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Tataw D, Nolan J, Kim SH. Micro-level Factors Associated with Youth Drug Use Among an Urban at-Risk Youth Sample. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01839-4. [PMID: 37884855 DOI: 10.1007/s40615-023-01839-4] [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: 08/25/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Youth drug use has reached global epidemic proportions with unequal distribution among communities with low income, immigrants, or ethnic status. PURPOSE This study seeks to understand the association between micro-level factors and youth drug use behavior among 2693 low-income, ethnic, and immigrant youths in Pomona, CA, USA. The study uneath's unique evidence and intervention elements necessary to resolve youth drug use in Pomona. METHODS We used social cognitive theory as a conceptual framework, and performed correlation and multiple linear regression analysis in a cross-sectional design. RESULTS AND DISCUSSION The results reveal that attitudes, perceptions, and behavior related to friends, participants, family, and adults in the participant's life and ease of access to drugs are associated with youth drug use. Variables related to friends and participants show a relatively stronger association with youth drug use in comparison to variables related to parents and adults in participants' lives. Equally, drug and non-drug antisocial behavior of friends and participants show a stronger association with youth drug use relative to prosocial behavior. Also, when a diverse set of predictor variables are combined together, their association to the outcome variable is stronger than that of a single variable. RECOMMENDATIONS Future interventions in Pomona should prioritize strategies which target participants and friends over activities targeting parents and adults. Interventions targeting antisocial behavior should be prioritized over prosocial behavior. Program implementers should also develop unique evidence and tools which will help parents influence the drug use behavior of youths in Pomona and similar communities.
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Affiliation(s)
- David Tataw
- School of Allied Health, College of Health and Human Services, Northern Kentucky University, Highland Heights, KY, USA.
| | - Joseph Nolan
- Department of Mathematics and Statistics, College of Arts and Sciences, Northern Kentucky University, Highland Heights, KY, USA
| | - Suk-Hee Kim
- School of Social Work, College of Health and Human Services, Northern Kentucky University, Highland Heights, KY, USA
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2
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Motion energy analysis during speech tasks in medication-naïve individuals with at-risk mental states for psychosis. SCHIZOPHRENIA 2022; 8:73. [PMID: 36114187 PMCID: PMC9481869 DOI: 10.1038/s41537-022-00283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/03/2022] [Indexed: 12/16/2022]
Abstract
Movement abnormalities are commonly observed in schizophrenia and at-risk mental states (ARMS) for psychosis. They are usually detected with clinical interviews, such that automated analysis would enhance assessment. Our aim was to use motion energy analysis (MEA) to assess movement during free-speech videos in ARMS and control individuals, and to investigate associations between movement metrics and negative and positive symptoms. Thirty-two medication-naïve ARMS and forty-six healthy control individuals were filmed during speech tasks. Footages were analyzed using MEA software, which assesses movement by differences in pixels frame-by-frame. Two regions of interest were defined—head and torso—and mean amplitude, frequency, and coefficient of variability of movements for them were obtained. These metrics were correlated with the Structured Interview for Prodromal Syndromes (SIPS) symptoms, and with the risk of conversion to psychosis—inferred with the SIPS risk calculator. ARMS individuals had significantly lower mean amplitude of head movement and higher coefficients of movement variability for both head and torso, compared to controls. Higher coefficient of variability was related to higher risk of conversion. Negative correlations were seen between frequency of movement and most SIPS negative symptoms. All positive symptoms were correlated with at least one movement variable. Movement abnormalities could be automatically detected in medication-naïve ARMS subjects by means of a motion energy analysis software. Significant associations of movement metrics with symptoms were found, supporting the importance of movement analysis in ARMS. This could be a potentially important tool for early diagnosis, intervention, and outcome prediction.
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Lipsmeier F, Taylor KI, Postuma RB, Volkova-Volkmar E, Kilchenmann T, Mollenhauer B, Bamdadian A, Popp WL, Cheng WY, Zhang YP, Wolf D, Schjodt-Eriksen J, Boulay A, Svoboda H, Zago W, Pagano G, Lindemann M. Reliability and validity of the Roche PD Mobile Application for remote monitoring of early Parkinson's disease. Sci Rep 2022; 12:12081. [PMID: 35840753 PMCID: PMC9287320 DOI: 10.1038/s41598-022-15874-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
Digital health technologies enable remote and therefore frequent measurement of motor signs, potentially providing reliable and valid estimates of motor sign severity and progression in Parkinson’s disease (PD). The Roche PD Mobile Application v2 was developed to measure bradykinesia, bradyphrenia and speech, tremor, gait and balance. It comprises 10 smartphone active tests (with ½ tests administered daily), as well as daily passive monitoring via a smartphone and smartwatch. It was studied in 316 early-stage PD participants who performed daily active tests at home then carried a smartphone and wore a smartwatch throughout the day for passive monitoring (study NCT03100149). Here, we report baseline data. Adherence was excellent (96.29%). All pre-specified sensor features exhibited good-to-excellent test–retest reliability (median intraclass correlation coefficient = 0.9), and correlated with corresponding Movement Disorder Society–Unified Parkinson's Disease Rating Scale items (rho: 0.12–0.71). These findings demonstrate the preliminary reliability and validity of remote at-home quantification of motor sign severity with the Roche PD Mobile Application v2 in individuals with early PD.
