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Zampieri C, Leary JB, Shahim P, Damiano D, Ho PS, Pham DL, Chan L. Associations between white matter integrity and postural control in adults with traumatic brain injury. PLoS One 2023; 18:e0288727. [PMID: 38011096 PMCID: PMC10681193 DOI: 10.1371/journal.pone.0288727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 11/29/2023] Open
Abstract
Abnormalities of postural sway have been extensively reported in traumatic brain injury (TBI). However, the underlying neural correlates of balance disturbances in TBI remain to be elucidated. Studies in children with TBI have reported associations between the Sensory Organization Test (SOT) and measures of white matter (WM) integrity with diffusion tensor imaging (DTI) in brain areas responsible for multisensory integration. This study seeks to replicate those associations in adults as well as explore relationships between DTI and the Limits of Stability (LOS) Test. Fifty-six participants (43±17 years old) with a history of TBI were tested 30 days to 5 years post-TBI. This study confirmed results in children for associations between the SOT and the medial lemniscus as well as middle cerebellar peduncle, and revealed additional associations with the posterior thalamic radiation. Additionally, this study found significant correlations between abnormal LOS scores and impaired WM integrity in the cingulum, corpus callosum, corticopontine and corticospinal tracts, fronto-occipital fasciculi, longitudinal fasciculi, medial lemniscus, optic tracts and thalamic radiations. Our findings indicate the involvement of a broad range of WM tracts in the control of posture, and demonstrate the impact of TBI on balance via disruptions to WM integrity.
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Affiliation(s)
- Cris Zampieri
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jacob B. Leary
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pashtun Shahim
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Diane Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pei-Shu Ho
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dzung L. Pham
- Center for Neuroscience and Regenerative Medicine, The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland, United States of America
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Mofateh R, Salehi R, Mehravar M, Negahban H. Quantifying lower extremity inter-segmental coordination variability during walking in people with multiple sclerosis with high and low fear of falling. Mult Scler Relat Disord 2022; 68:104258. [PMID: 36544317 DOI: 10.1016/j.msard.2022.104258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fear of falling (FOF) is associated with gait disturbances in people with multiple sclerosis (PwMS). However, previous studies mostly assessed FOF-related changes in gait patterns of PwMS using spatio-temporal gait parameters. Considering the complex nature of gait control, investigation of the higher order properties of the human movement system, particularly inter-segmental coordination variability may provide valuable information about underlying deficits in motor control patterns in PwMS with different levels of FOF. Therefore, the purpose of this study was to clarify the differences in lower extremity inter-segmental coordination variability between healthy controls and PwMS with high and low FOF. METHODS This cross-sectional study examined gait patterns of 40 PwMS and 20 age-and-sex-matched healthy controls during treadmill walking at a preferred walking speed for 3 min. The falls efficacy scale-international questionnaire was used to stratify PwMS into high and low FOF subgroups. Variability in coordinative relationships between shank-thigh and foot-shank segments was determined using deviation phase (DP), which is the average standard deviation calculated from all points of the ensemble continuous relative phase (CRP) curve during the stance and swing phases of gait. RESULTS DP values for shank-thigh (p = 0.005 and p < 0.001, respectively) and foot-shank inter-segmental relationships (p < 0.001) during the stance phase as well as for foot-shank inter-segmental relationships during the swing phase (p = 0.03) were significantly greater in PwMS with high FOF compared to those with low FOF and healthy controls. In addition, both groups of PwMS with high and low FOF indicated greater shank-thigh DP values compared to healthy controls during the swing phase (p < 0.001 and p = 0.002, respectively). CONCLUSION The findings suggest unsteadiness in neuromuscular organization during walking in PwMS with high FOF. Rehabilitative interventions targeting impairments in lower extremity inter-segmental coordination and FOF may be useful to improve walking and reduce risk of falls in PwMS with high FOF.
