Effects of Fatigue on Balance in Individuals With Parkinson Disease: Influence of Medication and Brain-Derived Neurotrophic Factor Genotype

Association between fatigue and MDS-UPDRS in individuals with Parkinson's disease: cross-sectional study

BACKGROUND

Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD.

METHODS

A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale.

RESULTS

A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms.

CONCLUSION

Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

Lower Limb Muscle Fatigue Alters Spatiotemporal Gait Parameters and Turning Difficulty Characteristics in Parkinson's Disease

OBJECTIVE

To determine the effects of lower limb muscle fatigue on spatiotemporal gait parameters and turning difficulty characteristics during the extended Timed Up and Go (extended TUG) test in individuals with different severity stages of Parkinson's disease (PD).

METHODS

Forty individuals with PD, classified as Hoehn and Yahr (H&Y) stages 2 and 3 participated in this pre- and post-experimental study design. The participants performed a continuous sit-to-stand task from a chair based on 30 cycles/min set-up to induce lower limb muscle fatigue. They performed extended TUG test immediately before and after completing the fatigue protocol. Spatiotemporal gait parameters and turning difficulty characteristics were recorded using two GoPro® Hero 4 Silver cameras. Data were subjected to a repeated-measure ANOVA.

RESULTS

Individuals with PD experience significant changes in spatiotemporal gait parameters, specifically stride velocity and length, under conditions of lower limb muscle fatigue (p=0.001). These changes were more pronounced in individuals with PD in the H&Y stage 3 group. Additionally, both PD groups exhibited difficulty with turning, requiring more than five steps to complete a 180° turn and taking more than 3 seconds to accomplish it.

CONCLUSION

These findings highlight the impact of muscle fatigue on gait performance in PD and suggest that individuals in later stages of the disease may be particularly affected. Further research is needed to explore interventions that can mitigate these gait impairments and improve mobility in individuals with PD.

A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease

Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.

"Going Backward": Effects of age and fatigue on posterior-directed falls in Parkinson disease

BACKGROUND

Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue.

OBJECTIVE

We sought to investigate the influences of performance fatigue and age on postural control in persons with PD.

METHODS

Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables.

RESULTS

After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued.

CONCLUSIONS

The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.

The effect of fatigue on balance performance in Parkinson's disease

Introduction

Balance loss and falls are a common and multifactorial finding in persons with Parkinson's Disease (pwPD). Objective fatigability is thought to contribute to falls in other neurologic conditions, but its impact on balance in pwPD is not known. The two-fold purpose of this study was to: 1) establish that a 6-minute walk (6MW_Fast) is a stimulus to subjective fatigue for pwPD; and, 2) determine if the Mini Balance Evaluation Systems Test (MBT) is sensitive to change that was induced by a fatiguing condition.

Methods

Using a randomized crossover design, 19 research participants performed a Mini Balance Evaluation Systems Test (MBT) before and after either a ‘fast’ 6-minute walk (6MW_Fast) to induce fatigue or a 6-minute rest.

Results

VASF scores increased after the 6MW_Fast. Total MBT scores in research participants with Modified Hoehn and Yahr (H&Y) scores of 3.0 and above differed significantly before and after the ‘fast’ 6-minute walk (p = .007, n = 9) while participants with H&Y scores of 1.5 to 2.5 (p = .084, n = 10) did not, suggesting that more disabled pwPD were more likely to experience fatigability that interfered with balance.

Conclusions

A 6MW_Fast is a sufficient stimulus to induce subjective fatigue in pwPD and to decrease total MBT scores for more disabled pwPD. Balance evaluations should occur when pwPD are in fatigued and unfatigued states to determine whether fatigue has an impact on balance performance.

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Both subjective fatigue and objective fatigability can occur in Parkinsons Disease (PD).

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Objective fatigability may be a factor in balance impairment in persons with PD.

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Balance assessments in PD should be made with the patient in both a fatigued and non fatigued state.

Dose-dependent neuroprotective effect of oriental phyto-derived glycyrrhizin on experimental neuroterminal norepinephrine depletion in a rat brain model

The dose-dependent neuroprotective role of licorice-derived glycyrrhizin during subacute neuroterminal norepinephrine (NE) depletion was studied in rat brain. Experimental design included thirty 5-week-old male rats randomly divided into five groups. Compared to the saline-injected control group, the group receiving daily intraperitoneal injection of fusaric acid (FA; 5 mg/kg/b.w.) for 30 days showed pharmacological depletion of NE. The neuroprotective effects of three successively increasing oral doses of glycyrrhizin were examined in FA-treated rats. Neurochemical parameters and histo-/immunohistopathological changes in the hippocampus were examined. FA generated global hippocampal stress with altered neurobiochemical parameters, accompanied by immune-confirmed inflammatory tissue damage, and noticeable behavioral changes. Although glycyrrhizin after FA-induced intoxication did not correct the recorded drop in the NE level, it decreased the dopamine levels to control levels. Similarly, glycyrrhizin at a high dose restored the serotonin level to its normal value and blocked the FA-induced increase in the level of its metabolite, 5-hydroxyindoleacetic acid. The FA-induced rise in γ-aminobutyric acid (GABA) and histamine was alleviated after administration of a high dose of glycyrrhizin. This was accompanied by improvements in the bioenergetic status and neuronal regenerative capacity through recovery of ATP and brain-derived neurotrophic factor levels to the pre-intoxicated values. High doses of glycyrrhizin also ameliorated the FA-generated behavioral changes and oxidative damage, manifested by the reduction in the expression of cortical pro-apoptotic caspase 3 in the same group. This study suggests that glycyrrhizin can potentially mend most of the previously evoked neuronal damage induced by FA intoxication in the brain of an experimental rat model.