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de Andrade VCS, Alonso AC, Luna NMS, Rogatto FBT, Brech GC, Bocalini DS, Greve JMD. EFFECTS OF TREADMILL GAIT TRAINING ON BALANCE IN PARKINSON'S PATIENTS AFTER DEEP BRAIN STIMULATION. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e266917. [PMID: 39086846 PMCID: PMC11288324 DOI: 10.1590/1413-785220243203e266917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 08/02/2024]
Abstract
Objective After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.
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Affiliation(s)
| | - Angelica Castilho Alonso
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Laboratório de Estudo do Movimento, São Paulo, SP, Brazil
- Universidade São Judas Tadeu, Programa de Pos-Graduação em Ciências do Envelhecimento, São Paulo, SP, Brazil
| | - Natalia Mariana Silva Luna
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Laboratório de Estudo do Movimento, São Paulo, SP, Brazil
- Universidade São Judas Tadeu, Programa de Pos-Graduação em Ciências do Envelhecimento, São Paulo, SP, Brazil
| | | | - Guilherme Carlos Brech
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Laboratório de Estudo do Movimento, São Paulo, SP, Brazil
- Universidade São Judas Tadeu, Programa de Pos-Graduação em Ciências do Envelhecimento, São Paulo, SP, Brazil
| | - Danilo Sales Bocalini
- Universidade Federal do Espírito Santo, Centro de Educação Física e Desporto, Laboratório de Fisiologia e Bioquímica Experimental, Vitoria, ES, Brazil
| | - Júlia Maria D'Andrea Greve
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Laboratório de Estudo do Movimento, São Paulo, SP, Brazil
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Miyahara Y, Phokaewvarangkul O, Kerr S, Anan C, Toriumi H, Bhidayasiri R. Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial. Front Neurol 2024; 15:1327448. [PMID: 38348165 PMCID: PMC10859456 DOI: 10.3389/fneur.2024.1327448] [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: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD. Methods This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score. Results TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred. Conclusion The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential. Clinical trial registration https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.
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Affiliation(s)
- Yuka Miyahara
- Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Wat Pho Thai Traditional Medical School, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Stephen Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Haruki Toriumi
- Department of Acupuncture, Shonan Keiiku Hospital, Fujisawa, Japan
- Toriumi Acupuncture Clinic, Tokyo, Japan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Mirelman A, Siderowf A, Chahine L. Outcome Assessment in Parkinson Disease Prevention Trials: Utility of Clinical and Digital Measures. Neurology 2022; 99:52-60. [PMID: 35970590 DOI: 10.1212/wnl.0000000000200236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prodromal phase of Parkinson disease (PD) is accompanied by subtle clinical signs that are not sufficient for diagnosis but could potentially be measured in the context of clinical trials of therapies intended to delay or prevent more definitive clinical features. The objective of this study was to review the available literature on the presence and time course of subtle motor features in prodromal PD in the context of planning for possible clinical trials. METHODS We reviewed the available literature based on expert opinion. We considered a range of outcomes including measurement of clinical features, patient-reported outcomes, digital markers, and clinical diagnosis. RESULTS We considered these features and measures in the context of patient stratification, intermediate outcomes, and clinically relevant end points, including phenoconversion. DISCUSSION Substantial progress has been made in understanding how motor features evolve in the period immediately before a PD diagnosis. Digital measures hold substantial progress for measurement precision and may be additionally relevant because they can be used in naturalistic environments outside the clinic. Future studies should focus on advancing digital sensor technology and analysis and developing methods to implement available methods, particularly determination of a clinical diagnosis of PD, in a clinical trial context.
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Affiliation(s)
- Anat Mirelman
- From the Sackler School of Medicine and Sagol School of Neuroscience (A.M.), Tel Aviv University, Israel; Department of Neurology (A.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Neurology (L.C.), University of Pittsburgh, PA
| | - Andrew Siderowf
- From the Sackler School of Medicine and Sagol School of Neuroscience (A.M.), Tel Aviv University, Israel; Department of Neurology (A.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Neurology (L.C.), University of Pittsburgh, PA.
| | - Lana Chahine
- From the Sackler School of Medicine and Sagol School of Neuroscience (A.M.), Tel Aviv University, Israel; Department of Neurology (A.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Department of Neurology (L.C.), University of Pittsburgh, PA
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Jang JH, Park S, An J, Choi JD, Seol IC, Park G, Lee SH, Moon Y, Kang W, Jung ES, Cha JY, Kim CY, Kim S, Jung IC, Yoo H. Gait Disturbance Improvement and Cerebral Cortex Rearrangement by Acupuncture in Parkinson's Disease: A Pilot Assessor-Blinded, Randomized, Controlled, Parallel-Group Trial. Neurorehabil Neural Repair 2020; 34:1111-1123. [PMID: 33198568 DOI: 10.1177/1545968320969942] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Parkinson's disease (PD) leads to impaired mobility and limited independence. OBJECTIVE We investigated the effects of acupuncture on gait disturbance and analyzed hemodynamic changes caused by acupuncture in the cerebral cortex of patients with PD. METHODS Participants (n = 26) with gait disturbance due to PD were randomly assigned to the intervention (acupuncture twice a week for 4 weeks + conventional therapy) or control (conventional therapy) groups. We analyzed gait parameters using the GAITRite system and hemodynamic responses in the cerebral cortices using functional near-infrared spectroscopy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, neurotransmitter levels, as well as the immediate effects of acupuncture in patients with PD. RESULTS The participants tended to walk with hypometric gait (high cadence, short steps) overground. After acupuncture treatment, those in the intervention group showed a significant reduction in cadence and the UPDRS scores involving "walking and balance" compared with those in the control group (P = .004 and P = .020, respectively); the stride, swing, and single support times were significantly increased (P = .006, P = .001, and P = .001, respectively). Oxyhemoglobin levels in the intervention group while walking on a treadmill were significantly increased in the prefrontal and supplementary motor areas. The oxyhemoglobin levels in the prefrontal cortex and swing time revealed significant positive correlations. CONCLUSIONS Our findings indicated that acupuncture tended to improve hypometric gait and rearranged activation of the cerebral cortex. Thus, acupuncture may be a useful complementary treatment for gait disturbance, including hypometric gait, in patients with PD. Trial Registration Number. Clinical Research Information Service (KCT0002603), https://cris.nih.go.kr/cris/index.jsp.
