (PPMI) study who underwent diffusion MRI at baseline and 2 years later. FW changes were quantified for regions of interest (ROI) within the basal ganglia, thalamus, brainstem, and cerebellum. Results Baseline FW in all ROIs did not differ between groups. Over 2 years, PIGD had a greater percentage increase in FW in the putamen, globus pallidus, and cerebellar lobule V. A logistic regression model incorporating percent change in motor scores and FW in these brain regions achieved 91.4% accuracy in discriminating TD and PIGD, surpassing models based solely on clinical measures (74.3%) or imaging (76.1%). Conclusion The results further suggest the use of FW to study disease progression in PD and provide insight into the differential course of brain changes in early-stage PD subtypes.
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Affiliation(s)
- Abigail E. Bower
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Sophia J. Crisomia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jae Woo Chung
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Justin P. Martello
- Department of Neurosciences, Christiana Care Health System, Newark, DE, United States
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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Qin G, Xie H, Shi L, Zhao B, Gan Y, Yin Z, Xu Y, Zhang X, Chen Y, Jiang Y, Zhang Q, Zhang J. Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson's disease patients with postural instability/gait disturbance. Front Neurosci 2023; 17:1228711. [PMID: 37712094 PMCID: PMC10498764 DOI: 10.3389/fnins.2023.1228711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023] Open
Abstract
Postural instability/gait disturbance (PIGD) is very common in advanced Parkinson's disease, and associated with cognitive dysfunction. Research suggests that low frequency (5-12 Hz) subthalamic nucleus-deep brain stimulation (STN-DBS) could improve cognition in patients with Parkinson's disease (PD). However, the clinical effectiveness of low frequency stimulation in PIGD patients has not been explored. This study was designed in a double-blinded randomized cross-over manner, aimed to verify the effect of low frequency STN-DBS on cognition of PIGD patients. Twenty-nine PIGD patients with STN-DBS were tested for cognitive at off (no stimulation), low frequency (5 Hz), and high frequency (130 Hz) stimulation. Neuropsychological tests included the Stroop Color-Word Test (SCWT), Verbal fluency test, Symbol Digital Switch Test, Digital Span Test, and Benton Judgment of Line Orientation test. For conflict resolution of executive function, low frequency stimulation significantly decreased the completion time of SCWT-C (p = 0.001) and Stroop interference effect (p < 0.001) compared to high frequency stimulation. However, no significant differences among stimulation states were found for other cognitive tests. Here we show, low frequency STN-DBS improved conflict resolution of executive function compared to high frequency. Our results demonstrated the possibility of expanding the treatment coverage of DBS to cognitive function in PIGD, which will facilitate integration of low frequency stimulation into future DBS programming.
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Affiliation(s)
- Guofan Qin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Zhang X, Li L, Qi L, Fu Y, Sun D, Chen S, Xu W, Liu C, Zhou X, He G. Distribution pattern of iron deposition in the basal ganglia of different motor subtypes of Parkinson's disease. Neurosci Lett 2023; 807:137249. [PMID: 37061026 DOI: 10.1016/j.neulet.2023.137249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE The quantitative susceptibility mapping (QSM) technique was used to analyze the distribution pattern of iron deposition in the basal ganglia region of patients with motor subtypes of Parkinson's disease (PD) and to explore the difference in iron content in the basal ganglia region of PD motor subtypes on the major motor symptomatic side. METHODS The study included 76 patients with PD and 37 healthy controls (HC). Patients with PD were divided into two groups: postural instability/gait disorder (PIGD)(n = 48), and tremor dominance (TD)(n = 28). We classified patients with PD according to the side of the major motor symptoms as left PIGD (n = 23), left TD (n = 14), right PIGD (n = 25), and right TD (n = 14). All subjects underwent brain magnetic resonance scanning to obtain QSM and susceptibility values in the corresponding regions of interest (ROI). RESULTS (1) Compared with the HC, the bilateral SN in the PD-PIGD and TD group showed greater susceptibility values. The susceptibility values in the left CN, bilateral PUT were also greater in the PD-PIGD group than the HC. (2) Compared with the TD, the left PUT susceptibility values were greater in the PIGD group, especially in patients whose major symptomatic side were on the right limb. (3) Correlation analysis showed that in the PD group, bilateral SN was positively correlated with the unified Parkinson's disease rating scale III part scores of the Movement Disorder Society (MDS-UPDRS III) and the Hoehn-Yahr stage. Bilateral dentate nucleus (DN) susceptibility values were significantly positively correlated with TD scores, and left PUT susceptibility values were positively correlated with PIGD scores. The left SN within the PIGD group was positively correlated with the PIGD score. CONCLUSION There were different iron deposition patterns in the basal ganglia between the PD-PIGD and TD groups. There also seems to be a difference in iron deposition in PD motor subtypes on different major motor symptom sides.
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Affiliation(s)
- Xun Zhang
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Lei Li
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Longxiu Qi
- Department of Magnetic Resonance, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Yigang Fu
- Department of Magnetic Resonance, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Dingming Sun
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Songjie Chen
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Weihu Xu
- Department of Magnetic Resonance, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Changxia Liu
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Xiao Zhou
- Department of Magnetic Resonance, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China
| | - Guojun He
- Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People's Hospital of Yancheng, Yancheng, Jiangsu, P.R.China.
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Rusz J, Krupička R, Vítečková S, Tykalová T, Novotný M, Novák J, Dušek P, Růžička E. Speech and gait abnormalities in motor subtypes of de-novo Parkinson's disease. CNS Neurosci Ther 2023. [PMID: 36942517 DOI: 10.1111/cns.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
AIM To investigate the presence and relationship of temporal speech and gait parameters in patients with postural instability/gait disorder (PIGD) and tremor-dominant (TD) motor subtypes of Parkinson's disease (PD). METHODS Speech samples and instrumented walkway system assessments were acquired from a total of 60 de-novo PD patients (40 in TD and 20 in PIGD subtype) and 40 matched healthy controls. Objective acoustic vocal assessment of seven distinct speech timing dimensions was related to instrumental gait measures including velocity, cadence, and stride length. RESULTS Compared to controls, PIGD subtype showed greater consonant timing abnormalities by prolonged voice onset time (VOT) while also shorter stride length during both normal walking and dual task, while decreased velocity and cadence only during dual task. Speaking rate was faster in PIGD than TD subtype. In PIGD subtype, prolonged VOT correlated with slower gait velocity (r = -0.56, p = 0.01) and shorter stride length (r = -0.59, p = 0.008) during normal walking, whereas relationships were also found between decreased cadence in dual task and irregular alternating motion rates (r = -0.48, p = 0.04) and prolonged pauses (r = -0.50, p = 0.03). No correlation between speech and gait was detected in TD subtype. CONCLUSION Our findings suggest that speech and gait rhythm disorder share similar underlying pathomechanisms specific for PIGD subtype.