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Affiliation(s)
- Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Kirsten I Taylor
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, QC, Canada
| | - Ekaterina Volkova-Volkmar
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Timothy Kilchenmann
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Atieh Bamdadian
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Werner L Popp
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wei-Yi Cheng
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Yan-Ping Zhang
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Detlef Wolf
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Jens Schjodt-Eriksen
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Anne Boulay
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Hanno Svoboda
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wagner Zago
- Prothena Biosciences Inc, South San Francisco, CA, USA
| | - Gennaro Pagano
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Michael Lindemann
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
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Antipsychotics withdrawal in adults with intellectual disability and challenging behaviour: study protocol for a multicentre double-blind placebo-controlled randomised trial. BMC Psychiatry 2021; 21:439. [PMID: 34488701 PMCID: PMC8422779 DOI: 10.1186/s12888-021-03437-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In people with intellectual disability (ID) and challenging behaviour, antipsychotics (AP) are often used off-label and for a long period. Despite a lack of evidence for efficacy for challenging behaviour and concerns about common and clinically relevant side effects, complete withdrawal often fails. We postulate three possible hypotheses for withdrawal failure: 1. Influence of subjective interpretation of behavioural symptoms by caregivers and family; 2. Beneficial effects from AP treatment on undiagnosed psychiatric illness, through improvement in sleep or a direct effect on behaviour; and 3. Misinterpretation of withdrawal symptoms as a recurrence of challenging behaviour. METHODS To investigate our hypotheses, we have designed a multicentre double-blind, placebo-controlled randomised trial in which AP (pipamperone or risperidone) are withdrawn. In the withdrawal group, the AP dose is reduced by 25% every 4 weeks and in the control group the dose remains unaltered. Behaviour, sleep, psychiatric disorders, withdrawal symptoms and side effects will be measured and compared between the two groups. If drop-out from the protocol is similar in both groups (non-inferiority), the first hypothesis will be supported. If drop-out is higher in the withdrawal group and an increase is seen in psychiatric disorders, sleep problems and/or behavioural problems compared to the control group, this suggests effectiveness of AP, and indications for AP use should be reconsidered. If drop-out is higher in the withdrawal group and withdrawal symptoms and side effects are more common in the withdrawal group compared to the control group, this supports the hypothesis that withdrawal symptoms contribute to withdrawal failure. DISCUSSION In order to develop AP withdrawal guidelines for people with ID, we need to understand why withdrawal of AP is not successful in the majority of people with ID and challenging behaviour. With this study, we will bridge the gap between the lack of available evidence on AP use and withdrawal on the one hand and the international policy drive to reduce prescription of AP in people with ID and challenging behaviour on the other hand. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register (NTR 7232) on October 6, 2018 ( www.trialregister.nl ).
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Sangarapillai K, Norman BM, Almeida QJ. Analyzing the effects of PDSAFEx™ on the motor symptoms of Parkinson's disease: A retrospective study. NeuroRehabilitation 2020; 46:589-593. [PMID: 32508333 DOI: 10.3233/nre-203025] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The cardinal motor symptoms of Parkinson's disease (PD) include postural instability, bradykinesia, tremor and rigidity. The overall Unified Parkinson's Disease Rating Scale (UPDRS-III) indicates, the gold-standard treatment for PD (dopaminergic-therapy) is very effective in improving these symptoms. However, recent research indicated that 2 of the 4 cardinal symptoms of PD (balance and tremor) remain unimproved by dopaminergic-therapy. This prompts the investigation of other alternative and adjunct treatments such as exercise rehabilitation. Unfortunately, like drug studies, exercise studies often focus on overall symptom improvement yet fail to monitor changes to specific symptoms. This may be problematic for individuals with different symptomatic phenotypes. If tremor/balance were the main concern, then adjunct therapies may be critically important when these symptoms may be dopa-resistant. Thus, it is important for all therapies to examine individual symptomatic-improvement. Interestingly, recent studies show PDSAFEx™ (a sensory integration therapy) to have a significantly improve motor symptoms in comparison to traditional exercise (14). Yet, the effects of PDSAFEx™ on individual PD symptoms is unknown. OBJECTIVE To explore the effects of PDSAFEx™ on PD symptoms in adjunct to medications. METHODS UPDRS-III scores of 229 cases were retrospectively examined and analysed in SPSS using Wilcoxon pairs singed-rank test to evaluate specific symptom-improvements. RESULTS PDSAFEx™ was confirmed to improve overall motor symptoms (p = 0.0001), but more importantly a significant improvement to tremor (p < 0.00001) and balance (p < 0.00001) were also identified. CONCLUSIONS These findings suggest that PDSAFEx™ is an important adjunct to medications, since it is able to address all four cardinal symptoms of PD.