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Affiliation(s)
- Razieh Mofateh
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Salehi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehravar
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Horn MJ, Gokcal E, Becker AJ, Das AS, Warren AD, Schwab K, Goldstein JN, Biffi A, Rosand J, Polimeni JR, Viswanathan A, Greenberg SM, Gurol ME. Cerebellar atrophy and its implications on gait in cerebral amyloid angiopathy. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328553. [PMID: 35534189 PMCID: PMC10936558 DOI: 10.1136/jnnp-2021-328553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Recent data suggest that cerebral amyloid angiopathy (CAA) causes haemorrhagic lesions in cerebellar cortex as well as subcortical cerebral atrophy. However, the potential effect of CAA on cerebellar tissue loss and its clinical implications have not been investigated. METHODS Our study included 70 non-demented patients with probable CAA, 70 age-matched healthy controls (HCs) and 70 age-matched patients with Alzheimer's disease (AD). The cerebellum was segmented into percent of cerebellar subcortical volume (pCbll-ScV) and percent of cerebellar cortical volume (pCbll-CV) represented as percent (p) of estimated total intracranial volume. We compared pCbll-ScV and pCbll-CV between patients with CAA, HCs and those with AD. Gait velocity (metres/second) was used to investigate gait function in patients with CAA. RESULTS Patients with CAA had significantly lower pCbll-ScV compared with both HC (1.49±0.1 vs 1.73±0.2, p<0.001) and AD (1.49±0.1 vs 1.66±0.24, p<0.001) and lower pCbll-CV compared with HCs (6.03±0.5 vs 6.23±0.6, p=0.028). Diagnosis of CAA was independently associated with lower pCbll-ScV compared with HCs (p<0.001) and patients with AD (p<0.001) in separate linear regression models adjusted for age, sex and presence of hypertension. Lower pCbll-ScV was independently associated with worse gait velocity (β=0.736, 95% CI 0.28 to 1.19, p=0.002) in a stepwise linear regression analysis including pCbll-CV along with other relevant variables. INTERPRETATION Patients with CAA show more subcortical cerebellar atrophy than HC or patients with AD and more cortical cerebellar atrophy than HCs. Reduced pCbll-ScV correlated with lower gait velocity in regression models including other relevant variables. Overall, this study suggests that CAA causes cerebellar injury, which might contribute to gait disturbance.
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Affiliation(s)
- Mitchell J Horn
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Elif Gokcal
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alex J Becker
- Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alvin S Das
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D Warren
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Schwab
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessandro Biffi
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan R Polimeni
- Athinoula A Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Anand Viswanathan
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Steven M Greenberg
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Edip Gurol
- J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Association between fear of falling and spatial and temporal parameters of gait in older adults: the FIBRA-RJ study. Eur Geriatr Med 2022; 13:407-413. [DOI: 10.1007/s41999-021-00601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
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Rurak BK, Rodrigues JP, Power BD, Drummond PD, Vallence AM. Reduced Cerebellar Brain Inhibition Measured Using Dual-Site TMS in Older Than in Younger Adults. THE CEREBELLUM 2021; 21:23-38. [PMID: 33880658 DOI: 10.1007/s12311-021-01267-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/30/2022]
Abstract
Dual-site transcranial magnetic stimulation (TMS) can be used to measure the cerebellar inhibitory influence on the primary motor cortex, known as cerebellar brain inhibition (CBI), which is thought to be important for motor control. The aim of this study was to determine whether age-related differences in CBI (measured at rest) were associated with an age-related decline in bilateral motor control measured using the Purdue Pegboard task, the Four Square Step Test, and a 10-m walk. In addition, we examined test re-test reliability of CBI measured using dual-site TMS with a figure-of-eight coil in two sessions. There were three novel findings. First, CBI was less in older than in younger adults, which is likely underpinned by an age-related loss of Purkinje cells. Second, greater CBI was associated with faster 10-m walking performance in older adults, but slower 10-m walking performance in younger adults. Third, moderate intraclass correlation coefficients (ICCs: 0.53) were found for CBI in younger adults; poor ICCs were found for CBI (ICC: 0.40) in older adults. Together, these results have important implications for the use of dual-site TMS to increase our understanding of age- and disease-related changes in cortical motor networks, and the role of functional connectivity in motor control.
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Affiliation(s)
- B K Rurak
- Discipline of Psychology, College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia. .,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Perth, WA, 6150, Australia.