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Affiliation(s)
- Jung-Hee Jang
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea.,Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sangsoo Park
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Jinung An
- Convergence Research Center for Wellness, Digist R4-814, Dalseong-Gun, Daegu, Republic of Korea
| | - Jong-Duk Choi
- College of Health & Medical Science, Graduate School, Daejeon City, Republic of Korea
| | - In Chan Seol
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Gunhyuk Park
- Korea Institute of Oriental Medicine, Naju-si, Jeollanam-do, Republic of Korea
| | | | - Young Moon
- College of Health & Medical Science, Graduate School, Daejeon City, Republic of Korea
| | - Weechang Kang
- Daejeon University, Dong-gu, Daejeon City, Republic of Korea
| | - Eun-Sun Jung
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Ji-Yun Cha
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Chan-Young Kim
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Siyeon Kim
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - In Chul Jung
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
| | - Horyong Yoo
- Dunsan Korean Medicine Hospital, Seo-gu, Daejeon, Republic of Korea
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Álvarez I, Latorre J, Aguilar M, Pastor P, Llorens R. Validity and sensitivity of instrumented postural and gait assessment using low-cost devices in Parkinson's disease. J Neuroeng Rehabil 2020; 17:149. [PMID: 33176833 PMCID: PMC7656721 DOI: 10.1186/s12984-020-00770-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate assessment of balance and gait is necessary to monitor the clinical progress of Parkinson's disease (PD). Conventional clinical scales can be biased and have limited accuracy. Novel interactive devices are potentially useful to detect subtle posture or gait-related impairments. METHODS Posturographic and single and dual-task gait assessments were performed to 54 individuals with PD and 43 healthy controls with the Wii Balance Board and the Kinect v2 and the, respectively. Individuals with PD were also assessed with the Tinetti Performance Oriented Mobility Assessment, the Functional Gait Assessment and the 10-m Walking Test. The influence of demographic and clinical variables on the performance in the instrumented posturographic and gait tests, the sensitivity of these tests to the clinical condition and phenotypes, and their convergent validity with clinical scales were investigated. RESULTS Individuals with PD in H&Y I and I.5 stages showed similar performance to controls. The greatest differences in posture and gait were found between subjects in H&Y II.5 and H&Y I-I.5 stage, as well as controls. Dual-tasking enhanced the differences among all groups in gait parameters. Akinetic/rigid phenotype showed worse postural control and gait than other phenotypes. High significant correlations were found between the limits of stability and most of gait parameters with the clinical scales. CONCLUSIONS Low-cost devices showed potential to objectively quantify posture and gait in established PD (H&Y ≥ II). Dual-tasking gait evaluation was more sensitive to detect differences among PD stages and compared to controls than free gait. Gait and posture were more impaired in akinetic/rigid PD.
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Affiliation(s)
- Ignacio Álvarez
- Fundació Docència i Recerca Mútua de Terrassa, Terrassa, Barcelona, Spain
- Movement disorders Unit, Department of Neurology, Memory Disorders Unit, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto Interuniversitario de Investigación en Bioingeniería, Universitat Politècnica de València, Ciudad Politécnica de la Innovación-Building 8B-Access M-Floor 0, Camino de Vera s/n, 46022, Valencia, Spain
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Río Tajo 1, 46011, Valencia, Spain
| | - Miquel Aguilar
- Fundació Docència i Recerca Mútua de Terrassa, Terrassa, Barcelona, Spain
- Movement disorders Unit, Department of Neurology, Memory Disorders Unit, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Pau Pastor
- Fundació Docència i Recerca Mútua de Terrassa, Terrassa, Barcelona, Spain
- Movement disorders Unit, Department of Neurology, Memory Disorders Unit, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto Interuniversitario de Investigación en Bioingeniería, Universitat Politècnica de València, Ciudad Politécnica de la Innovación-Building 8B-Access M-Floor 0, Camino de Vera s/n, 46022, Valencia, Spain.
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Río Tajo 1, 46011, Valencia, Spain.
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Onder H, Ozyurek O. The impact of distinct cognitive dual-tasks on gait in Parkinson's disease and the associations with the clinical features of Parkinson's disease. Neurol Sci 2020; 42:2775-2783. [PMID: 33150515 DOI: 10.1007/s10072-020-04874-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the impact of distinct cognitive dual-task abilities in patients with Parkinson's disease (PD) and compare the impact of these dual-tasks in association with the severity of PD and its clinical features. MATERIALS AND METHODS Modified Hoehn and Yahr Scale, UPDRS, and Standardized Mini-Mental State Examination (SMMSE) were evaluated in all PD patients. The subtype of PD and the presence of freezing of gait (FOG) were also evaluated. The Timed Up and Go (TUG) test was applied under single- and dual-task conditions including the digit span-forwards, digit span-backwards, delayed recall memory, counting down the days, counting backwards from 20, and animal fluency tests. RESULTS Most of the cognitive dual-tasks resulted in deterioration in gait performance in our PD subjects. Remarkably, the completion time of TUG duration under single- and dual-task of counting down days was higher in the FOG (+) PD subjects (p = 0.008, p = 0.050, respectively). Besides, the TUG duration under the dual-task of counting down days was found to be positively correlated with the UPDRS-motor scores and FOG scores. CONCLUSION We think that the concurrent execution of the dual-task of counting down days, which requires complex attentional skills, may disturb gait via a mechanism of overloading of the attentional reserves proceeding gait which is already defective in PD subjects. The neural correlate of this domain and its significance in performing dual-tasks in PD should be investigated in future large-scale studies. The results of these studies may provide substantial perspectives regarding the pathophysiology of gait disturbance in PD.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey.