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Affiliation(s)
- Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Radim Krupička
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Slávka Vítečková
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Jan Novák
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czechia
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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Wang Z, You Z. Impacts of motor phenotype on cognitive function in patients with Parkinson's disease 1 year after subthalamic-nucleus deep brain stimulation. Geriatr Gerontol Int 2023; 23:85-90. [PMID: 36641801 DOI: 10.1111/ggi.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/03/2022] [Accepted: 11/20/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurological disorder that affects both motor and cognitive functioning. This study aimed to examine the impact of motor phenotype on cognitive function 1 year after subthalamic-nucleus deep brain stimulation (STN-DBS). METHODS The prospectively collected data of 37 patients with PD were retrospectively analyzed. The patients were divided into two group according to their motor phenotype: the postural instability and gait disturbance (PIGD) group comprised 16 patients, and the tremor-dominant (TD) group comprised 21 patients. The clinical characteristics and cognitive functions of all patients were examined at baseline and at the 1-year follow-up after STN-DBS. RESULTS The data showed that STN-DBS significantly improved motor functions (P < 0.05). A repeated-measures analysis of variance indicated a considerable group × time interaction impact on the memory quotient score (P < 0.001) and Tmin (P = 0.033). CONCLUSIONS A distinct relationship between the neuropsychological spectrum and motor phenotype of PD patients was observed at the 1-year follow-up after STN-DBS, with worse cognitive outcomes in patients with the PIGD phenotype. Geriatr Gerontol Int 2023; 23: 85-90.
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Affiliation(s)
- Zhengyang Wang
- Department of Neurology, Jiangsu Taizhou People's Hospital, Taizhou, China
| | - ZhiFei You
- Department of Neurology, Jiangsu Taizhou People's Hospital, Taizhou, China
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10
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Shen D, Cao L, Ling Y, Li D, Ren K, Shi W, Chen Z, Zhou H, Liu J. Bilateral globus pallidus interna deep brain stimulation in Parkinson's disease: Therapeutic effects and motor outcomes prediction in a short-term follow up. Front Hum Neurosci 2023; 16:1023917. [PMID: 36699962 PMCID: PMC9868647 DOI: 10.3389/fnhum.2022.1023917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objective We aimed to compare the motor effect of bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) on motor subtypes of Parkinson's disease (PD) patients and identify preoperative predictive factors of short-term motor outcome. Methods We retrospectively investigated bilateral GPi DBS clinical outcomes in 55 PD patients in 1 year follow up. Motor outcome was measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III before and 1 year after surgery. Clinical outcomes were compared among different motor subtypes. Preoperative predictors of motor outcome were assessed by performing univariate and multivariate linear regression and logistic regression analyses. Results At 1 year following implantation, GPi DBS significantly improved the off-medication MDS-UPDRS III scores in all motor subtype cohorts, with prominent improvement in tremor. No significant difference of postoperative motor symptoms changes was found except greater tremor improvement achieved in both the tremor-dominant (TD) and indeterminate (IND) patients compared to the postural instability and gait difficulty (PIGD) patients. High percentage of PIGD patients were weak responders to DBS. Better levodopa responsiveness and more severe tremor predicted greater overall improvement of motor function in the entire cohort. Similarly, both levodopa responsiveness and tremor improvement were confirmed as predictors for motor improvement in PIGD patients. Conclusion Bilateral GPi DBS could effectively improve motor outcomes in PD patients regardless of motor subtypes. Both TD and IND patients obtained larger tremor improvement. The intensity of levodopa responsiveness and the severity of tremor could serve as predictors of motor improvement 1 year after GPi DBS.
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Affiliation(s)
- Dingding Shen
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Linghao Cao
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Ling
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Ren
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Weikun Shi
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Zhonglue Chen
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China,Zhonglue Chen,
| | - Haiyan Zhou
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Haiyan Zhou,
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China,*Correspondence: Jun Liu,
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11
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Steinbach MJ, Campbell RW, DeVore BB, Harrison DW. Laterality in Parkinson's disease: A neuropsychological review. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:126-140. [PMID: 33844619 DOI: 10.1080/23279095.2021.1907392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laterality of motor symptom onset in Parkinson's disease is both well-known and under-appreciated. Treatment of disorders that have asymmetric pathological features, such as stroke and epilepsy, demonstrate the importance of incorporating hemispheric lateralization and specialization into therapy and care planning. These practices could theoretically extend to Parkinson's disease, providing increased diagnostic accuracy and improved treatment outcomes. Additionally, while motor symptoms have generally received the majority of attention, non-motor features (e.g., autonomic dysfunction) also decrease quality of life and are influenced by asymmetrical neurodegeneration. Due to the laterality of cognitive and behavioral processes in the two brain hemispheres, analysis of hemibody side of onset can potentially give insight into expected symptom profile of the patient and allow for increased predictive accuracy of disease progression and outcome, thus opening the door to personalized and improved therapy in treating Parkinson's disease patients. This review discusses motor and non-motor symptoms (namely autonomic, sensory, emotional, and cognitive dysfunction) of Parkinson's disease in respect to hemispheric lateralization from a theoretical perspective in hopes of providing a framework for future research and personalized treatment.