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Affiliation(s)
- Kishoree Sangarapillai
- Wilfrid Laurier University (Movement Disorders Research and Rehabilitation Centre), Waterloo, Ontario, Canada
| | - Benjamin M Norman
- Wilfrid Laurier University (Movement Disorders Research and Rehabilitation Centre), Waterloo, Ontario, Canada
| | - Quincy J Almeida
- Wilfrid Laurier University (Movement Disorders Research and Rehabilitation Centre), Waterloo, Ontario, Canada
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Oliveira A, Dias D, Lopes EM, do Carmo Vilas-Boas M, Silva Cunha JP. A Textile Embedded Wearable Device for Movement Disorders Quantification. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4559-4562. [PMID: 33019008 DOI: 10.1109/embc44109.2020.9175772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Wearable devices have been showing promising results in a large range of applications: since industry, to entertainment and, in particular, healthcare. In the scope of movement disorders, wearable devices are being widely implemented for motor symptoms objective assessment. Currently, clinicians evaluate patients' motor symptoms resorting to subjective scales and visual perception, such as in Parkinson's Disease. The possibility to make use of wearable devices to quantify this disorder motor symptoms would bring an accurate follow-up on the disease progression, leading to more efficient treatments.Here we present a novel textile embedded low-power wearable device capable to be used in any scenario of movement disorders assessment due to its seamless, comfort and versatility. Regarding our research, it has already improved the setup of a wrist rigidity quantification system for Parkinson's Disease patients: the iHandU system. The wearable comprises a hardware sensing unit integrated in a textile band with an innovative design assuring higher comfort and easiness-to-use in movement disorders assessment. It enables to collect inertial data (9-axis) and has the possibility to integrate two analog sensors. A web platform was developed for data reading, visualization and recording. To ensure inertial data reliability, validation tests for the accelerometer and gyroscope sensors were conducted by comparison with its theoretical behavior, obtaining very good results.
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7
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Zhang Y, Burock MA. Diffusion Tensor Imaging in Parkinson's Disease and Parkinsonian Syndrome: A Systematic Review. Front Neurol 2020; 11:531993. [PMID: 33101169 PMCID: PMC7546271 DOI: 10.3389/fneur.2020.531993] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) allows measuring fractional anisotropy and similar microstructural indices of the brain white matter. Lower than normal fractional anisotropy as well as higher than normal diffusivity is associated with loss of microstructural integrity and neurodegeneration. Previous DTI studies in Parkinson's disease (PD) have demonstrated abnormal fractional anisotropy in multiple white matter regions, particularly in the dopaminergic nuclei and dopaminergic pathways. However, DTI is not considered a diagnostic marker for the earliest Parkinson's disease since anisotropic alterations present a temporally divergent pattern during the earliest Parkinson's course. This article reviews a majority of clinically employed DTI studies in PD, and it aims to prove the utilities of DTI as a marker of diagnosing PD, correlating clinical symptomatology, tracking disease progression, and treatment effects. To address the challenge of DTI being a diagnostic marker for early PD, this article also provides a comparison of the results from a longitudinal, early stage, multicenter clinical cohort of Parkinson's research with previous publications. This review provides evidences of DTI as a promising marker for monitoring PD progression and classifying atypical PD types, and it also interprets the possible pathophysiologic processes under the complex pattern of fractional anisotropic changes in the first few years of PD. Recent technical advantages, limitations, and further research strategies of clinical DTI in PD are additionally discussed.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry, War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Marc A Burock
- Department of Psychiatry, Mainline Health, Bryn Mawr Hospital, Bryn Mawr, PA, United States
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Walther S, van Harten PN, Waddington JL, Cuesta MJ, Peralta V, Dupin L, Foucher JR, Sambataro F, Morrens M, Kubera KM, Pieters LE, Stegmayer K, Strik W, Wolf RC, Hirjak D. Movement disorder and sensorimotor abnormalities in schizophrenia and other psychoses - European consensus on assessment and perspectives. Eur Neuropsychopharmacol 2020; 38:25-39. [PMID: 32713718 DOI: 10.1016/j.euroneuro.2020.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