| | - Ozge Ozyurek
- Department of Psychology, Yozgat City Hospital, Yozgat, Turkey
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Sharpe G, Macerollo A, Fabbri M, Tripoliti E. Non-pharmacological Treatment Challenges in Early Parkinson's Disease for Axial and Cognitive Symptoms: A Mini Review. Front Neurol 2020; 11:576569. [PMID: 33101185 PMCID: PMC7546346 DOI: 10.3389/fneur.2020.576569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments. Objective: The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD. Results: Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii FitTM training for cognition. Conclusions: Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these "orphan" symptoms, from the very beginning of the disease. The concept "the sooner the better" should be applied to multidisciplinary non-pharmacological management in PD.
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Affiliation(s)
- Gabriella Sharpe
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Antonella Macerollo
- Department of Neurology, The Walton Center for Neurology and Neurosurgery, Liverpool, United Kingdom
- Department of Neurosciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Margherita Fabbri
- Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network, NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Elina Tripoliti
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
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8
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Letter regarding the article "Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson's disease: a controlled study". Neurol Sci 2019; 41:1281-1282. [PMID: 31754874 DOI: 10.1007/s10072-019-04125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
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Micó-Amigo ME, Kingma I, Heinzel S, Nussbaum S, Heger T, van Lummel RC, Berg D, Maetzler W, van Dieën JH. Dual vs. Single Tasking During Circular Walking: What Better Reflects Progression in Parkinson's Disease? Front Neurol 2019; 10:372. [PMID: 31139130 PMCID: PMC6527841 DOI: 10.3389/fneur.2019.00372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 03/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background and Aim: Reliable, valid and sensitive measures of dual-task-associated impairments in patients with Parkinson's disease (PD) may reveal progressive deficits unnoticed under single-task walking. The aim of this study was to quantitatively identify markers of progressive gait deficits in idiopathic PD while walking over a circular trajectory condition in single-task walking and in different dual-task conditions: (1) circular walking while checking boxes on a paper sheet as fast as possible and (2) circular walking while performing subtraction of 7 as fast as possible. In addition, we aimed to study the added value of dual-tasking assessment over single (circular) walking task assessment in the study of PD progression. Methods: The assessments were performed every 6 months over a (up to) 5 years period for 22 patients in early-stage PD, 27 patients in middle-stage PD and 25 healthy controls (HC). Longitudinal changes of 27 gait features extracted from accelerometry were compared between PD groups and HCs using generalized estimating equations analysis, accounting for gait speed, age, and levodopa medication state confounders when required. In addition, dual-task-interference with gait and cognitive performance was assessed, as well as their combination. Results: The results support the validity and robustness of some of the gait features already identified in our previous work as progression markers of the disease in single-task circular walking. However, fewer gait features from dual-task than from single-task assessments were identified as markers of progression in PD. Moreover, we did not clearly identify progressive worsening of dual-task-interference in patients with PD, although some group differences between early and middle stages of PD vs. the control group were observed for dual-task interference with the gait task and with the concurrent tasks. Conclusions: Overall, the results showed that dual-tasking did not have added value in the study of PD progression from circular gait assessments. Our analyses suggest that, while single-task walking might be sensitive enough, dual-tasking may introduce additional (error) variance to the data and may represent complex composite measures of cognitive and motor performance.
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Affiliation(s)
- M Encarna Micó-Amigo
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Tanja Heger
- Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Xie F, Gao X, Yang W, Chang Z, Yang X, Wei X, Huang Z, Xie H, Yue Z, Zhou F, Wang Q. Advances in the Research of Risk Factors and Prodromal Biomarkers of Parkinson's Disease. ACS Chem Neurosci 2019; 10:973-990. [PMID: 30590011 DOI: 10.1021/acschemneuro.8b00520] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease in the world. With the advent of an aging population and improving life expectancy worldwide, the number of PD patients is expected to increase, which may lead to an urgent need for effective preventive and diagnostic strategies for PD. Although there is increasing research regarding the pathogenesis of PD, there is limited knowledge regarding the prevention of PD. Moreover, the diagnosis of PD depends on clinical criteria, which require the occurrence of bradykinesia and at least one symptom of rest tremor or rigidity. However, converging evidence from clinical, genetic, neuropathological, and imaging studies suggests the initiation of PD-specific pathology prior to the initial presentation of these classical motor clinical features by years or decades. This latent stage of neurodegeneration in PD is a particularly important stage for effective neuroprotective therapies, which might retard the progression or prevent the onset of PD. Therefore, the exploration of risk factors and premotor biomarkers is not only crucial to the early diagnosis of PD but is also helpful in the development of effective neuroprotection and health care strategies for appropriate populations at risk for PD. In this review, we searched and summarized ∼249 researches and 31 reviews focusing on the risk factors and prodromal biomarkers of PD and published in MEDLINE.