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12
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Okubadejo NU, Okunoye O, Ojo OO, Arabambi B, Akinyemi RO, Osaigbovo GO, Abubakar SA, Iwuozo EU, Wahab KW, Agabi OP, Agulanna U, Imarhiagbe FA, Abiodun OV, Achoru CO, Adebowale AA, Adeniji O, Akpekpe JE, Ali MW, Ani-Osheku I, Arigbodi O, Balarabe SA, Bello AH, Ekenze OS, Erameh CO, Farombi TH, Fawale MB, Komolafe MA, Nwani PO, Nwazor EO, Nyandaiti Y, Obehighe EE, Obiabo YO, Odeniyi OA, Odiase FE, Ojini FI, Onwuegbuzie GA, Osemwegie N, Oshinaike OO, Otubogun FM, Oyakhire SI, Taiwo FT, Williams UE, Ozomma S, Zubair Y, Hernandez D, Bandres-Ciga S, Blauwendraat C, Singleton A, Houlden H, Hardy J, Rizig M. APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease. NPJ Parkinsons Dis 2022; 8:155. [PMID: 36371506 PMCID: PMC9653490 DOI: 10.1038/s41531-022-00411-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD.
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Affiliation(s)
- Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria.
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria.
| | - Olaitan Okunoye
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
| | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Babawale Arabambi
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Sani A Abubakar
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Emmanuel U Iwuozo
- Neurology Unit, Benue State University & Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Kolawole W Wahab
- Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Osigwe P Agabi
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Uchechi Agulanna
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Frank A Imarhiagbe
- University of Benin & University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | | | - Akintunde A Adebowale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | | | | | - Ifeyinwa Ani-Osheku
- Asokoro District Hospital, Asokoro, Abuja, Federal Capital Territory, Nigeria
| | - Ohwotemu Arigbodi
- Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Salisu A Balarabe
- Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University & Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Oluchi S Ekenze
- Neurology Unit, Department of Medicine, Faculty of Medical Sciences, University of Nigeria & University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | | | - Temitope H Farombi
- Chief Tony Anenih Geriatrics Center, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Michael B Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Paul O Nwani
- Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ernest O Nwazor
- Department of Medicine, Madonna University College of Medical Sciences, Elele, Rivers State & Federal Medical Center, Owerri, Imo State, Nigeria
| | - Yakub Nyandaiti
- University of Maiduguri & University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | | | - Yahaya O Obiabo
- Department of Internal Medicine, Delta State University & Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Francis E Odiase
- University of Benin & University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Francis I Ojini
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Gerald A Onwuegbuzie
- University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Abuja, Federal Capital Territory, Nigeria
| | - Nosakhare Osemwegie
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olajumoke O Oshinaike
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | | | - Shyngle I Oyakhire
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Funlola T Taiwo
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Uduak E Williams
- Department of Internal Medicine, University of Calabar/University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria
| | - Simon Ozomma
- Department of Internal Medicine, University of Calabar/University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria
| | - Yusuf Zubair
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Dena Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
- Neurogenetics Laboratory, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - John Hardy
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
| | - Mie Rizig
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
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Joza S, Camicioli R, Martin WRW, Wieler M, Gee M, Ba F. Pedunculopontine Nucleus Dysconnectivity Correlates With Gait Impairment in Parkinson’s Disease: An Exploratory Study. Front Aging Neurosci 2022; 14:874692. [PMID: 35875799 PMCID: PMC9304714 DOI: 10.3389/fnagi.2022.874692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gait impairment is a debilitating and progressive feature of Parkinson’s disease (PD). Increasing evidence suggests that gait control is partly mediated by cholinergic signaling from the pedunculopontine nucleus (PPN). Objective We investigated whether PPN structural connectivity correlated with quantitative gait measures in PD. Methods Twenty PD patients and 15 controls underwent diffusion tensor imaging to quantify structural connectivity of the PPN. Whole brain analysis using tract-based spatial statistics and probabilistic tractography were performed using the PPN as a seed region of interest for cortical and subcortical target structures. Gait metrics were recorded in subjects’ medication ON and OFF states, and were used to determine if specific features of gait dysfunction in PD were related to PPN structural connectivity. Results Tract-based spatial statistics revealed reduced structural connectivity involving the corpus callosum and right superior corona radiata, but did not correlate with gait measures. Abnormalities in PPN structural connectivity in PD were lateralized to the right hemisphere, with pathways involving the right caudate nucleus, amygdala, pre-supplementary motor area, and primary somatosensory cortex. Altered connectivity of the right PPN-caudate nucleus was associated with worsened cadence, stride time, and velocity while in the ON state; altered connectivity of the right PPN-amygdala was associated with reduced stride length in the OFF state. Conclusion Our exploratory analysis detects a potential correlation between gait dysfunction in PD and a characteristic pattern of connectivity deficits in the PPN network involving the right caudate nucleus and amygdala, which may be investigated in future larger studies.
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Affiliation(s)
- Stephen Joza
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Marguerite Wieler
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Myrlene Gee
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Fang Ba,
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14
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The emerging postural instability phenotype in idiopathic Parkinson disease. NPJ Parkinsons Dis 2022; 8:28. [PMID: 35304493 PMCID: PMC8933561 DOI: 10.1038/s41531-022-00287-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/01/2022] [Indexed: 01/15/2023] Open
Abstract
Identification of individuals at high risk for rapid progression of motor and cognitive signs in Parkinson disease (PD) is clinically significant. Postural instability and gait dysfunction (PIGD) are associated with greater motor and cognitive deterioration. We examined the relationship between baseline clinical factors and the development of postural instability using 5-year longitudinal de-novo idiopathic data (n = 301) from the Parkinson’s Progressive Markers Initiative (PPMI). Logistic regression analysis revealed baseline features associated with future postural instability, and we designated this cohort the emerging postural instability (ePI) phenotype. We evaluated the resulting ePI phenotype rating scale validity in two held-out populations which showed a significantly higher risk of postural instability. Emerging PI phenotype was identified before onset of postural instability in 289 of 301 paired comparisons, with a median progression time of 972 days. Baseline cognitive performance was similar but declined more rapidly in ePI phenotype. We provide an ePI phenotype rating scale (ePIRS) for evaluation of individual risk at baseline for progression to postural instability.