Over the last three decades, movement disorder as well as sensorimotor and psychomotor functioning in schizophrenia (SZ) and other psychoses has gained greater scientific and clinical relevance as an intrinsic component of the disease process of psychotic illness; this extends to early psychosis prediction, early detection of motor side effects of antipsychotic medication, clinical outcome monitoring, treatment of psychomotor syndromes (e.g. catatonia), and identification of new targets for non-invasive brain stimulation. In 2017, a systematic cooperation between working groups interested in movement disorder and sensorimotor/psychomotor functioning in psychoses was initiated across European universities. As a first step, the members of this group would like to introduce and define the theoretical aspects of the sensorimotor domain in SZ and other psychoses. This consensus paper is based on a synthesis of scientific evidence, good clinical practice and expert opinions that were discussed during recent conferences hosted by national and international psychiatric associations. While reviewing and discussing the recent theoretical and experimental work on neural mechanisms and clinical implications of sensorimotor behavior, we here seek to define the key principles and elements of research on movement disorder and sensorimotor/psychomotor functioning in psychotic illness. Finally, the members of this European group anticipate that this consensus paper will stimulate further multimodal and prospective studies on hypo- and hyperkinetic movement disorders and sensorimotor/psychomotor functioning in SZ and other psychotic disorders.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Peter N van Harten
- Psychiatric Center GGz Centraal, Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Spain. Instituto de Investigación Sanitaria de Navarra (IdisNa), Spain
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain, Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Lucile Dupin
- Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Université de Paris, Paris, France
| | - Jack R Foucher
- ICube - CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, Strasbourg, France; CEMNIS - Noninvasive Neuromodulation Center, University Hospital Strasbourg, Strasbourg, France
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Manuel Morrens
- Department of Psychiatry, University Psychiatric Center Duffel, Duffel, Belgium; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Lydia E Pieters
- Psychiatric Center GGz Centraal, Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - R Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Boot E, Mentzel TQ, Palmer LD, van Harten PN, Marras C, Lang AE, Bassett AS. Age-Related Parkinsonian Signs in Microdeletion 22q11.2. Mov Disord 2020; 35:1239-1245. [PMID: 32386091 PMCID: PMC7497092 DOI: 10.1002/mds.28080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
Background The recurrent hemizygous 22q11.2 deletion associated with 22q11.2 deletion syndrome has been identified as a genetic risk factor for early‐onset PD. However, little is known about early motor signs in this condition. Objectives We examined the presence, severity and possible factors associated with parkinsonism in adults with 22q11.2 deletion syndrome and without PD. Methods We compared motor signs between 82 adults with 22q11.2 deletion syndrome and 25 healthy controls, using the MDS‐UPDRS part III, and three‐dimensional motion‐tracker technology to quantify components of bradykinesia. Results Median MDS‐UPDRS part III total and bradykinesia subscores were significantly higher in 22q11.2 deletion syndrome (median age: 26 years; range, 17–65) than in controls (P = 0.000; P = 0.000, respectively). Age was a significant contributor to bradykinesia subscore (B = 0.06; P = 0.01) and to the electronic bradykinesia component, velocity (B = –0.02; P = 0.000); psychotic illness did not significantly impact these analyses. In 22q11.2 deletion syndrome, MDS‐UPDRS–defined bradykinesia was present in 18.3%, rigidity in 14.6%, and rest tremor in 12.2%. Conclusions Parkinsonian motor signs appear to be common and age related in 22q11.2 deletion syndrome. Longitudinal studies are needed to investigate possible symptom progression to PD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Erik Boot
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada.,Advisium,'s Heeren Loo Zorggroep, Amersfoort, The Netherlands.,Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Thierry Q Mentzel
- Innova, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
| | - Lisa D Palmer
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Peter N van Harten
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Innova, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands
| | - Connie Marras
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Division of Cardiology, Department of Medicine, and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Borzi L, Varrecchia M, Sibille S, Olmo G, Artusi CA, Fabbri M, Rizzone MG, Romagnolo A, Zibetti M, Lopiano L. Smartphone-Based Estimation of Item 3.8 of the MDS-UPDRS-III for Assessing Leg Agility in People With Parkinson's Disease. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:140-147. [PMID: 35402940 PMCID: PMC8975117 DOI: 10.1109/ojemb.2020.2993463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022] Open
Abstract
Goal: In this paper we investigated the use of smartphone sensors and Artificial Intelligence techniques for the automatic quantification of the MDS-UPDRS-Part III Leg Agility (LA) task, representative of lower limb bradykinesia. Methods: We collected inertial data from 93 PD subjects. Four expert neurologists provided clinical evaluations. We employed a novel Artificial Neural Network approach in order to get a continuous output, going beyond the MDS-UPDRS score discretization. Results: We found a Pearson correlation of 0.92 between algorithm output and average clinical score, compared to an inter-rater agreement index of 0.88. Furthermore, the classification error was less than 0.5 scale point in about 80% cases. Conclusions: We proposed an objective and reliable tool for the automatic quantification of the MDS-UPDRS Leg Agility task. In perspective, this tool is part of a larger monitoring program to be carried out during activities of daily living, and managed by the patients themselves.