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Affiliation(s)
- Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaoya Gao
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Wanlin Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Huifang Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
| | - Zhenyu Yue
- Department of Neurology, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, Hess Research Center Ninth Floor, New York, New York 10029, United States
| | - Fengli Zhou
- Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Gongye Road 253, Guangzhou, Guangdong 510280, P. R. China
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11
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Ferrazzoli D, Ortelli P, Riboldazzi G, Maestri R, Frazzitta G. Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in "de-novo" Parkinsonian subjects: a randomized controlled trial with 18-month follow-up. J Neurol 2018; 265:906-916. [PMID: 29442177 PMCID: PMC5878188 DOI: 10.1007/s00415-018-8792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/20/2023]
Abstract
Background Dopamine Replacement Therapy (DRT) represents the most effective treatment for Parkinson’s disease (PD). Nevertheless, several symptoms are unresponsive to treatment and its long-term use leads to serious side effects. To optimize the pharmacological management of PD, dopamine-agonists are often prescribed to “de-novo” patients. Moreover, several studies have shown the effectiveness and the synergic effect of rehabilitation in treating PD. Objective To evaluate the synergism between DRT and rehabilitation in treating PD, by investigating the short and the long-term effectiveness of a multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT) in a group of patients treated with Rotigotine. Materials and methods In this multicenter, single blinded, parallel-group, 1:1 allocation ratio, randomized, non-inferiority trial, 36 “de-novo” PD patients were evaluated along 18 months: 17 were treated with Rotigotine plus MIRT; 19 were treated with Rotigotine alone (R). The primary outcome measure was the total score of Unified Parkinson’s Disease Rating Scale (UPDRS). The secondary outcomes included the UPDRS sub-sections II and III (UPDRS II-III), the 6-Minute Walk Test (6MWT), the Timed Up and Go Test (TUG) and the amount of Rotigotine. Patients were evaluated at baseline (T0), 6 months (T1), 1 year (T2), and at 18 months (T3). Results No differences in UPDRS scores in the two groups (total score, III part and II part, p = 0.48, p = 0.90 and p = 0.40, respectively) were found in the time course. Conversely, a greater improvement in Rotigotine + MIRT group was observed for 6MWT (p < 0.0001) and TUG (p = 0.03). Along time, the dosage of Rotigotine was higher in patients who did not undergo MIRT, at all observation times following T0. Conclusions Over the course of 18 months, the effectiveness of the combined treatment (Rotigotine + MIRT) on the patients’ global clinical status, evaluated with total UPDRS, was not inferior to that of the pharmacological treatment with Rotigotine alone. Importantly, rehabilitation allowed patients to gain better motor performances with lower DRT dosage.
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Affiliation(s)
- D Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy.
| | - P Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
| | - G Riboldazzi
- Parkinson's Disease and Movement Disorders Center, ASST dei Sette Laghi, Varese, Italy
- Parkinson's disease Rehabilitation Center, Fondazione Borghi, Brebbia, Varese, Italy
| | - R Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Via per Montescano 3, Montescano, 27040, Pavia, Italy
| | - G Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
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12
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Kwon KY, Lee HM, Kang SH, Pyo SJ, Kim HJ, Koh SB. Recuperation of slow walking in de novo Parkinson's disease is more closely associated with increased cadence, rather than with expanded stride length. Gait Posture 2017; 58:1-6. [PMID: 28692855 DOI: 10.1016/j.gaitpost.2017.06.266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/21/2017] [Accepted: 06/25/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Gait characteristics in the early stages of Parkinson's disease (PD) have been less investigated so far. Moreover, the levodopa effect on gait in early PD remains to be further elucidated. We prospectively designed the study to examine gait dynamics and effect of dopaminergic treatment in patients with de novo PD. METHODS Spatiotemporal parameters were measured in healthy controls and drug naïve patients with PD, using computerized analysis with GAITRite system during usual gait. In PD group, motor symptoms and gait parameters were examined in both drug naive and levodopa 100mg trial conditions. RESULTS Twenty four de novo PD patients and 27 healthy controls (matched for age, sex, and height) were selected for the study. Compared with the controls, patients with de novo PD showed the decrease in stride length, in both Med-OFF and Med-ON conditions. Notably, drug naïve patients with PD demonstrated slow walking velocity, whereas those with levodopa administration exhibited the increase of cadence by shortening stride time, which resulted in the improvement of gait speed. In addition, the stride length (gait hypokinesia) correlated with postural instability and gait difficulty subscore, but not with tremor, rigidity, bradykinesia, or total motor score. CONCLUSION As a compensatory mechanism of slow walking, we found that the increment in cadence (frequency) is more important than the increment in stride length (amplitude) in gait dynamics in de novo PD. Additionally, the results may indicate that gait hypokinesia in PD could be regarded as one of axial symptoms.
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Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Soonchunhyang University School of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hye Mi Lee
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Kang
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seon Jong Pyo
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han Jun Kim
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Beom Koh
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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13
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Belghali M, Chastan N, Cignetti F, Davenne D, Decker LM. Loss of gait control assessed by cognitive-motor dual-tasks: pros and cons in detecting people at risk of developing Alzheimer's and Parkinson's diseases. GeroScience 2017; 39:305-329. [PMID: 28551877 DOI: 10.1007/s11357-017-9977-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/02/2017] [Indexed: 12/26/2022] Open
Abstract
Alzheimer's and Parkinson's diseases are age-related progressive neurodegenerative diseases of increasing prevalence worldwide. In the absence of curative therapy, current research is interested in prevention, by identifying subtle signs of early-stage neurodegeneration. Today, the field of behavioral neuroscience has emerged as one of the most promising areas of research on this topic. Recently, it has been shown that the exacerbation of gait disorders under dual-task conditions (i.e., simultaneous performance of cognitive and motor tasks) could be a characteristic feature of Alzheimer's and Parkinson's diseases. The cognitive-motor dual-task paradigm during walking allows to assess whether (i) executive attention is abnormally impaired in prodromal Alzheimer's disease or (ii) compensation strategies are used in order to preserve gait function when the basal ganglia system is altered in prodromal Parkinson's disease. This review aims at (i) identifying patterns of dual-task-related gait changes that are specific to Alzheimer's and Parkinson's diseases, respectively, (ii) demonstrating that these changes could potentially be used as prediagnostic markers for disease onset, (iii) reviewing pros and cons of existing dual-task studies, and (iv) proposing future directions for clinical research.