| | | | - B D Power
- Hollywood Private Hospital, Perth, WA, Australia.,School of Medicine Fremantle, University of Notre Dame Australia, Perth, WA, Australia
| | - P D Drummond
- Discipline of Psychology, College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Perth, WA, 6150, Australia
| | - A M Vallence
- Discipline of Psychology, College of Science, Health, Engineering, and Education, Murdoch University, Perth, Australia.,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Perth, WA, 6150, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Perth, WA, Australia
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Wang Z, Lane C, Terza M, Khemani P, Lui S, McKinney WS, Mosconi MW. Upper and Lower Limb Movement Kinematics in Aging FMR1 Gene Premutation Carriers. Brain Sci 2020; 11:E13. [PMID: 33374331 PMCID: PMC7823457 DOI: 10.3390/brainsci11010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder associated with a premutation cytosine-guanine-guanine (CGG) trinucleotide repeat expansion of the FMR1 gene. FXTAS is estimated to be the most common single-gene form of ataxia in the aging population. Gait ataxia and intention tremor are the primary behavioral symptoms of FXTAS, though clinical evaluation of these symptoms often is subjective, contributing to difficulties in reliably differentiating individuals with FXTAS and asymptomatic premutation carriers. This study aimed to clarify the extent to which quantitative measures of gait and upper limb kinematics may serve as biobehavioral markers of FXTAS degeneration. Nineteen premutation carriers (aged 46-77 years), including 9 with possible, probable, or definite FXTAS and 16 sex- and IQ-matched healthy controls, completed tests of non-constrained walking and reaching while both standing (static reaching) and walking (dynamic reaching) to quantify gait and upper limb control, respectively. For the non-constrained walking task, participants wore reflective markers and walked at their preferred speed on a walkway. During the static reaching task, participants reached and lifted boxes of different sizes while standing. During the dynamic reaching task, participants walked to reach and lift the boxes. Movement kinematics were examined in relation to clinical ratings of neuromotor impairments and CGG repeat length. During non-constrained walking, individuals with FXTAS showed decreased stride lengths and stride velocities, increased percentages of double support time, and increased variabilities of cadence and center of mass relative to both asymptomatic premutation carriers and controls. While individuals with FXTAS did not show any static reaching differences relative to the other two groups, they showed multiple differences during dynamic reaching trials, including reduced maximum reaching velocity, prolonged acceleration time, and jerkier movement of the shoulder, elbow, and hand. Gait differences during non-constrained walking were associated with more severe clinically rated posture and gait symptoms. Reduced maximum reaching velocity and increased jerkiness during dynamic reaching were each related to more severe clinically rated kinetic dysfunction and overall neuromotor symptoms in FMR1 premutation carriers. Our findings suggest kinematic alterations consistent with gait ataxia and upper limb bradykinesia are each selectively present in individuals with FXTAS, but not asymptomatic aging premutation carriers. Consistent with neuropathological and magnetic resonance imaging (MRI) studies of FXTAS, these findings implicate cerebellar and basal ganglia degeneration associated with neuromotor decline. Our results showing associations between quantitative kinematic differences in FXTAS and clinical ratings suggest that objective assessments of gait and reaching behaviors may serve as critical and reliable targets for detecting FXTAS risk and monitoring progression.
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Affiliation(s)
- Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32611-0164, USA;
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
| | - Callie Lane
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Matthew Terza
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611-8205, USA;
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA 98121, USA;
| | - Su Lui
- Huaxi Magnetic Resonance Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China;
| | - Walker S. McKinney
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
| | - Matthew W. Mosconi
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
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Little VL, McGuirk TE, Perry LA, Patten C. Pelvic excursion during walking post-stroke: A novel classification system. Gait Posture 2018; 62:395-404. [PMID: 29627499 DOI: 10.1016/j.gaitpost.2018.03.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/09/2018] [Accepted: 03/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Researchers and clinicians often use gait speed to classify hemiparetic gait dysfunction because it offers clinical predictive capacity. However, gait speed fails to distinguish unique biomechanical characteristics that differentiate aspects of gait dysfunction. RESEARCH QUESTION Here we describe a novel classification of hemiparetic gait dysfunction based on biomechanical traits of pelvic excursion. We hypothesize that individuals with greater deviation of pelvic excursion, relative to controls, demonstrate greater impairment in key gait characteristics. METHODS We compared 41 participants (61.0 ± 11.2yrs) with chronic post-stroke hemiparesis to 21 non-disabled controls (55.8 ± 9.0yrs). Participants walked on an instrumented split-belt treadmill at self-selected walking speed. Pelvic excursion was quantified as the peak-to-peak magnitude of pelvic motion in three orthogonal planes (i.e., tilt, rotation, and obliquity). Raw values of pelvic excursion were compared against the distribution of control data to establish deviation scores which were assigned bilaterally for the three planes producing six values per individual. Deviation scores were then summed to produce a composite pelvic deviation score. Based on composite scores, participants were allocated to one of three categories of hemiparetic gait dysfunction with progressively increasing pelvic excursion deviation relative to controls: Type I (n = 15) - minimal pelvic excursion deviation; Type II (n = 20) - moderate pelvic excursion deviation; and Type III (n = 6) - marked pelvic excursion deviation. We assessed resulting groups for asymmetry in key gait parameters including: kinematics, joint powers temporally linked to the stance-to-swing transition, and timing of lower extremity muscle activity. RESULTS All groups post-stroke walked at similar self-selected speeds; however, classification based on pelvic excursion deviation revealed progressive asymmetry in gait kinematics, kinetics and temporal patterns of muscle activity. SIGNIFICANCE The progressive asymmetry revealed in multiple gait characteristics suggests exaggerated pelvic motion contributes to gait dysfunction post-stroke.