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Affiliation(s)
- Luigi Borzi
- Department of Control and Computing EngineeringPolitecnico di Torino 10138 Torino Italy
| | - Marilena Varrecchia
- Department of Control and Computing EngineeringPolitecnico di Torino 10138 Torino Italy
| | - Stefano Sibille
- Department of Control and Computing EngineeringPolitecnico di Torino 10138 Torino Italy
| | - Gabriella Olmo
- Department of Control and Computing EngineeringPolitecnico di Torino 10138 Torino Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini,"University of Turin 10124 Torino Italy
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11
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Borzì L, Varrecchia M, Olmo G, Artusi CA, Fabbri M, Rizzone MG, Romagnolo A, Zibetti M, Lopiano L. Home monitoring of motor fluctuations in Parkinson’s disease patients. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40860-019-00086-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Bobić V, Djurić-Jovičić M, Dragašević N, Popović MB, Kostić VS, Kvaščev G. An Expert System for Quantification of Bradykinesia Based on Wearable Inertial Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E2644. [PMID: 31212680 PMCID: PMC6603543 DOI: 10.3390/s19112644] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/15/2019] [Accepted: 06/04/2019] [Indexed: 01/26/2023]
Abstract
Wearable sensors and advanced algorithms can provide significant decision support for clinical practice. Currently, the motor symptoms of patients with neurological disorders are often visually observed and evaluated, which may result in rough and subjective quantification. Using small inertial wearable sensors, fine repetitive and clinically important movements can be captured and objectively evaluated. In this paper, a new methodology is designed for objective evaluation and automatic scoring of bradykinesia in repetitive finger-tapping movements for patients with idiopathic Parkinson's disease and atypical parkinsonism. The methodology comprises several simple and repeatable signal-processing techniques that are applied for the extraction of important movement features. The decision support system consists of simple rules designed to match universally defined criteria that are evaluated in clinical practice. The accuracy of the system is calculated based on the reference scores provided by two neurologists. The proposed expert system achieved an accuracy of 88.16% for files on which neurologists agreed with their scores. The introduced system is simple, repeatable, easy to implement, and can provide good assistance in clinical practice, providing a detailed analysis of finger-tapping performance and decision support for symptom evaluation.
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Affiliation(s)
- Vladislava Bobić
- University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia.
- Innovation Center, School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia.
| | - Milica Djurić-Jovičić
- Innovation Center, School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia.
| | - Nataša Dragašević
- Clinic of Neurology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Mirjana B Popović
- University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia.
- Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Vladimir S Kostić
- Clinic of Neurology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Goran Kvaščev
- University of Belgrade-School of Electrical Engineering, 11000 Belgrade, Serbia.
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13
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Lorio S, Sambataro F, Bertolino A, Draganski B, Dukart J. The Combination of DAT-SPECT, Structural and Diffusion MRI Predicts Clinical Progression in Parkinson's Disease. Front Aging Neurosci 2019; 11:57. [PMID: 30930768 PMCID: PMC6428714 DOI: 10.3389/fnagi.2019.00057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
There is an increasing interest in identifying non-invasive biomarkers of disease severity and prognosis in idiopathic Parkinson’s disease (PD). Dopamine-transporter SPECT (DAT-SPECT), diffusion tensor imaging (DTI), and structural magnetic resonance imaging (sMRI) provide unique information about the brain’s neurotransmitter and microstructural properties. In this study, we evaluate the relative and combined capability of these imaging modalities to predict symptom severity and clinical progression in de novo PD patients. To this end, we used MRI, SPECT, and clinical data of de novo drug-naïve PD patients (n = 205, mean age 61 ± 10) and age-, sex-matched healthy controls (n = 105, mean age 58 ± 12) acquired at baseline. Moreover, we employed clinical data acquired at 1 year follow-up for PD patients with or without L-Dopa treatment in order to predict the progression symptoms severity. Voxel-based group comparisons and covariance analyses were applied to characterize baseline disease-related alterations for DAT-SPECT, DTI, and sMRI. Cortical and subcortical alterations in de novo PD patients were found in all evaluated imaging modalities, in line with previously reported midbrain-striato-cortical network alterations. The combination of these imaging alterations was reliably linked to clinical severity and disease progression at 1 year follow-up in this patient population, providing evidence for the potential use of these modalities as imaging biomarkers for disease severity and prognosis that can be integrated into clinical trials.
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Affiliation(s)
- Sara Lorio
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Roche Pharma and Early Development, Neuroscience, Ophthalmology and Rare Diseases, F. Hoffmann-La Roche Ltd., Basel, Switzerland.,Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Fabio Sambataro
- Roche Pharma and Early Development, Neuroscience, Ophthalmology and Rare Diseases, F. Hoffmann-La Roche Ltd., Basel, Switzerland.,Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Alessandro Bertolino
- Roche Pharma and Early Development, Neuroscience, Ophthalmology and Rare Diseases, F. Hoffmann-La Roche Ltd., Basel, Switzerland.,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Juergen Dukart
- Roche Pharma and Early Development, Neuroscience, Ophthalmology and Rare Diseases, F. Hoffmann-La Roche Ltd., Basel, Switzerland.,Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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14
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Caligiuri MP, Teulings HL, Dean CE, Lohr JB. The nature of bradykinesia in schizophrenia treated with antipsychotics. Psychiatry Res 2019; 273:537-543. [PMID: 30710809 PMCID: PMC6561794 DOI: 10.1016/j.psychres.2019.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
Recognizing drug-induced parkinsonian bradykinesia in psychosis patients can be challenging due to overlapping presentation with psychomotor slowing associated with depression, negative symptoms, or cognitive disturbances. In this study, we apply prior findings on the pathophysiology of bradykinesia in Parkinson's disease to gain an understanding of motor slowing in psychosis patients. Handwriting movements from 57 healthy participants and 70 psychosis patients were recorded on a digitizing tablet. Temporal and kinematic features were extracted from handwritten loops and circles. An independent objective measure based on peak velocity for circles written at maximum speed was used to classify patients as bradykinetic. Using a statistical cut-point derived from normative data, 64% of the patients met criterion for bradykinesia compared with 46% using a conventional observer-based severity rating scale. Bradykinetic patients produced handwriting movements with longer stroke durations, smaller amplitudes and lower peak velocities compared with non-bradykinetic patients. Thirty-six percent of the pen strokes produced by the bradykinetic patients were non-ballistic compare with 20% for the non-bradykinetic patients. The proportion of nonballistic movements observed in handwriting was unrelated to current antipsychotic dose, severity of negative psychosis or depression. The ease-of-use and standardization of a tablet-based approach to quantifying parkinsonian bradykinesia can aid in diagnosing parkinsonian bradykinesia in patients treated with antipsychotics.