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Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luo C, Gao Y, Hu N, Wei X, Xiao Y, Wang W, Lui S, Gong Q. Distinct hippocampal subfield atrophy in Parkinson's disease regarding motor subtypes. Parkinsonism Relat Disord 2021; 93:66-70. [PMID: 34808520 DOI: 10.1016/j.parkreldis.2021.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Global hippocampal atrophy has been repeatedly reported in patients with Parkinson's disease (PD). However, there is limited literature on the differential involvement of hippocampal subfields among PD motor subtypes. This study aimed to investigate hippocampal subfield alterations in patients with PD based on their predominant symptoms. METHOD We enrolled 31 PD patients with the tremor-dominant (TD) subtype, 27 PD patients with postural instability and gait disturbance-dominant (PIGD) subtype, and 40 healthy controls (HCs). All participants underwent high-spatial-resolution T1-weighted magnetic resonance imaging. The volume of hippocampal subfields was measured using FreeSurfer software, compared across groups, and correlated with clinical features. RESULTS We found volumetric reductions in the hippocampal subfield in both patient subtypes compared to HCs, which were more pronounced in the PIGD subtype. The PIGD subtype had accelerated age-related alterations in the hippocampus compared to the TD subtype. Bilateral hippocampal volumes were positively associated with cognitive performance levels, but not with disease severity and duration in patients. CONCLUSIONS Alterations in the hippocampal subfields of patients with PD differed based on their predominant symptoms. These findings are of relevance for understanding the pathophysiology of the increased risk of cognitive impairment in PIGD.
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Affiliation(s)
- Chunyan Luo
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Gao
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Na Hu
- Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Xia Wei
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Xiao
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Su Lui
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
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Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions. Front Aging Neurosci 2021; 13:709484. [PMID: 34720988 PMCID: PMC8549481 DOI: 10.3389/fnagi.2021.709484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
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Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia.,Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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The Impact of Sex on the Neurocognitive Functions of Patients with Parkinson's Disease. Brain Sci 2021; 11:brainsci11101331. [PMID: 34679396 PMCID: PMC8533932 DOI: 10.3390/brainsci11101331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to understand the impact of sex on the neurocognitive function of patients with Parkinson's disease (PD). Ninety-four participants with idiopathic PD and 167 age-matched healthy individuals as normal controls (NCs) were recruited and underwent comprehensive neuropsychological assessments. Sex differences were found in NCs, but not in patients with PD. Among male participants, patients with PD showed worse performance on the Digit Symbol Substitution (DSS) (p < 0.001) test and Symbol Search (SS) (p < 0.001) than NCs. Among female participants, patients with PD showed worse performance on the category score of the Modified Wisconsin Card Sorting Test (p < 0.001), SS (p < 0.001), and pentagon copying (p < 0.001) than NCs. After controlling for the effects of age and years of education, Hoehn and Yahr stage was found to predict the performance of the Color Trails Test part A (βA = 0.241, pA = 0.036), Stroop Color and Word Test (β = -0.245, p = 0.036), and DSS (β = -0.258, p = 0.035) in men with PD. These results indicate the differential effect of sex on the neurocognitive function among healthy aging and PD populations. The disappearance of sex differences, which is present in healthy aging, in patients with PD suggests a gradual loss of the neuroprotective effect of estrogen after the initiation of the neurodegenerative process. This study also found mental flexibility and visuospatial function to be the susceptible cognitive domains in women with PD, while the disease severity could predict the working memory and processing speed in men with PD.
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Masilamoni GJ, Weinkle A, Papa SM, Smith Y. Cortical Serotonergic and Catecholaminergic Denervation in MPTP-Treated Parkinsonian Monkeys. Cereb Cortex 2021; 32:1804-1822. [PMID: 34519330 DOI: 10.1093/cercor/bhab313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/14/2022] Open
Abstract
Decreased cortical serotonergic and catecholaminergic innervation of the frontal cortex has been reported at early stages of Parkinson's disease (PD). However, the limited availability of animal models that exhibit these pathological features has hampered our understanding of the functional significance of these changes during the course of the disease. In the present study, we assessed longitudinal changes in cortical serotonin and catecholamine innervation in motor-symptomatic and asymptomatic monkeys chronically treated with low doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Densitometry and unbiased stereological techniques were used to quantify changes in serotonin and tyrosine hydroxylase (TH) immunoreactivity in frontal cortices of 3 control monkeys and 3 groups of MPTP-treated monkeys (motor-asymptomatic [N = 2], mild parkinsonian [N = 3], and moderate parkinsonian [N = 3]). Our findings revealed a significant decrease (P < 0.001) in serotonin innervation of motor (Areas 4 and 6), dorsolateral prefrontal (Areas 9 and 46), and limbic (Areas 24 and 25) cortical areas in motor-asymptomatic MPTP-treated monkeys. Both groups of symptomatic MPTP-treated animals displayed further serotonin denervation in these cortical regions (P < 0.0001). A significant loss of serotonin-positive dorsal raphe neurons was found in the moderate parkinsonian group. On the other hand, the intensity of cortical TH immunostaining was not significantly affected in motor asymptomatic MPTP-treated monkeys, but underwent a significant reduction in the moderate symptomatic group (P < 0.05). Our results indicate that chronic intoxication with MPTP induces early pathology in the corticopetal serotonergic system, which may contribute to early non-motor symptoms in PD.