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Affiliation(s)
- Virginia L Little
- Neural Control of Movement Lab, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; Brain Rehabilitation R&D Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Rd., Gainesville, FL 32608-1197, USA.
| | - Theresa E McGuirk
- Neural Control of Movement Lab, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; Brain Rehabilitation R&D Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Rd., Gainesville, FL 32608-1197, USA.
| | - Lindsay A Perry
- Brain Rehabilitation R&D Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Rd., Gainesville, FL 32608-1197, USA.
| | - Carolynn Patten
- Neural Control of Movement Lab, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; Brain Rehabilitation R&D Center (151A), Malcom Randall VA Medical Center, 1601 SW Archer Rd., Gainesville, FL 32608-1197, USA; Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, FL 32610-0154, USA.
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Ehsani F, Samaei A, Zoghi M, Hedayati R, Jaberzadeh S. The effects of cerebellar transcranial direct current stimulation on static and dynamic postural stability in older individuals: a randomized double-blind sham-controlled study. Eur J Neurosci 2017; 46:2875-2884. [PMID: 28973782 DOI: 10.1111/ejn.13731] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022]
Abstract
The aging population is growing rapidly. Risk of falling is higher in older people compared to young adults due to several reasons including poor posture and balance. The main aim of this study was to investigate the effect of cerebellar anodal transcranial direct current stimulation (a-tDCS) on static and dynamic postural stability in older individuals. Twenty-nine older adults participated in this study and were randomly allocated to two groups of active a-tDCS (experimental; n = 14) or sham tDCS group (n = 15). Experimental group received cerebellar a-tDCS for 20 min with intensity of 1.5 mA. Anterior-posterior and medial-lateral postural stability indices (postural sway) in addition to Berg Balance Score were measured before and after the intervention. Postural sways in static and dynamic postural tasks were significantly decreased (P < 0.05) after cerebellar a-tDCS, in addition to Berg Balance Score that increased significantly in active cerebellar a-tDCS group (P < 0.05). However, there were no significant changes in postural stability indices or Berg Balance Score in sham group (P > 0.05). The findings indicated immediate effect of cerebellar a-tDCS on improvement of postural control and balance in older individuals.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran
| | - Afshin Samaei
- Department of Internal Medicine, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Rozita Hedayati
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Microstructural integrity of white matter tracts amongst older fallers: A DTI study. PLoS One 2017; 12:e0179895. [PMID: 28658309 PMCID: PMC5489210 DOI: 10.1371/journal.pone.0179895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives This study assesses the whole brain microstructural integrity of white matter tracts (WMT) among older individuals with a history of falls compared to non-fallers. Methods 85 participants (43 fallers, 42 non-fallers) were evaluated with conventional MRI and diffusion tensor imaging (DTI) sequences of the brain. DTI metrics were obtained from selected WMT using tract-based spatial statistics (TBSS) method. This was followed by binary logistic regression to investigate the clinical variables that could act as confounding elements on the outcomes. The TBSS analysis was then repeated, but this time including all significant predictor variables from the regression analysis as TBSS covariates. Results The mean diffusivity (MD) and axial diffusivity (AD) and to a lesser extent radial diffusivity (RD) values of the projection fibers and commissural bundles were significantly different in fallers (p < 0.05) compared to non-fallers. However, the final logistic regression model obtained showed that only functional reach, white matter lesion volume, hypertension and orthostatic hypotension demonstrated statistical significant differences between fallers and non-fallers. No significant differences were found in the DTI metrics when taking into account age and the four variables as covariates in the repeated analysis. Conclusion This DTI study of 85 subjects, do not support DTI metrics as a singular factor that contributes independently to the fall outcomes. Other clinical and imaging factors have to be taken into account.