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Affiliation(s)
- Maroua Belghali
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
| | - Nathalie Chastan
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France.,Department of Neurophysiology, UNIROUEN, Rouen University Hospital-Charles Nicolle, Normandie Univ, 76000, Rouen, France
| | - Fabien Cignetti
- CNRS, LNC UMR 7291, Aix-Marseille Univ, 13331, Marseille, France
| | - Damien Davenne
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
| | - Leslie M Decker
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France.
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14
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Belghali M, Chastan N, Davenne D, Decker LM. Improving Dual-Task Walking Paradigms to Detect Prodromal Parkinson's and Alzheimer's Diseases. Front Neurol 2017; 8:207. [PMID: 28588547 PMCID: PMC5438971 DOI: 10.3389/fneur.2017.00207] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/27/2017] [Indexed: 12/22/2022] Open
Abstract
Gait control is a complex movement, relying on spinal, subcortical, and cortical structures. The presence of deficits in one or more of these structures will result in changes in gait automaticity and control, as is the case in several neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). By reviewing recent findings in this field of research, current studies have shown that gait performance assessment under dual-task conditions could contribute to predict both of these diseases. Such suggestions are relevant mainly for people at putatively high risk of developing AD (i.e., older adults with mild cognitive impairment subtypes) or PD (i.e., older adults with either Mild Parkinsonian signs or LRRK2 G2019S mutation). Despite the major importance of these results, the type of cognitive task that should be used as a concurrent secondary task has to be selected among the plurality of tasks proposed in the literature. Furthermore, the key aspects of gait control that represent sensitive and specific "gait signatures" for prodromal AD or PD need to be determined. In the present perspective article, we suggest the use of a Stroop interference task requiring inhibitory attentional control and a set-shifting task requiring reactive flexibility as being particularly relevant secondary tasks for challenging gait in prodromal AD and PD, respectively. Investigating how inhibition and cognitive flexibility interfere with gait control is a promising avenue for future research aimed at enhancing early detection of AD and PD, respectively.
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Affiliation(s)
| | - Nathalie Chastan
- Normandie Université, UNICAEN, INSERM, COMETE, Caen, France.,Department of Neurophysiology, Normandie Université, UNIROUEN, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - Damien Davenne
- Normandie Université, UNICAEN, INSERM, COMETE, Caen, France
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15
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Salazar RD, Ren X, Ellis TD, Toraif N, Barthelemy OJ, Neargarder S, Cronin-Golomb A. Dual tasking in Parkinson's disease: Cognitive consequences while walking. Neuropsychology 2017; 31:613-623. [PMID: 28414497 DOI: 10.1037/neu0000331] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Cognitive deficits are common in Parkinson's disease (PD) and exacerbate the functional limitations imposed by PD's hallmark motor symptoms, including impairments in walking. Though much research has addressed the effect of dual cognitive-locomotor tasks on walking, less is known about their effect on cognition. The purpose of this study was to investigate the relation between gait and executive function, with the hypothesis that dual tasking would exacerbate cognitive vulnerabilities in PD as well as being associated with gait disturbances. METHOD Nineteen individuals with mild-moderate PD without dementia and 13 age- and education-matched normal control adults (NC) participated. Executive function (set-shifting) and walking were assessed singly and during dual tasking. RESULTS Dual tasking had a significant effect on cognition (reduced set-shifting) and on walking (speed, stride length) for both PD and NC, and also on stride frequency for PD only. The impact of dual tasking on walking speed and stride frequency was significantly greater for PD than NC. Though the group by condition interaction was not significant, PD had fewer set-shifts than NC on dual task. Further, relative to NC, PD showed significantly greater variability in cognitive performance under dual tasking, whereas variability in motor performance remained unaffected by dual tasking. CONCLUSIONS Dual tasking had a significantly greater effect in PD than in NC on cognition as well as on walking. The results suggest that assessment and treatment of PD should consider the cognitive as well as the gait components of PD-related deficits under dual-task conditions. (PsycINFO Database Record
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Affiliation(s)
- Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University
| | - Xiaolin Ren
- Department of Physical Therapy and Athletic Training
| | - Terry D Ellis
- Department of Physical Therapy and Athletic Training
| | - Noor Toraif
- Department of Psychological and Brain Sciences, Boston University
| | | | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University
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16
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Micó-Amigo ME, Kingma I, Faber GS, Kunikoshi A, van Uem JMT, van Lummel RC, Maetzler W, van Dieën JH. Is the Assessment of 5 Meters of Gait with a Single Body-Fixed-Sensor Enough to Recognize Idiopathic Parkinson's Disease-Associated Gait? Ann Biomed Eng 2017; 45:1266-1278. [PMID: 28108943 PMCID: PMC5397518 DOI: 10.1007/s10439-017-1794-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
Quantitative assessment of gait in patients with Parkinson’s disease (PD) is an important step in addressing motor symptoms and improving clinical management. Based on the assessment of only 5 meters of gait with a single body-fixed-sensor placed on the lower back, this study presents a method for the identification of step-by-step kinematic parameters in 14 healthy controls and in 28 patients at early-to-moderate stages of idiopathic PD. Differences between groups in step-by-step kinematic parameters were evaluated to understand gait impairments in the PD group. Moreover, a discriminant model between groups was built from a subset of significant and independent parameters and based on a 10-fold cross-validated model. The discriminant model correctly classified a total of 89.5% participants with four kinematic parameters. The sensitivity of the model was 95.8% and the specificity 78.6%. The results indicate that the proposed method permitted to reasonably recognize idiopathic PD-associated gait from 5-m walking assessments. This motivates further investigation on the clinical utility of short episodes of gait assessment with body-fixed-sensors.