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Affiliation(s)
- Gunasingh Jeyaraj Masilamoni
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Udall Center of Excellence for Parkinson's Disease, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Allison Weinkle
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Stella M Papa
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Yoland Smith
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Udall Center of Excellence for Parkinson's Disease, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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20
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Bugalho P, Ladeira F, Barbosa R, Marto JP, Borbinha C, da Conceição L, Salavisa M, Saraiva M, Meira B, Fernandes M. Progression in Parkinson's Disease: Variation in Motor and Non-motor Symptoms Severity and Predictors of Decline in Cognition, Motor Function, Disability, and Health-Related Quality of Life as Assessed by Two Different Methods. Mov Disord Clin Pract 2021; 8:885-895. [PMID: 34405096 DOI: 10.1002/mdc3.13262] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/28/2021] [Accepted: 05/05/2021] [Indexed: 01/14/2023] Open
Abstract
Background Parkinson's disease (PD) is multi-symptom disease with variable progression. Objectives We performed a longitudinal study to address the evolution of motor symptoms (MS) and non-motor symptoms (NMS), predictors of motor-, cognitive-, disability-, and health-related quality of life (HRQL) status and the relative usefullness of a battery of separate NMS scales (BSS) versus the Non-Motor Symptom Scale (NMSS). Methods Seventy-two patients were assessed at baseline and 4 years later with the NMSS and BSS. We assessed the following outcomes: cognition (Montreal Cognitive Assessment scale [MoCA]), disability (Unified Parkinson's Disease Rating Scale Part II [UPDRS II], Schwab and England [S&E]), motor dysfunction (Unified Parkinson's Disease Rating Scale Part III [UPDRS III], Hoehn and Yahr [HY]), and HRQL (EuroQol [EQ] EQ-vertical visual analogue scale [VAS] and EQ-Index). Statistical analysis included a comparison between scales scores at both time points and multivariate regression analysis to calculate the impact of each baseline symptom in outcomes. NMSS and BSS were introduced in separate models. Results NMSS Domain 4: perception/hallucinations, Parkinson's Psychosis Questionnaire, Apathy Scale, NMSS Domain 7: urinary, S&E, UPDRS II, HY, and MoCA scores worsened significantly. Dementia increased to a 4-year prevalence of 39.8%. In the multivariate model using BSS, cognitive state variation was significantly predicted by baseline HY, EQ-Index, and S&E. Using the NMSS, MoCA change was significantly associated with NMSS Domain 4: perceptions/hallucination score, cognitive status with UPDRS III score, HRQL with NMSS Domain 4: perception/hallucinations score, and S&E. Conclusion Our study suggests that NMS progress heterogeneously, BSS approach being more sensitive to change than NMSS. The multivariate analysis has shown that S&E and NMSS Domain 4: perception/hallucinations scores are the stronger predictors of HRQL and cognitive dysfunction variation, favoring NMSS over the BSS approach.
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Affiliation(s)
- Paulo Bugalho
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal.,CEDOC, Chronic Diseases Research Center NOVA Medical School Lisbon Portugal
| | - Filipa Ladeira
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Raquel Barbosa
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal.,CEDOC, Chronic Diseases Research Center NOVA Medical School Lisbon Portugal
| | - João P Marto
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal.,CEDOC, Chronic Diseases Research Center NOVA Medical School Lisbon Portugal
| | - Claudia Borbinha
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Laurete da Conceição
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Manuel Salavisa
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marlene Saraiva
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Bruna Meira
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marco Fernandes
- Department of Neurology, Hospital de Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
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21
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Mehta S, Lal V. Exploring the Relationship between Bradykinesia and Cognitive Impairment in Parkinson's Disease. Neurol India 2021; 69:609-610. [PMID: 34169852 DOI: 10.4103/0028-3886.319239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sahil Mehta
- Department of Neurology, PGIMER, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, PGIMER, Chandigarh, India
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22
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Sousa NMF, Macedo RC, Brucki SMD. Cross-sectional associations between cognition and mobility in Parkinson's disease. Dement Neuropsychol 2021; 15:105-111. [PMID: 33907603 PMCID: PMC8049584 DOI: 10.1590/1980-57642021dn15-010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cross-sectional studies show an association of decline in mental flexibility and
inhibitory control with reduced gait speed and falls, as well as divided
attention deficit and difficulty in initiating gait.
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Affiliation(s)
- Nariana Mattos Figueiredo Sousa
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil.,Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Roberta Correa Macedo
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
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23
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Huang Y, Ma J, Jiang B, Yang N, Fu F, Chen X, Liu C, Miao X, Mao H, Zheng R, Wang J, Ding K, Zhang X. Effect of nutritional risk on cognitive function in patients with chronic obstructive pulmonary disease. J Int Med Res 2021; 49:300060521990127. [PMID: 33535842 PMCID: PMC7869158 DOI: 10.1177/0300060521990127] [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] [Indexed: 12/31/2022] Open
Abstract
Objective We aimed to clarify the cognitive function of patients with chronic obstructive pulmonary disease (COPD) and different nutritional status. Methods Among 95 patients with COPD in this retrospective study, we administered the Nutritional Risk Screening 2002 (NRS 2002) and Mini-Mental State Examination (MMSE). We recorded patients’ clinical characteristics, comorbidities, and laboratory measurements. According to NRS 2002 scores, patients were divided into two groups: no nutritional risk with NRS 2002 < 3 (n = 54) and nutritional risk, with NRS 2002 ≥ 3 (n = 41). Results We found a negative correlation between NRS 2002 and MMSE scores in participants with COPD (r = −0.313). Patients with nutritional risk were more likely to be cognitively impaired than those with no nutritional risk. Multivariate logistic regression analysis indicated that malnutrition was an independent risk factor for cognitive impairment, after adjusting for confounders (odds ratio [OR] = 4.120, 95% confidence interval [CI]: 1.072–15.837). We found a similar association between NRS 2002 and MMSE scores at 90-day follow-up using a Pearson’s correlation test (r = −0.493) and logistic regression analysis (OR = 7.333, 95% CI: 1.114–48.264). Conclusions Patients with COPD at nutritional risk are more likely to have cognitive impairment.
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Affiliation(s)
- Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiedong Ma
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Bingqian Jiang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Naiping Yang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Fangyi Fu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunyan Liu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Huanhuan Mao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rongrong Zheng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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24
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Chen KK, Jin ZH, Gao L, Qi L, Zhen QX, Liu C, Wang P, Liu YH, Wang RD, Liu YJ, Fang JP, Su Y, Yan XY, Liu AX, Fang BY. Efficacy of short-term multidisciplinary intensive rehabilitation in patients with different Parkinson's disease motor subtypes: a prospective pilot study with 3-month follow-up. Neural Regen Res 2021; 16:1336-1343. [PMID: 33318414 PMCID: PMC8284270 DOI: 10.4103/1673-5374.301029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Parkinson's disease (PD) can be classified into three motor-based subtypes: postural instability/gait difficulty (PIGD), tremor dominant (TD), and indeterminate. The neuropathophysiological mechanisms of the three motor subtypes are different, which may lead to different responses to therapy. Sixty-nine patients with idiopathic Parkinson's disease (Hoehn-Yahr stage ≤ 3) were screened from 436 patients with Parkinsonism recruited through outpatient services and the internet. According to the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) TD/PIGD ratio, the patients were divided into PIGD (TD/PIGD ≤ 0.09; n = 36), TD (TD/PIGD ≥1.15; n = 19), and indeterminate (TD/PIGD = 0.90-1.15; n = 14) groups. All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment (MIRT) during hospitalization, as well as a remote home rehabilitation health education class. Compared with the scores at admission, all patients showed significant improvements in their MDS-UPDRS III score, walking ability, balance, and posture control at discharge. Moreover, the MDS-UPDRS III score improvement was greater in the PIGD group than in the TD group. The follow-up data, collected for 3 months after discharge, showed that overall symptom improvement in each group was maintained for 1-3 months. Furthermore, there were no significant differences in the duration or grade effects of symptom improvement among the three groups. These findings suggest that 2 weeks of MIRT is effective for improving motor performance in all three motor subtypes. Patients in the PIGD group had a better response after hospitalization than those in the TD group. This study was approved by the Institutional Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University of China (approval No. 2018bkky022) on May 7, 2018 and registered with the Chinese Clinical Trial Registry (registration No. ChiCTR1900020771) on January 19, 2019.