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Disturbances of automatic gait control mechanisms in higher level gait disorder. Gait Posture 2016; 48:47-51. [PMID: 27477707 DOI: 10.1016/j.gaitpost.2016.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/21/2016] [Accepted: 04/26/2016] [Indexed: 02/02/2023]
Abstract
The underlying mechanisms responsible for the gait changes in frontal gait disorder (FGD), a form of higher level gait disorders, are poorly understood. We investigated the relationship between stride length and cadence (SLCrel) in people with FGD (n=15) in comparison to healthy older adults (n=21) to improve our understanding of the changes to gait in FGD. Gait data was captured using an electronic walkway system as participants walked at five self-selected speed conditions: preferred, very slow, slow, fast and very fast. Linear regression was used to determine the strength of the relationship (R(2)), slope and intercept. In the FGD group 9 participants had a strong SLCrel (linear group) (R(2)>0.8) and 6 a weak relationship (R(2)<0.8) (nonlinear group). The linear FGD group did not differ to healthy control for slope (p>0.05) but did have a lower intercept (p<0.001). The linear FGD group modulated gait speed by adjusting stride length and cadence similar to controls whereas the nonlinear FGD participants adjusted stride length but not cadence similar to controls. The non-linear FGD group had greater disturbance to their gait, poorer postural control and greater fear of falling compared to the linear FGD group. Investigation of the SLCrel resulted in new insights into the underlying mechanisms responsible for the gait changes found in FGD. The findings suggest stride length regulation was disrupted in milder FGD but as the disorder worsened, cadence control also became disordered resulting in a break down in the relationship between stride length and cadence.
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Anderson-Mooney AJ, Schmitt FA, Head E, Lott IT, Heilman KM. Gait dyspraxia as a clinical marker of cognitive decline in Down syndrome: A review of theory and proposed mechanisms. Brain Cogn 2016; 104:48-57. [PMID: 26930369 PMCID: PMC4801771 DOI: 10.1016/j.bandc.2016.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/13/2016] [Accepted: 02/21/2016] [Indexed: 12/15/2022]
Abstract
Down syndrome (DS) is the most common genetic cause of intellectual disability in children. With aging, DS is associated with an increased risk for Alzheimer's disease (AD). The development of AD neuropathology in individuals with DS can result in further disturbances in cognition and behavior and may significantly exacerbate caregiver burden. Early detection may allow for appropriate preparation by caregivers. Recent literature suggests that declines in gait may serve as an early marker of AD-related cognitive disorders; however, this relationship has not been examined in individuals with DS. The theory regarding gait dyspraxia and cognitive decline in the general population is reviewed, and potential applications to the population with individuals with DS are highlighted. Challenges and benefits in the line of inquiry are discussed. In particular, it appears that gait declines in aging individuals with DS may be associated with known declines in frontoparietal gray matter, development of AD-related pathology, and white matter losses in tracts critical to motor control. These changes are also potentially related to the cognitive and functional changes often observed during the same chronological period as gait declines in adults with DS. Gait declines may be an early marker of cognitive change, related to the development of underlying AD-related pathology, in individuals with DS. Future investigations in this area may provide insight into the clinical changes associated with development of AD pathology in both the population with DS and the general population, enhancing efforts for optimal patient and caregiver support and propelling investigations regarding safety/quality of life interventions and disease-modifying interventions.
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Affiliation(s)
- Amelia J Anderson-Mooney
- University of Kentucky College of Medicine, Department of Neurology, 740 S. Limestone, Suite B-101, Lexington, KY 40536, United States.
| | - Frederick A Schmitt
- University of Kentucky College of Medicine, Department of Neurology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 312, Lexington, KY 40536, United States.
| | - Elizabeth Head
- University of Kentucky, Department of Molecular & Biomedical Pharmacology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 203, Lexington, KY 40536, United States.
| | - Ira T Lott
- University of California - Irvine School of Medicine, Department of Pediatrics, Bldg 2 3rd Floor Rt 81, 101 The City Drive, Mail Code: 4482, Orange, CA 92668, United States.
| | - Kenneth M Heilman
- University of Florida College of Medicine, Department of Neurology, Room L3-100, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, United States.
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Mosconi MW, Wang Z, Schmitt LM, Tsai P, Sweeney JA. The role of cerebellar circuitry alterations in the pathophysiology of autism spectrum disorders. Front Neurosci 2015; 9:296. [PMID: 26388713 PMCID: PMC4555040 DOI: 10.3389/fnins.2015.00296] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/06/2015] [Indexed: 01/23/2023] Open
Abstract
The cerebellum has been repeatedly implicated in gene expression, rodent model and post-mortem studies of autism spectrum disorder (ASD). How cellular and molecular anomalies of the cerebellum relate to clinical manifestations of ASD remains unclear. Separate circuits of the cerebellum control different sensorimotor behaviors, such as maintaining balance, walking, making eye movements, reaching, and grasping. Each of these behaviors has been found to be impaired in ASD, suggesting that multiple distinct circuits of the cerebellum may be involved in the pathogenesis of patients' sensorimotor impairments. We will review evidence that the development of these circuits is disrupted in individuals with ASD and that their study may help elucidate the pathophysiology of sensorimotor deficits and core symptoms of the disorder. Preclinical studies of monogenetic conditions associated with ASD also have identified selective defects of the cerebellum and documented behavioral rescues when the cerebellum is targeted. Based on these findings, we propose that cerebellar circuits may prove to be promising targets for therapeutic development aimed at rescuing sensorimotor and other clinical symptoms of different forms of ASD.