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Affiliation(s)
| | | | | | - James B. Lohr
- University of California, San Diego, CA,VA San Diego, Center of Excellence for Stress and Mental Health
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15
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16
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Motion energy analysis reveals altered body movement in youth at risk for psychosis. Schizophr Res 2018; 200:35-41. [PMID: 28587814 PMCID: PMC5712481 DOI: 10.1016/j.schres.2017.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing evidence suggests that movement abnormalities occur prior to the onset of psychosis. Innovations in technology and software provide the opportunity for a fine-tuned and sensitive measurement of observable behavior that may be particularly useful to detecting the subtle movement aberrations present during the prodromal period. METHODS In the present study, 54 youth at ultrahigh risk (UHR) for psychosis and 62 healthy controls participated in structured clinical interviews to assess for an UHR syndrome. The initial 15min of the baseline clinical interview was assessed using Motion Energy Analysis (MEA) providing frame-by-frame measures of total movement, amplitude, speed, and variability of both head and body movement separately. RESULTS Result showed region-specific group differences such that there were no differences in head movement but significant differences in body movement. Specifically, the UHR group showed greater total body movement and speed of body movements, and lower variation in body movement compared to healthy controls. However, there were no significant associations with positive, negative or disorganized symptom domains. CONCLUSION This study represents an innovative perspective on gross motor function in the UHR group. Importantly, the automated approach used in this study provides a sensitive and objective measure of body movement abnormalities, potentially guiding novel assessment and prevention of symptom development in those at risk for psychosis.
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17
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Dutschke LL, Stegmayer K, Ramseyer F, Bohlhalter S, Vanbellingen T, Strik W, Walther S. Gesture impairments in schizophrenia are linked to increased movement and prolonged motor planning and execution. Schizophr Res 2018; 200:42-49. [PMID: 28709771 DOI: 10.1016/j.schres.2017.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
Schizophrenia patients present with a variety of impaired nonverbal communication skills. Performance of hand gestures is frequently impaired and associated with ratings of motor abnormalities. However, the impact of motor abnormalities to gesture performance remains unclear. To test the association between quantitative measures of motor behavior and qualitative ratings of gesture performance, we quantified movement parameters semi-automatically in videotaped recordings of gesture assessment. Thirty-one patients with schizophrenia (77.4%), schizophreniform (19.4%) or schizoaffective disorder (3.2%) and 32 healthy controls matched for age, gender and education underwent clinical assessment. Performance of the test of upper limb apraxia (TULIA) was video-taped in all subjects. The videos were analyzed with motion energy analysis software (MEA) to determine motion and time parameters. Patients and controls differed significantly in quantitative gesture performance: patients required more movement and more time to complete the tasks. Differences increased in patients with qualitatively impaired gesture production ratings (p<0.01). Group differences were most pronounced in the pantomime domain, when gestures are performed following verbal instruction. In patients, ratings of motor abnormalities correlated with duration of movement, while behavioral disorganization correlated with the amount of movements during gesture performance. Disorder related motor symptoms, aberrant action observation, planning and monitoring as well as internal clock abnormalities may explain the poor performance of hand gestures in schizophrenia. Quantitative video analysis offers a unique possibility to analyze movement patterns as a direct functional output of the motor system. In the future, it may assist monitoring, staging and prognosis in schizophrenia.
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Affiliation(s)
- Lars Levi Dutschke
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Fabian Ramseyer
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
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18
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Dean DJ, Walther S, Bernard JA, Mittal VA. Motor clusters reveal differences in risk for psychosis, cognitive functioning, and thalamocortical connectivity: evidence for vulnerability subtypes. Clin Psychol Sci 2018; 6:721-734. [PMID: 30319928 PMCID: PMC6178957 DOI: 10.1177/2167702618773759] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abnormal development of parallel cortical-striatal networks may contribute to abnormal motor, cognitive, and affective behavior prior to the onset of psychosis. Partitioning individuals at clinical high-risk (CHR) using motor behavior may provide a novel perspective on different etiological pathways or patient subtypes. A K-means cluster analysis was conducted in CHR (N=69; 42% female, mean age=18.67 years) young adults using theoretically distinct measures of motor behavior. The resulting subtypes were then compared on positive and negative symptoms at baseline, and 2-year risk of psychosis conversion. CHR participants were followed for 2 years to determine conversion to psychosis. CHR subtypes and healthy controls (N=61; 57% female, mean age=18.58 years) were compared on multiple cognitive domains and cortical-striatal connectivity. Results suggest 3 vulnerability subtypes of CHR individuals with different profiles of motor performance, symptoms, risk for conversion to psychosis, cognition, and thalamocortical connectivity. This approach may reflect a novel strategy for promoting tailored risk assessment as well as future research developing individualized medicine.