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Affiliation(s)
- Ke-Ke Chen
- Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China
| | - Zhao-Hui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lei Gao
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Qi
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiao-Xia Zhen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Cui Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ping Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yong-Hong Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jin-Ping Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Yan
- Peking University Clinical Research Institute, Beijing, China
| | - Ai-Xian Liu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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25
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Beretta VS, Conceição NR, Nóbrega-Sousa P, Orcioli-Silva D, Dantas LKBF, Gobbi LTB, Vitório R. Transcranial direct current stimulation combined with physical or cognitive training in people with Parkinson's disease: a systematic review. J Neuroeng Rehabil 2020; 17:74. [PMID: 32539819 PMCID: PMC7296764 DOI: 10.1186/s12984-020-00701-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pharmacologic therapy is the primary treatment used to manage Parkinson's disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. AIMS This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. METHODS The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. RESULTS Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. CONCLUSION The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.
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Affiliation(s)
- Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Núbia Ribeiro Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Luana Karla Braz Fonseca Dantas
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil.
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil.
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
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26
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Tsuboi T, Lemos Melo Lobo Jofili Lopes J, Patel B, Legacy J, Moore K, Eisinger RS, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Parkinson's disease motor subtypes and bilateral GPi deep brain stimulation: One-year outcomes. Parkinsonism Relat Disord 2020; 75:7-13. [PMID: 32428801 DOI: 10.1016/j.parkreldis.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to explore the differences in motor symptoms and quality of life (QOL) outcomes following bilateral globus pallidus internus deep brain stimulation (GPi DBS), across well-defined motor subtypes of Parkinson's disease (PD), to improve clinical decision making. METHODS This single-center retrospective study investigated bilateral GPi DBS outcomes in 65 PD patients. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire (PDQ-39) before and one year after surgery. Outcomes were compared between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) subtypes and between the TD and akinetic-rigid (AR) subtypes. RESULTS For the entire cohort, motor function (UPDRS III) in the Off-medication state, motor complications (UPDRS IV), activities of daily living (ADL, UPDRS II), and the ADL and discomfort domains of PDQ-39 significantly improved one year following GPi implantation compared to baseline (effect size = 1.32, 1.15, 0.25, 0.45, and 0.34, respectively). GPi DBS improved the Off-medication UPDRS III scores regardless of the motor subtypes. However, compared to the PIGD and AR patients, the TD patients showed greater improvement in overall UPDRS III postoperatively primarily due to greater tremor improvement in the Off-medication state. The outcomes in akinesia, rigidity, axial symptoms and QOL were similar among all subtypes. CONCLUSION Bilateral GPi DBS was effective for advanced PD patients regardless of motor subtypes. Greater tremor improvement in the TD patients accounted for greater Off-medication motor improvement. Longer-term GPi DBS outcomes across different motor subtypes and brain targets should be further studied.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | | | - Bhavana Patel
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joseph Legacy
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kathryn Moore
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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27
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Li J, Gu C, Zhu M, Li D, Chen L, Zhu X. Correlations between blood lipid, serum cystatin C, and homocysteine levels in patients with Parkinson's disease. Psychogeriatrics 2020; 20:180-188. [PMID: 31828903 DOI: 10.1111/psyg.12483] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/29/2019] [Accepted: 09/21/2019] [Indexed: 12/15/2022]
Abstract
AIM The aim was too study the correlations between blood lipid, serum cystatin C (Cys C) and homocysteine (Hcy) levels in patients with Parkinson's disease (PD). METHODS A total of 322 PD patients and 214 healthy subjects were selected as case and control groups, respectively. The risk factors were explored by logistic regression analysis. The case group was subtyped according to main motor symptoms and age of onset. The correlations of significantly different indices with age, duration of disease, and equivalent dose of levodopa were studied by Spearman's correlation analysis. Receiver operating characteristic curves were plotted to analyze diagnostic values. RESULTS Compared to the control group, the PD group had lower serum total cholesterol, triglyceride, and apolipoprotein B (Apo B) levels and higher high-density lipoprotein cholesterol (HDL-C), Hcy, and Cys C levels (P < 0.05). Decreased Apo B level and increased HDL-C and Hcy levels were independent risk factors (P < 0.05). The Cys C level of early-onset patients was lower than of late-onset patients (P < 0.05). Hcy (r = 0.198, P < 0.05) and Cys C (r = 0.281, P < 0.05) levels were positively correlated with age. Triglyceride level was negatively correlated with age (r = -0.202, P < 0.05) and disease duration (r = -0.198, P < 0.05). Unified Parkinson's Disease Rating Scale III score was positively correlated with disease duration (r = 0.435, P < 0.05) and equivalent dose of levodopa (r = 0.423, P < 0.05). The areas under the curve for Apo B, HDL-C, and Hcy levels were 0.341, 0.588, and 0.643, respectively (P < 0.05). The combination of Apo B, HDL-C, and Hcy levels showed high diagnostic value, with a sensitivity of 76.4% and specificity of 69.5%. CONCLUSIONS Low serum levels of total cholesterol, triglyceride, and Apo B, and high levels of HDL-C, Hcy, and Cys C may be correlated with PD onset and progression. Decreased Apo B level and elevated HDL-C and Hcy levels are independent risk factors. Early-onset and late-onset PD may have different progression mechanisms.