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Affiliation(s)
- Matthew W Mosconi
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas Lawrence, KS, USA ; Center for Autism and Developmental Disabilities, University of Texas Southwestern Dallas, TX, USA ; Department of Psychiatry, University of Texas Southwestern Dallas, TX, USA ; Department of Pediatrics, University of Texas Southwestern Dallas, TX, USA
| | - Zheng Wang
- Center for Autism and Developmental Disabilities, University of Texas Southwestern Dallas, TX, USA ; Department of Psychiatry, University of Texas Southwestern Dallas, TX, USA
| | - Lauren M Schmitt
- Center for Autism and Developmental Disabilities, University of Texas Southwestern Dallas, TX, USA ; Department of Psychiatry, University of Texas Southwestern Dallas, TX, USA
| | - Peter Tsai
- Center for Autism and Developmental Disabilities, University of Texas Southwestern Dallas, TX, USA ; Department of Psychiatry, University of Texas Southwestern Dallas, TX, USA ; Department of Pediatrics, University of Texas Southwestern Dallas, TX, USA ; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Dallas, TX, USA ; Department of Neuroscience, University of Texas Southwestern Dallas, TX, USA
| | - John A Sweeney
- Center for Autism and Developmental Disabilities, University of Texas Southwestern Dallas, TX, USA ; Department of Psychiatry, University of Texas Southwestern Dallas, TX, USA ; Department of Pediatrics, University of Texas Southwestern Dallas, TX, USA
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Little VL, McGuirk TE, Patten C. Impaired limb shortening following stroke: what's in a name? PLoS One 2014; 9:e110140. [PMID: 25329317 PMCID: PMC4199676 DOI: 10.1371/journal.pone.0110140] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 09/17/2014] [Indexed: 11/27/2022] Open
Abstract
Background Difficulty advancing the paretic limb during the swing phase of gait is a prominent manifestation of walking dysfunction following stroke. This clinically observable sign, frequently referred to as ‘foot drop’, ostensibly results from dorsiflexor weakness. Objective Here we investigated the extent to which hip, knee, and ankle motions contribute to impaired paretic limb advancement. We hypothesized that neither: 1) minimal toe clearance and maximal limb shortening during swing nor, 2) the pattern of multiple joint contributions to toe clearance and limb shortening would differ between post-stroke and non-disabled control groups. Methods We studied 16 individuals post-stroke during overground walking at self-selected speed and nine non-disabled controls who walked at matched speeds using 3D motion analysis. Results No differences were detected with respect to the ankle dorsiflexion contribution to toe clearance post-stroke. Rather, hip flexion had a greater relative influence, while the knee flexion influence on producing toe clearance was reduced. Conclusions Similarity in the ankle dorsiflexion, but differences in the hip and knee, contributions to toe clearance between groups argues strongly against dorsiflexion dysfunction as the fundamental impairment of limb advancement post-stroke. Marked reversal in the roles of hip and knee flexion indicates disruption of inter-joint coordination, which most likely results from impairment of the dynamic contribution to knee flexion by the gastrocnemius muscle in preparation for swing. These findings suggest the need to reconsider the notion of foot drop in persons post-stroke. Redirecting the focus of rehabilitation and restoration of hemiparetic walking dysfunction appropriately, towards contributory neuromechanical impairments, will improve outcomes and reduce disability.