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Affiliation(s)
- M E Micó-Amigo
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands.
| | - I Kingma
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G S Faber
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A Kunikoshi
- McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - J M T van Uem
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - R C van Lummel
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B.V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - W Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany.,DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - J H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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17
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Nieuwhof F, Reelick MF, Maidan I, Mirelman A, Hausdorff JM, Olde Rikkert MG, Bloem BR, Muthalib M, Claassen JA. Measuring prefrontal cortical activity during dual task walking in patients with Parkinson's disease: feasibility of using a new portable fNIRS device. Pilot Feasibility Stud 2016; 2:59. [PMID: 27965875 PMCID: PMC5154104 DOI: 10.1186/s40814-016-0099-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many patients with Parkinson's disease (PD) have difficulties in performing a second task during walking (i.e., dual task walking). Functional near-infrared spectroscopy (fNIRS) is a promising approach to study the presumed contribution of dysfunction within the prefrontal cortex (PFC) to such difficulties. In this pilot study, we examined the feasibility of using a new portable and wireless fNIRS device to measure PFC activity during different dual task walking protocols in PD. Specifically, we tested whether PD patients were able to perform the protocol and whether we were able to measure the typical fNIRS signal of neuronal activity. METHODS We included 14 PD patients (age 71.2 ± 5.4 years, Hoehn and Yahr stage II/III). The protocol consisted of five repetitions of three conditions: walking while (i) counting forwards, (ii) serially subtracting, and (iii) reciting digit spans. Ability to complete this protocol, perceived exertion, burden of the fNIRS devices, and concentrations of oxygenated (O2Hb) and deoxygenated (HHb) hemoglobin from the left and right PFC were measured. RESULTS Two participants were unable to complete the protocol due to fatigue and mobility safety concerns. The remaining 12 participants experienced no burden from the two fNIRS devices and completed the protocol with ease. Bilateral PFC O2Hb concentrations increased during walking while serially subtracting (left PFC 0.46 μmol/L, 95 % confidence interval (CI) 0.12-0.81, right PFC 0.49 μmol/L, 95 % CI 0.14-0.84) and reciting digit spans (left PFC 0.36 μmol/L, 95 % CI 0.03-0.70, right PFC 0.44 μmol/L, 95 % CI 0.09-0.78) when compared to rest. HHb concentrations did not differ between the walking tasks and rest. CONCLUSIONS These findings suggest that a new wireless fNIRS device is a feasible measure of PFC activity in PD during dual task walking. Future studies should reduce the level of noise and inter-individual variability to enable measuring differences in PFC activity between different dual walking conditions and across health states.
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Affiliation(s)
- Freek Nieuwhof
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Departments of Neurology, Geriatric Medicine, and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miriam F. Reelick
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Departments of Neurology, Geriatric Medicine, and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inbal Maidan
- Department of Neurology, Center for the study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Department of Neurology, Center for the study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M. Hausdorff
- Department of Neurology, Center for the study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marcel G.M. Olde Rikkert
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Departments of Neurology, Geriatric Medicine, and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Departments of Neurology, Geriatric Medicine, and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jurgen A.H.R. Claassen
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Departments of Neurology, Geriatric Medicine, and Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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18
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Yang PH, Zhu JX, Huang YD, Zhang XY, Lei P, Bush AI, Xiang Q, Su ZJ, Zhang QH. Human Basic Fibroblast Growth Factor Inhibits Tau Phosphorylation via the PI3K/Akt-GSK3β Signaling Pathway in a 6-Hydroxydopamine-Induced Model of Parkinson's Disease. NEURODEGENER DIS 2016; 16:357-69. [PMID: 27228974 DOI: 10.1159/000445871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Basic fibroblast growth factor (bFGF) has been increasingly investigated due to its neuroprotection in neurodegenerative disorders. Because there are still no cures for any of these disorders, it is crucial to identify new therapeutic targets and screen potential drugs. The increased phosphorylation of tau at Ser396 leads to intracellular tau accumulation, which forms neurofibrillary tangles in Parkinson's disease (PD). In this study, neuroprotection by bFGF was observed, and the mechanisms related to its regulation of phosphorylated tau were investigated. METHODS bFGF-loaded liposome carriers were intranasally administered to rats. The neuroprotective effects of bFGF were assessed in a PD model induced by 6-hydroxydopamine (6-OHDA) in vivo and in vitro. The phosphorylation of tau was measured, and the PI3K/Akt-GSK3β signaling pathway was investigated. RESULTS Our study demonstrated that liposomes markedly assisted in the delivery of bFGF to the striatum and substantia nigra of rats and enhanced the neuroprotective effects of bFGF on dopaminergic neurons. bFGF treatment significantly ameliorated the behavioral deficits induced by 6-OHDA, rescued the loss of tyrosine hydroxylase-positive neurons and increased the number of Nissl bodies. bFGF reduced the phosphorylation of tau and GSK3β and increased the phosphorylation of PI3K/Akt. CONCLUSION Liposomes markedly assisted in the delivery of bFGF to the brain and enhanced the neuroprotective effects of bFGF by inhibiting the phosphorylation of tau. bFGF down-regulated the phosphorylation of tau by increasing the phosphorylation of GSK3β via the PI3K/Akt signaling pathway. These findings provide a new vision of bFGF as a potential therapy for PD.