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Affiliation(s)
- Jia Li
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chengzhi Gu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Min Zhu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Dan Li
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Lan Chen
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiangyang Zhu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
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28
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Sousa NMF, Macedo RC. Relationship between cognitive performance and mobility in patients with Parkinson's disease: A cross-sectional study. Dement Neuropsychol 2019; 13:403-409. [PMID: 31844493 PMCID: PMC6907702 DOI: 10.1590/1980-57642018dn13-040006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gait disorders may be associated with cognitive impairment, and slow speed
predicts cognitive impairment and dementia. Objective: To investigate the
relationships between cognitive function and gait performance in patients with
Parkinson’s disease (PD) who attended a hospital neurorehabilitation program.
Methods: Descriptive and inferential statistics (Pearson’s correlation) were
used for data analysis. The cognitive functions were evaluated through Digit
Span, Mental Control, Trail Making Test, Phonemic Verbal Fluency Task, and
Addenbrooke’s Cognitive Examination III. The motor function was assessed through
10-meter walk test, Mini BESTest and Timed Up and Go Test. Results: A total of
65 patients were included in this study. Of these, 66.15% were males, mean age
was 61.14 (8.39) years, mean educational was 12 (8) years, disease progression
time was 5.45 (4.37) years. 64.61% were in stages I and II of the Hoehn and Yahr
stage. The correlation analyses showed that balance skills are significantly
correlated with the ability to switch attention between two tasks and
visuospatial function. The function mobility showed a significant correlation
with cognitive tests. Conclusion: Data suggest the importance of the aspects of
switch attention and mental flexibility in gait, evidencing the greater
difficulty for double tasks.
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Affiliation(s)
| | - Roberta Correa Macedo
- Rede SARAH de Hospitais de Reabilitação Ringgold standard institution - Reabilitação Neurológica, Salvador, BA, Brazil
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29
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Alvarado-Bolaños A, Cervantes-Arriaga A, Arredondo-Blanco K, Salinas-Barboza K, Isais-Millán S, Rodríguez-Violante M. Falls in persons with Parkinson's disease: Do non-motor symptoms matter as much as motor symptoms? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:761-767. [DOI: 10.1590/0004-282x20190148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022]
Abstract
ABSTRACT Falls are common among persons with Parkinson's disease (PD). On the other hand, predicting falls is complex as there are both generic and PD-specific contributors. In particular, the role of non-motor symptoms has been less studied. Objective: The objective of this study was to identify the role of non-motor predictors of falling in persons with PD (PwP). Methods: A cross-sectional study was carried out in PwP recruited from a movement disorders clinic. Clinical and demographical data were collected. All PwP were assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Variables were assessed at the bivariate level. Significant variables were put into a logistic regression model. Results: A total of 179 PwP were included. Overall, 16.8% of PwP had fallen in the past 12 months, with 53.3% of them being recurrent fallers. The mean number of monthly falls was 2.5 ± 3.3. Factors associated with falling in the bivariate analysis included the disease duration, Hoehn and Yahr stage, MDS-UPDRS part I and II, postural instability/gait disturbance (PIGD) subtype, NMSS urinary domain, NMSS miscellaneous domain, and non-motor severity burden (all p-values < 0.05). After multivariate analysis, only the disease duration (p = 0.03) and PIGD (p = 0.03) remained as independent risk factors. Conclusion: Disease duration and the PIGD subtype were identified as relevant risk factors for falls in PwP Non-motor symptoms appear to have a less important role as risk factors for falls.
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Affiliation(s)
| | | | | | | | | | - Mayela Rodríguez-Violante
- Instituto Nacional de Neurología y Neurocirugía, Mexico; Instituto Nacional de Neurología y Neurocirugía, Mexico
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30
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Maraki MI, Stefanis L, Yannakoulia M, Kosmidis MH, Xiromerisiou G, Dardiotis E, Hadjigeorgiou GM, Sakka P, Scarmeas N, Stamelou M. Motor function and the probability of prodromal Parkinson's disease in older adults. Mov Disord 2019; 34:1345-1353. [PMID: 31314148 DOI: 10.1002/mds.27792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Identification and characterization of Parkinson's disease (PD) in its prodromal stage is crucial. OBJECTIVE The objective of this study was to investigate the association between motor function and the probability of prodromal PD in a community-dwelling older population. METHODS We used data from a population-based cohort of older adults (HELIAD study). Subjective motor function was evaluated with a 12-item motor symptoms questionnaire and objective motor function indirectly with a physical activity questionnaire and two gait speed tests. The probability of prodromal PD was calculated according to the Movement Disorder Society research criteria for n = 1731 without PD. Regression multiadjusted models were used to investigate the associations between each motor measure and prodromal PD probability. RESULTS For each unit increase in motor symptoms score and for each kcal/kg/day lower energy expenditure (corresponding to 20 minutes of light walking/day for a 75-kg man) there was a 27% and 3% higher probability for prodromal PD, respectively (P < 0.001). Having at least one subjective motor symptom increased the odds of having possible/probable prodromal PD (n = 49; P < 0.05). Including subjective and indirect motor variables in the same model showed that both (symptoms and physical activity) contributed significantly to the model (P < 0.01). Excluding subthreshold parkinsonism from the calculation showed that gait speed less than 0.8 m/s was also associated with a higher prodromal PD probability score (P < 0.001). CONCLUSIONS Subjective motor symptoms as well as simple objective motor measures of physical activity or gait speed are associated with a higher probability of prodromal PD in older adults. These data may serve to enable the early identification of prodromal PD cohorts, particularly if they are confirmed in longitudinal studies. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Maria I Maraki
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.,Section of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Georgios M Hadjigeorgiou
- School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus, Cyprus, Greece
| | - Paraskevi Sakka
- Athens Association of Alzheimer's Disease and Related Disorders, Marousi, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, USA
| | - Maria Stamelou
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Parkinson's Disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece
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31
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Laurencin C, Thobois S. Malattia di Parkinson e depressione. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, Hass CJ, Hausdorff JM, Pelosin E, Almeida QJ. Gait impairments in Parkinson's disease. Lancet Neurol 2019; 18:697-708. [PMID: 30975519 DOI: 10.1016/s1474-4422(19)30044-4] [Citation(s) in RCA: 319] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease. Nonetheless, gait is not routinely assessed quantitatively but is described in general terms that are not sensitive to changes ensuing with disease progression. Quantifying multiple gait features (eg, speed, variability, and asymmetry) under natural and more challenging conditions (eg, dual-tasking, turning, and daily living) enhanced sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. Advances in the understanding of the multifactorial origins of gait changes in patients with Parkinson's disease promoted the development of new intervention strategies, such as neurostimulation and virtual reality, aimed at alleviating gait impairments and enhancing functional mobility. For clinical applicability, it is important to establish clear links between specific gait impairments, their underlying mechanisms, and disease progression to foster the acceptance and usability of quantitative gait measures as outcomes in future disease-modifying clinical trials.