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Affiliation(s)
- Virginia L. Little
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
- Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL, United States of America
- Brain Rehabilitation Research & Development Center, Malcolm-Randall VA Medical Center, Gainesville, FL, United States of America
| | - Theresa E. McGuirk
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
- Brain Rehabilitation Research & Development Center, Malcolm-Randall VA Medical Center, Gainesville, FL, United States of America
| | - Carolynn Patten
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
- Rehabilitation Science Doctoral Program, University of Florida, Gainesville, FL, United States of America
- Brain Rehabilitation Research & Development Center, Malcolm-Randall VA Medical Center, Gainesville, FL, United States of America
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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14
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The relationship between specific cognitive domains, fear of falling, and falls in people with multiple sclerosis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:281760. [PMID: 25165694 PMCID: PMC4131562 DOI: 10.1155/2014/281760] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022]
Abstract
The primary aim was to examine the relationship between seven definite aspects of cognition measured by a computerized cognitive testing tool on the history falls in people with mild to moderate MS (PwMS). Secondary aims focused on whether cognition performance is correlated to fear of falling, walking velocity, and a patient-rated measure of walking ability. One hundred and one PwMS were included in the study analysis. Fifty-two had a history of at least one fall during the past year. Outcome measures included a computerized cognitive test battery designed to evaluate multiple cognitive domains, gait speed, and self-reported questionnaires; 12-item MS walking scale (MSWS-12); and Falls Efficacy Scale International. Significant differences between fallers and nonfallers were exhibited in attention and verbal function, scoring 7.5% (P = 0.013) and 6.2% (P = 0.05), respectively, below the parallel scores of the nonfallers. Attention was the only cognitive component significantly correlated with the MSWS-12 self-reported questionnaire. Fear of falling was significantly correlated with 6 (out of 7) definite cognitive variables. The present findings support the concept that when evaluating and attempting to reduce fall risk, emphasis should be placed not only on traditional fall risk factors like muscle strength and motor function, but also on cognitive function.
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Hori M, Yoshida M, Yokoyama K, Kamagata K, Kumagai F, Fukunaga I, Kamiya K, Suzuki M, Masutani Y, Hamasaki N, Suzuki Y, Kyogoku S, Hattori N, Aoki S. Multiple sclerosis: Benefits of q-space imaging in evaluation of normal-appearing and periplaque white matter. Magn Reson Imaging 2014; 32:625-9. [DOI: 10.1016/j.mri.2014.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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16
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Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord 2014; 28:1520-33. [PMID: 24132840 DOI: 10.1002/mds.25674] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 12/18/2022] Open
Abstract
Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other.
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Affiliation(s)
- Marianna Amboni
- Isituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy; Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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17
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Nutt JG. Higher-level gait disorders: an open frontier. Mov Disord 2014; 28:1560-5. [PMID: 24132844 DOI: 10.1002/mds.25673] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/26/2013] [Accepted: 08/13/2013] [Indexed: 11/10/2022] Open
Abstract
The term higher-level gait disorders (HLGD) defines a category of balance and gait disorders that are not explained by deficits in strength, tone, sensation, or coordination. HLGD are characterized by various combinations of disequilibrium and impaired locomotion. A plethora of new imaging techniques are beginning to determine the neural circuits that are the basis of these disorders. Although a variety of neurodegenerative and other pathologies can produce HLGD, the most common cause appears to be microvascular disease that causes white-matter lesions and thereby disrupts balance/locomotor circuits.
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Affiliation(s)
- John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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18
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Bernard JA, Seidler RD. Moving forward: age effects on the cerebellum underlie cognitive and motor declines. Neurosci Biobehav Rev 2014; 42:193-207. [PMID: 24594194 PMCID: PMC4024443 DOI: 10.1016/j.neubiorev.2014.02.011] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/24/2022]
Abstract
Though the cortical contributions to age-related declines in motor and cognitive performance are well-known, the potential contributions of the cerebellum are less clear. The diverse functions of the cerebellum make it an important structure to investigate in aging. Here, we review the extant literature on this topic. To date, there is evidence to indicate that there are morphological age differences in the cerebellum that are linked to motor and cognitive behavior. Cerebellar morphology is often as good as - or even better - at predicting performance than the prefrontal cortex. We also touch on the few studies using functional neuroimaging and connectivity analyses that further implicate the cerebellum in age-related performance declines. Importantly, we provide a conceptual framework for the cerebellum influencing age differences in performance, centered on the notion of degraded internal models. The evidence indicating that cerebellar age differences associate with performance highlights the need for additional work in this domain to further elucidate the role of the cerebellum in age differences in movement control and cognitive function.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychology & Neuroscience, University of Colorado Boulder, United States.
