Relation of chair rising ability to activities of daily living and physical activity in Parkinson's disease

Cognition and Activity of Daily Living Function in people with Parkinson's disease

The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.

Association between Motor Signs and Cognitive Performance in Cognitively Unimpaired Older Adults: A Cross-Sectional Study Using the NACC Database

Aiming to examine whether specific motor signs are associated with worse performance in specific cognitive domains among cognitively unimpaired (CU) individuals, we performed a cross-sectional analysis of data from the baseline evaluations of older, CU participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. In total, 8149 CU (≥60 years) participants were included. Of these, 905 individuals scored ≥ 2 on at least one of the motor domains of the Unified Parkinson's Disease Rating Scale part III (UPDRSIII). Cognitively impaired individuals, participants with psychiatric disorders and/or under treatment with antipsychotic, anxiolytic, sedative or hypnotic agents were excluded. Nine motor signs were examined: hypophonia, masked facies, resting tremor, action/postural tremor, rigidity, bradykinesia, impaired chair rise, impaired posture/gait and postural instability. Their association with performance on episodic memory, semantic memory, language, attention, processing speed or executive function was assessed using crude and adjusted linear regression models. Individuals with impaired chair rise had worse episodic memory, semantic memory, processing speed and executive function, while those with bradykinesia had worse language, processing speed and executive function. Sensitivity analyses, by excluding participants with cerebrovascular disease or PD, or other Parkinsonism, produced similar results with the exception of the relationship between bradykinesia and language performance.

Technology-based therapy-response evaluation of axial motor symptoms under daily drug regimen of patients with Parkinson’s disease

Background

Axial disturbances are the most disabling symptoms of Parkinson’s disease (PD). Kinect-based objective measures could extract motion characteristics with high reliability and validity.

Purpose

The present research aimed to quantify the therapy–response of axial motor symptoms to daily medication regimen and to explore the correlates of the improvement rate (IR) of axial motor symptoms based on a Kinect camera.

Materials and methods

We enrolled 44 patients with PD and 21 healthy controls. All 65 participants performed the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale part III and the Kinect-based kinematic evaluation to assess arising from a chair, gait, posture, and postural stability before and after medication. Spearman’s correlation analysis and multiple linear regression model were performed to explore the relationships between motor feature IR and clinical data.

Results

All the features arising from a chair (P = 0.001), stride length (P = 0.001), velocity (P < 0.001), the height of foot lift (P < 0.001), and turning time (P = 0.001) improved significantly after a daily drug regimen in patients with PD. In addition, the anterior trunk flexion (lumbar level) exhibited significant improvement (P = 0.004). The IR of the axial motor symptoms score was significantly correlated with the IRs of kinematic features for gait velocity, stride length, foot lift height, and sitting speed (r_s = 0.345, P = 0.022; r_s = 0.382, P = 0.010; r_s = 0.314, P = 0.038; r_s = 0.518, P < 0.001, respectively). A multivariable regression analysis showed that the improvement in axial motor symptoms was associated with the IR of gait velocity only (β = 0.593, 95% CI = 0.023–1.164, P = 0.042).

Conclusion

Axial symptoms were not completely drug-resistant, and some kinematic features can be improved after the daily medication regimen of patients with PD.

Clinical features contributing to the sit-to-stand transfer in people with Parkinson’s disease: a systematic review

Introduction

The aim of this systematic review is to present the existing literature on the clinical motor, and non-motor factors contributing to sit-to-stand transfer in individuals with Parkinson's disease.

Data synthesis

Five databases (PubMed, PEDro, Cochrane, SCOPUS, and Ovid) were searched for literature on the contributing factors to sit-to-stand performance in Parkinson's disease. A quality check of these observational studies was done using the 'strengthening the reporting of observational studies in epidemiology' (STROBE) statement and the tool of the 'National Heart, Lung, and Blood Institute' (NHLBI). Descriptive and quantitative data were extracted and compiled, and a meta-analysis was performed to compute the standardised mean difference.

Results

Thirteen studies were selected; a majority of them provided a high-to-moderate level of evidence. Ten were cross-sectional, while the other three were case–control studies. Collectively, individuals with Parkinson's disease had a prolonged transfer time than those of age-matched healthy peers, particularly from peak horizontal velocity phase to seat-off phase, implying bradykinesia. A reduction in peak and rate to peak joint torques was also related to the decreased pace and stability of the sit-to-stand movement in individuals with Parkinson's disease. Additionally, they demonstrated exaggerated trunk flexion as a postural stabilisation strategy, allowing them to maintain and manoeuvre the relative positions of their centre of mass through the transitional phase of the transfer.

Conclusion

As per the existing literature, an alteration in strength, overall body bradykinesia, balance, posture, as well as cognition may result in an impaired sit-to-stand transfer in individuals with Parkinson's disease.