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Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jamie L Hamilton
- Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Chris J Hass
- College of Health and Human Performance, Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elisa Pelosin
- Department of Neuroscience (DINOGMI), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Quincy J Almeida
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada
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33
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The Dual-Tasking Overload on Functional Mobility Is Related to Specific Cognitive Domains in Different Subtypes of Parkinson's Disease. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Pantall A, Suresparan P, Kapa L, Morris R, Yarnall A, Del Din S, Rochester L. Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease. Front Neurol 2018; 9:1044. [PMID: 30568629 PMCID: PMC6290334 DOI: 10.3389/fneur.2018.01044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022] Open
Abstract
Early features of Parkinson's disease (PD) include both motor and cognitive changes, suggesting shared common pathways. A common motor dysfunction is postural instability, a known predictor of falls, which have a major impact on quality of life. Understanding mechanisms of postural dynamics in PD and specifically how they relate to cognitive changes is essential for developing effective interventions. The aims of this study were to examine the changes that occur in postural metrics over time and explore the relationship between postural and cognitive dysfunction. The study group consisted of 35 people (66 ± 8years, 12 female, UPDRS III: 22.5 ± 9.6) diagnosed with PD who were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation—PD Gait (ICICLE-GAIT) study. Postural and cognitive assessments were performed at 18, 36, and 54 months after enrolment. Participants stood still for 120 s, eyes open and arms by their side. Postural dynamics were measured using metrics derived from a single tri-axial accelerometer (Axivity AX3, York, UK) on the lower back. Accelerometry metrics included jerk (derivative of acceleration), root mean square, frequency, and ellipsis (acceleration area). Cognition was evaluated by neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and digit span. There was a significant decrease in accelerometry parameters, greater in the anteroposterior direction, and a decline in cognitive function over time. Accelerometry metrics were positively correlated with lower cognitive function and increased geriatric depression score and negatively associated with a qualitative measure of balance confidence. In conclusion, people with PD showed reduced postural dynamics that may represent a postural safety strategy. Associations with cognitive function and depression, both symptoms that may pre-empt motor symptoms, suggest shared neural pathways. Further studies, involving neuroimaging, may determine how these postural parameters relate to underlying neural and clinical correlates.
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Affiliation(s)
- Annette Pantall
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Piriya Suresparan
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Leanne Kapa
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Alison Yarnall
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Silvia Del Din
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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35
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Intzandt B, Beck EN, Silveira CR. The effects of exercise on cognition and gait in Parkinson’s disease: A scoping review. Neurosci Biobehav Rev 2018; 95:136-169. [DOI: 10.1016/j.neubiorev.2018.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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36
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Herman T, Shema-Shiratzky S, Arie L, Giladi N, Hausdorff JM. Depressive symptoms may increase the risk of the future development of freezing of gait in patients with Parkinson's disease: Findings from a 5-year prospective study. Parkinsonism Relat Disord 2018; 60:98-104. [PMID: 30236826 DOI: 10.1016/j.parkreldis.2018.09.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prospective studies identifying predictors of freezing of gait (FOG) in Parkinson's disease (PD) are limited. We aim to explore which symptoms are associated with future development of FOG in non-freezers. METHODS Fifty-seven PD patients without FOG at baseline were re-evaluated after a mean of five years. At baseline, disease severity [Unified Parkinson's Disease Rating Scale (MDS-UPDRS)], gait under single and dual-tasking, balance, cognition and other non-motor symptoms were assessed. The new-FOG-questionnaire (NFOG-Q) determined FOG. Multivariate binary logistic regression determined independent predictors of FOG. RESULTS At follow-up, 26 subjects (46%) had FOG while 31 remained non-freezers. At baseline, non-freezers (FOG-) and future freezers (FOG+) were similar (p > 0.10) with respect to age, gender, disease duration, dopaminergic medications, and cognitive function. However, FOG + had significantly worse scores on the Geriatric Depression Scale (GDS) (FOG+:5.2 ± 3.7; FOG-:2.4 ± 2.0, p = 0.005), PDQ-39, the NMS-questionnaire, UPDRS-part I, UPDRS-part III (off), and the Berg Balance Scale. In binary logistic regression, GDS, gait speed and UPDRS-III (on vs. off) were the only significant independent predictors of future FOG (GDS: OR = 10.93, p = 0.003, ΔUPDRS-III: OR = 1.34, p = 0.006). Moreover, 80% of the subjects who had marked depressive symptoms at baseline (GDS≥5) developed FOG at follow-up. In contrast, only 27% of those with few depressive symptoms at baseline became freezers (p < 0.001). CONCLUSIONS Depressive symptoms apparently precede the development of FOG. While elucidation of the relationship between depression and FOG needs further study, our findings offer another perspective regarding the pathophysiology of FOG and may help clinicians to estimate the risk of developing this debilitating phenomenon.
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Affiliation(s)
- Talia Herman
- The Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Shirley Shema-Shiratzky
- The Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liraz Arie
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Nir Giladi
- The Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- The Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA
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37
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Who will remain tremor dominant? The possible role of cognitive reserve in the time course of two common Parkinson's disease motor subtypes. J Neural Transm (Vienna) 2018; 125:1007-1011. [PMID: 29450651 DOI: 10.1007/s00702-018-1859-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
Abstract
In a prospective 5-year study among Parkinson's disease (PD) tremor-dominant (TD) patients, we investigated who will remain TD and who will later convert into the postural instability gait difficulty (PIGD) phenotype. At follow-up, 38% were still considered TD. At baseline the TD non-convertors had more years of education and better cognitive function than the convertors and significantly smaller deterioration in gait, balance, cognitive function and other non-motor symptoms. These results highlight the potential role of cognition in protecting against the development of PIGD symptoms.
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