| | - Rachael D Seidler
- Department of Psychology, University of Michigan, United States; School of Kinesiology, University of Michigan, United States; Neuroscience Program, University of Michigan, United States
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Holtzer R, Epstein N, Mahoney JR, Izzetoglu M, Blumen HM. Neuroimaging of mobility in aging: a targeted review. J Gerontol A Biol Sci Med Sci 2014; 69:1375-88. [PMID: 24739495 DOI: 10.1093/gerona/glu052] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relationship between mobility and cognition in aging is well established, but the relationship between mobility and the structure and function of the aging brain is relatively unknown. This, in part, is attributed to the technological limitations of most neuroimaging procedures, which require the individual to be immobile or in a supine position. Herein, we provide a targeted review of neuroimaging studies of mobility in aging to promote (i) a better understanding of this relationship, (ii) future research in this area, and (iii) development of applications for improving mobility. METHODS A systematic search of peer-reviewed studies was performed using PubMed. Search terms included (i) aging, older adults, or elderly; (ii) gait, walking, balance, or mobility; and (iii) magnetic resonance imaging, voxel-based morphometry, fluid-attenuated inversion recovery, diffusion tensor imaging, positron emission tomography, functional magnetic resonance imaging, electroencephalography, event-related potential, and functional near-infrared spectroscopy. RESULTS Poor mobility outcomes were reliably associated with reduced gray and white matter volume. Fewer studies examined the relationship between changes in task-related brain activation and mobility performance. Extant findings, however, showed that activation patterns in the cerebellum, basal ganglia, parietal and frontal cortices were related to mobility. Increased involvement of the prefrontal cortex was evident in both imagined walking conditions and conditions where the cognitive demands of locomotion were increased. CONCLUSIONS Cortical control of gait in aging is bilateral, widespread, and dependent on the integrity of both gray and white matter.
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Affiliation(s)
- Roee Holtzer
- Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, New York.
| | - Noah Epstein
- Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, New York
| | - Jeannette R Mahoney
- Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
| | - Meltem Izzetoglu
- Drexel University School of Biomedical Engineering, Philadelphia, Pennsylvania
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
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Hsu CL, Voss MW, Handy TC, Davis JC, Nagamatsu LS, Chan A, Bolandzadeh N, Liu-Ambrose T. Disruptions in brain networks of older fallers are associated with subsequent cognitive decline: a 12-month prospective exploratory study. PLoS One 2014; 9:e93673. [PMID: 24699668 PMCID: PMC3977422 DOI: 10.1371/journal.pone.0093673] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/07/2014] [Indexed: 11/24/2022] Open
Abstract
Cognitive impairment and impaired mobility are major public health concerns. There is growing recognition that impaired mobility is an early biomarker of cognitive impairment and dementia. The neural basis for this association is currently unclear. We propose disrupted functional connectivity as a potential mechanism. In this 12-month prospective exploratory study, we compared functional connectivity of four brain networks– the default mode network (DMN), fronto-executive network (FEN), fronto-parietal network (FPN), and the primary motor sensory network (SMN) – between community-dwelling older adults with ≥ two falls in the last 12 months and their non-falling counterparts (≤ one fall in the last 12 months). Functional connectivity was examined both at rest and during a simple motor tapping task. Compared with non-fallers, fallers showed more connectivity between the DMN and FPN during right finger tapping (p = 0.04), and significantly less functional connectivity between the SMN and FPN during rest (p≤0.05). Less connectivity between the SMN and FPN during rest was significantly associated with greater decline in both cognitive function and mobility over the12-month period (r = −0.32 and 0.33 respectively; p≤0.04). Thus, a recent history of multiple falls among older adults without a diagnosis of dementia may indicate sub-clinical changes in brain function and increased risk for subsequent decline.
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Affiliation(s)
- Chun Liang Hsu
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Michelle W. Voss
- Health, Brain, & Cognition Lab, University of Iowa, Iowa City, Iowa, United States of America
- Department of Psychology, University of Iowa, Iowa City, Iowa, United States of America
| | - Todd C. Handy
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia & Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C. Davis
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia & Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
| | - Lindsay S. Nagamatsu
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Chan
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Niousha Bolandzadeh
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
- * E-mail:
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Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75:51-61. [PMID: 23523272 DOI: 10.1016/j.maturitas.2013.02.009] [Citation(s) in RCA: 942] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 12/23/2022]
Abstract
Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30-40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. The direct costs alone from fall related injuries are a staggering 0.1% of all healthcare expenditures in the United States and up to 1.5% of healthcare costs in European countries. This figure does not include the indirect costs of loss of income both to the patient and caregiver, the intangible losses of mobility, confidence, and functional independence. Numerous studies have attempted to define the risk factors for falls in older adults. The present review provides a brief summary and update of the relevant literature, summarizing demographic and modifiable risk factors. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to manage falls in older patients are also summarized.
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