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Affiliation(s)
- Peng-Hui Yang
- Institute of Biomedicine and National Engineering Research Center of Genetic Medicine, Jinan University, Guangzhou, China
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19
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Van Uem JMT, Walgaard S, Ainsworth E, Hasmann SE, Heger T, Nussbaum S, Hobert MA, Micó-Amigo EM, Van Lummel RC, Berg D, Maetzler W. Quantitative Timed-Up-and-Go Parameters in Relation to Cognitive Parameters and Health-Related Quality of Life in Mild-to-Moderate Parkinson's Disease. PLoS One 2016; 11:e0151997. [PMID: 27055262 PMCID: PMC4824446 DOI: 10.1371/journal.pone.0151997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/06/2016] [Indexed: 12/11/2022] Open
Abstract
Introduction The instrumented-Timed-Up-and-Go test (iTUG) provides detailed information about the following movement patterns: sit-to-walk (siwa), straight walking, turning and walk-to-sit (wasi). We were interested in the relative contributions of respective iTUG sub-phases to specific clinical deficits most relevant for daily life in Parkinson’s disease (PD). More specifically, we investigated which condition–fast speed (FS) or convenient speed (CS)–differentiates best between mild- to moderate-stage PD patients and controls, which parameters of the iTUG sub-phases are significantly different between PD patients and controls, and how the iTUG parameters associate with cognitive parameters (with particular focus on cognitive flexibility and working memory) and Health-Related-Quality of Life (HRQoL). Methods Twenty-eight PD participants (65.1±7.1 years, H&Y stage 1–3, medication OFF state) and 20 controls (66.1±7.5 years) performed an iTUG (DynaPort®, McRoberts BV, The Netherlands) under CS and FS conditions. The PD Questionnaire 39 (PDQ-39) was employed to assess HRQoL. General cognitive and executive functions were assessed using the Montreal Cognitive Assessment and the Trail Making Test. Results The total iTUG duration and sub-phases durations under FS condition differentiated PD patients slightly better from controls, compared to the CS condition. The following sub-phases were responsible for the observed longer total duration PD patients needed to perform the iTUG: siwa, turn and wasi. None of the iTUG parameters correlated relevantly with general cognitive function. Turning duration and wasi maximum flexion velocity correlated strongest with executive function. Walking back duration correlated strongest with HRQoL. Discussion This study confirms that mild- to moderate-stage PD patients need more time to perform the iTUG than controls, and adds the following aspects to current literature: FS may be more powerful than CS to delineate subtle movement deficits in mild- to moderate-stage PD patients; correlation levels of intra-individual siwa and wasi parameters may be interesting surrogate markers for the level of automaticity of performed movements; and sub-phases and kinematic parameters of the iTUG may have the potential to reflect executive functioning and HRQoL aspects of PD patients.
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Affiliation(s)
- Janet M. T. Van Uem
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
- * E-mail:
| | | | | | - Sandra E. Hasmann
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Tanja Heger
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Susanne Nussbaum
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Markus A. Hobert
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Encarnación M. Micó-Amigo
- McRoberts, The Hague, The Netherlands
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Daniela Berg
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
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20
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O’Connell E, Guidon M. Fear of falling and dual-task performance in people with Parkinson’s disease. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.3109/21679169.2016.1156156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eimear O’Connell
- Physiotherapy Department, Mercy University Hospital, Cork, Ireland
| | - Marie Guidon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Clark DJ. Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies. Front Hum Neurosci 2015; 9:246. [PMID: 25999838 PMCID: PMC4419715 DOI: 10.3389/fnhum.2015.00246] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/17/2015] [Indexed: 01/29/2023] Open
Abstract
Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, “automaticity” refers to the ability of the nervous system to successfully control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: (a) functional significance of automaticity; (b) neurophysiology of automaticity; (c) measurement of automaticity; (d) mechanistic factors that compromise automaticity; and (e) strategies for rehabilitation of automaticity.
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Affiliation(s)
- David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System Gainesville, FL, USA ; Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
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Mills KA, Markun LC, San Luciano M, Rizk R, Allen IE, Racine CA, Starr PA, Alberts JL, Ostrem JL. Effect of subthalamic nucleus deep brain stimulation on dual-task cognitive and motor performance in isolated dystonia. J Neurol Neurosurg Psychiatry 2015; 86:404-9. [PMID: 25012202 PMCID: PMC4392192 DOI: 10.1136/jnnp-2014-307942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor complications of Parkinson's disease (PD) but may worsen specific cognitive functions. The effect of STN DBS on cognitive function in dystonia patients is less clear. Previous reports indicate that bilateral STN stimulation in patients with PD amplifies the decrement in cognitive-motor dual-task performance seen when moving from a single-task to dual-task paradigm. We aimed to determine if the effect of bilateral STN DBS on dual-task performance in isolated patients with dystonia, who have less cognitive impairment and no dementia, is similar to that seen in PD. METHODS Eight isolated predominantly cervical patients with dystonia treated with bilateral STN DBS, with average dystonia duration of 10.5 years and Montreal Cognitive Assessment score of 26.5, completed working memory (n-back) and motor (forced-maintenance) tests under single-task and dual-task conditions while on and off DBS. RESULTS A multivariate, repeated-measures analysis of variance showed no effect of stimulation status (On vs Off) on working memory (F=0.75, p=0.39) or motor function (F=0.22, p=0.69) when performed under single-task conditions, though as working memory task difficulty increased, stimulation disrupted the accuracy of force-tracking. There was a very small worsening in working memory performance (F=9.14, p=0.019) when moving from single-task to dual-tasks when using the 'dual-task loss' analysis. CONCLUSIONS This study suggests the effect of STN DBS on working memory and attention may be much less consequential in patients with dystonia than has been reported in PD.