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Affiliation(s)
- Derek J. Dean
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
- University of Colorado Boulder, Center for Neuroscience, Boulder, CO, USA
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Jessica A. Bernard
- Texas A&M University, Department of Psychological and Brain Sciences, College Station, TX, USA
- Texas A&M University, Institute for Neuroscience, College Station, TX, USA
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA
- Northwestern University, Department of Psychiatry, Chicago IL, USA
- Northwestern University, Institute for Policy Research, Evanston, IL, USA
- Northwestern University, Medical Social Sciences, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Evanston/Chicago, IL, USA
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19
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Abstract
PURPOSE OF REVIEW Motor abnormalities are an intrinsic feature of psychosis. Neurological soft signs, Parkinsonism, dyskinesia, and other motor phenomena are frequently observed in subjects at clinical or genetic risk for psychosis as well as first-episode patients, chronic patients. Here, we review the most recent literature on motor assessments and pathophysiology in psychosis. RECENT FINDINGS Instrumental measures of fine motor performance, balance, spontaneous motor activity, and gesture indicated motor abnormalities in subjects at risk and across stages of schizophrenia. Motor phenomena are associated with distinct symptom dimensions and may indicate poor outcomes. Neuroimaging studies demonstrated altered neural maturation within critical motor networks in subjects at risk. Furthermore, specific categories of motor dysfunction were associated with distinct structural and functional alterations in the motor system in schizophrenia. Motor abnormalities provide a unique window into the pathobiology of psychosis and have the potential to guide screening, staging, and outcome prediction.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008, Bern, Switzerland.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Department of Psychiatry, Northwestern University, Evanston, IL, USA.,Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA.,Institute for Policy Research, Northwestern University, Evanston, IL, USA.,Institute for Developmental Science, Northwestern University, Evanston, IL, USA
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20
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Rahmim A, Huang P, Shenkov N, Fotouhi S, Davoodi-Bojd E, Lu L, Mari Z, Soltanian-Zadeh H, Sossi V. Improved prediction of outcome in Parkinson's disease using radiomics analysis of longitudinal DAT SPECT images. Neuroimage Clin 2017; 16:539-544. [PMID: 29868437 PMCID: PMC5984570 DOI: 10.1016/j.nicl.2017.08.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 02/01/2023]
Abstract
No disease modifying therapies for Parkinson's disease (PD) have been found effective to date. To properly power clinical trials for discovery of such therapies, the ability to predict outcome in PD is critical, and there is a significant need for discovery of prognostic biomarkers of PD. Dopamine transporter (DAT) SPECT imaging is widely used for diagnostic purposes in PD. In the present work, we aimed to evaluate whether longitudinal DAT SPECT imaging can significantly improve prediction of outcome in PD patients. In particular, we investigated whether radiomics analysis of DAT SPECT images, in addition to use of conventional non-imaging and imaging measures, could be used to predict motor severity at year 4 in PD subjects. We selected 64 PD subjects (38 male, 26 female; age at baseline (year 0): 61.9 ± 7.3, range [46,78]) from the Parkinson's Progressive Marker Initiative (PPMI) database. Inclusion criteria included (i) having had at least 2 SPECT scans at years 0 and 1 acquired on a similar scanner, (ii) having undergone a high-resolution 3 T MRI scan, and (iii) having motor assessment (MDS-UPDRS-III) available in year 4 used as outcome measure. Image analysis included automatic region-of-interest (ROI) extraction on MRI images, registration of SPECT images onto the corresponding MRI images, and extraction of radiomic features. Non-imaging predictors included demographics, disease duration as well as motor and non-motor clinical measures in years 0 and 1. The image predictors included 92 radiomic features extracted from the caudate, putamen, and ventral striatum of DAT SPECT images at years 0 and 1 to quantify heterogeneity and texture in uptake. Random forest (RF) analysis with 5000 trees was used to combine both non-imaging and imaging variables to predict motor outcome (UPDRS-III: 27.3 ± 14.7, range [3,77]). The RF prediction was evaluated using leave-one-out cross-validation. Our results demonstrated that addition of radiomic features to conventional measures significantly improved (p < 0.001) prediction of outcome, reducing the absolute error of predicting MDS-UPDRS-III from 9.00 ± 0.88 to 4.12 ± 0.43. This shows that radiomics analysis of DAT SPECT images has a significant potential towards development of effective prognostic biomarkers in PD.