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Affiliation(s)
- Kelly A Mills
- Department of Neurology, University of California, San Francisco, California, USA Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Leslie C Markun
- Department of Neurology, University of California, San Francisco, California, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, California, USA
| | - Rami Rizk
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Caroline A Racine
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, California, USA Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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23
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Lewis SJG. Neurological update: emerging issues in gait disorders. J Neurol 2015; 262:1590-5. [DOI: 10.1007/s00415-015-7686-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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24
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Panyakaew P, Anan C, Bhidayasiri R. Visual deprivation elicits subclinical postural inflexibilities in early Parkinson's disease. J Neurol Sci 2015; 349:214-9. [PMID: 25656100 DOI: 10.1016/j.jns.2015.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Postural instability is often experienced in the late stages of PD and is a marker of disease progression. Little information is available on the role of visual inputs as an adaptive strategy to compensate for postural instability in PD. The purpose of this study was to determine visual dependency for postural control in early PD. METHODS Thirty early PD subjects without postural complaints and 30 matched controls were evaluated for subtle postural instability using static posturography under eyes opened and eyes closed conditions. RESULTS No significant differences between groups were observed under eyes opened condition. In eyes closed condition, there was significantly greater mean sway in the mediolateral direction (p=0.01), mean sway velocity (p=0.03), lateral sway velocity (p=0.04), and sway area (p=0.04) in PD than in the control subjects. 95% confidence ellipse of mean sway was largest in PD patients with eyes closed. A strong and significant correlation was observed between disease duration and mean mediolateral sway, sway area, mean sway and lateral sway velocity, and a moderate correlation was shown between Hoehn & Yahr stage and mean mediolateral sway, and sway area. CONCLUSION Our findings suggest that visual dependency exists in early PD and visual deprivation task can help identify subclinical postural instability.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles 90095, USA.
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25
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Recent Advances and Applications of Metabolomics to Investigate Neurodegenerative Diseases. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 122:95-132. [DOI: 10.1016/bs.irn.2015.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eisen A, Kiernan M, Mitsumoto H, Swash M. Amyotrophic lateral sclerosis: a long preclinical period? J Neurol Neurosurg Psychiatry 2014; 85:1232-8. [PMID: 24648037 DOI: 10.1136/jnnp-2013-307135] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The onset of amyotrophic lateral sclerosis (ALS) is conventionally considered as commencing with the recognition of clinical symptoms. We propose that, in common with other neurodegenerations, the pathogenic mechanisms culminating in ALS phenotypes begin much earlier in life. Animal models of genetically determined ALS exhibit pathological abnormalities long predating clinical deficits. The overt clinical ALS phenotype may develop when safety margins are exceeded subsequent to years of mitochondrial dysfunction, neuroinflammation or an imbalanced environment of excitation and inhibition in the neuropil. Somatic mutations, the epigenome and external environmental influences may interact to trigger a metabolic cascade that in the adult eventually exceeds functional threshold. A long preclinical and subsequent presymptomatic period pose a challenge for recognition, since it offers an opportunity for protective and perhaps even preventive therapeutic intervention to rescue dysfunctional neurons. We suggest, by analogy with other neurodegenerations and from SOD1 ALS mouse studies, that vulnerability might be induced in the perinatal period.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hiroshi Mitsumoto
- Wesley J. Howe Professor of Neurology at CUMC, Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute of New York, Columbia University Medical Center, New York, USA
| | - Michael Swash
- Queen Mary University of London, UK Institute of Neuroscience, University of Lisbon, Portugal
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Kline JE, Poggensee K, Ferris DP. Your brain on speed: cognitive performance of a spatial working memory task is not affected by walking speed. Front Hum Neurosci 2014; 8:288. [PMID: 24847239 PMCID: PMC4021146 DOI: 10.3389/fnhum.2014.00288] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/18/2014] [Indexed: 11/13/2022] Open
Abstract
When humans walk in everyday life, they typically perform a range of cognitive tasks while they are on the move. Past studies examining performance changes in dual cognitive-motor tasks during walking have produced a variety of results. These discrepancies may be related to the type of cognitive task chosen, differences in the walking speeds studied, or lack of controlling for walking speed. The goal of this study was to determine how young, healthy subjects performed a spatial working memory task over a range of walking speeds. We used high-density electroencephalography to determine if electrocortical activity mirrored changes in cognitive performance across speeds. Subjects stood (0.0 m/s) and walked (0.4, 0.8, 1.2, and 1.6 m/s) with and without performing a Brooks spatial working memory task. We hypothesized that performance of the spatial working memory task and the associated electrocortical activity would decrease significantly with walking speed. Across speeds, the spatial working memory task caused subjects to step more widely compared with walking without the task. This is typically a sign that humans are adapting their gait dynamics to increase gait stability. Several cortical areas exhibited power fluctuations time-locked to memory encoding during the cognitive task. In the somatosensory association cortex, alpha power increased prior to stimulus presentation and decreased during memory encoding. There were small significant reductions in theta power in the right superior parietal lobule and the posterior cingulate cortex around memory encoding. However, the subjects did not show a significant change in cognitive task performance or electrocortical activity with walking speed. These findings indicate that in young, healthy subjects walking speed does not affect performance of a spatial working memory task. These subjects can devote adequate cortical resources to spatial cognition when needed, regardless of walking speed.
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Affiliation(s)
- Julia E Kline
- Department of Biomedical Engineering, University of Michigan Ann Arbor, MI, USA
| | | | - Daniel P Ferris
- Department of Biomedical Engineering, University of Michigan Ann Arbor, MI, USA ; School of Kinesiology, University of Michigan Ann Arbor, MI, USA
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