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Affiliation(s)
- Arman Rahmim
- Department of Radiology, Johns Hopkins University, Baltimore, United States
- Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, United States
| | - Peng Huang
- Departments of Oncology and Biostatistics, Johns Hopkins University, Baltimore, United States
| | - Nikolay Shenkov
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada
| | - Sima Fotouhi
- Department of Radiology, Johns Hopkins University, Baltimore, United States
| | - Esmaeil Davoodi-Bojd
- Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, MI, United States
| | - Lijun Lu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Zoltan Mari
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Hamid Soltanian-Zadeh
- Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, MI, United States
- CIPCE, School of Electrical & Computer Engineering, University of Tehran, Tehran, Iran
| | - Vesna Sossi
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada
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21
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Mentzel CL, Bakker PR, van Os J, Drukker M, Matroos GE, Tijssen MAJ, van Harten PN. Blink rate is associated with drug-induced parkinsonism in patients with severe mental illness, but does not meet requirements to serve as a clinical test: the Curacao extrapyramidal syndromes study XIII. J Negat Results Biomed 2017; 16:15. [PMID: 28841828 PMCID: PMC6888915 DOI: 10.1186/s12952-017-0079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug-induced parkinsonism (DIP) has a high prevalence and is associated with poorer quality of life. To find a practical clinical tool to assess DIP in patients with severe mental illness (SMI), the association between blink rate and drug-induced parkinsonism (DIP) was assessed. METHODS In a cohort of 204 SMI patients receiving care from the only mental health service of the previous Dutch Antilles, blink rate per minute during conversation was assessed by an additional trained movement disorder specialist. DIP was rated on the Unified Parkinson's Disease Rating Scale (UPDRS) in 878 assessments over a period of 18 years. Diagnostic values of blink rate were calculated. RESULTS DIP prevalence was 36%, average blink rate was 14 (standard deviation (SD) 11) for patients with DIP, and 19 (SD 14) for patients without. There was a significant association between blink rate and DIP (p < 0.001). With a blink rate cut-off of 20 blinks per minute, sensitivity was 77% and specificity was 38%. A 10% percentile cut-off model resulted in an area under the ROC curve of 0.61. A logistic prediction model between dichotomous DIP and continuous blink rate per minute an area under the ROC curve of 0.70. CONCLUSIONS There is a significant association between blink rate and DIP as diagnosed on the UPDRS. However, blink rate sensitivity and specificity with regard to DIP are too low to replace clinical rating scales in routine psychiatric practice. TRIAL REGISTRATION The study was started over 20 years ago in 1992, at the time registering a trial was not common practice, therefore the study was never registered.
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Affiliation(s)
- Charlotte L Mentzel
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. .,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands.
| | - P Roberto Bakker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Marjan Drukker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
| | | | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands
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22
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van den Noort JC, Verhagen R, van Dijk KJ, Veltink PH, Vos MCPM, de Bie RMA, Bour LJ, Heida CT. Quantification of Hand Motor Symptoms in Parkinson's Disease: A Proof-of-Principle Study Using Inertial and Force Sensors. Ann Biomed Eng 2017; 45:2423-2436. [PMID: 28726022 PMCID: PMC5622175 DOI: 10.1007/s10439-017-1881-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
Abstract
This proof-of-principle study describes the methodology and explores and demonstrates the applicability of a system, existing of miniature inertial sensors on the hand and a separate force sensor, to objectively quantify hand motor symptoms in patients with Parkinson’s disease (PD) in a clinical setting (off- and on-medication condition). Four PD patients were measured in off- and on- dopaminergic medication condition. Finger tapping, rapid hand opening/closing, hand pro/supination, tremor during rest, mental task and kinetic task, and wrist rigidity movements were measured with the system (called the PowerGlove). To demonstrate applicability, various outcome parameters of measured hand motor symptoms of the patients in off- vs. on-medication condition are presented. The methodology described and results presented show applicability of the PowerGlove in a clinical research setting, to objectively quantify hand bradykinesia, tremor and rigidity in PD patients, using a single system. The PowerGlove measured a difference in off- vs. on-medication condition in all tasks in the presented patients with most of its outcome parameters. Further study into the validity and reliability of the outcome parameters is required in a larger cohort of patients, to arrive at an optimal set of parameters that can assist in clinical evaluation and decision-making.
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Affiliation(s)
- Josien C van den Noort
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Rens Verhagen
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Kees J van Dijk
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Michelle C P M Vos
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ciska T Heida
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
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23
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van Harten PN, Walther S, Kent JS, Sponheim SR, Mittal VA. The clinical and prognostic value of motor abnormalities in psychosis, and the importance of instrumental assessment. Neurosci Biobehav Rev 2017; 80:476-487. [PMID: 28711662 DOI: 10.1016/j.neubiorev.2017.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 01/15/2023]
Abstract
Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviours to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner. Further, converging evidence has laid the groundwork for theoretically and empirically derived categorization and conceptualization. This review summarizes these advances, stressing the importance of motor abnormalities for understanding vulnerability across different stages of psychosis and introducing these innovative instrumental approaches. Patients, researchers and clinicians will benefit from these new developments, as better assessment aids the development of targeted interventions to ultimately improve the care for individuals experiencing psychosis.
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Affiliation(s)
- Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands; Psychiatric Centre GGz Central, Amersfoort, The Netherlands.
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston/Chicago, USA
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