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Radlicka-Borysewska A, Jabłońska J, Lenarczyk M, Szumiec Ł, Harda Z, Bagińska M, Barut J, Pera J, Kreiner G, Wójcik DK, Rodriguez Parkitna J. Non-motor symptoms associated with progressive loss of dopaminergic neurons in a mouse model of Parkinson's disease. Front Neurosci 2024; 18:1375265. [PMID: 38745938 PMCID: PMC11091341 DOI: 10.3389/fnins.2024.1375265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Parkinson's disease (PD) is characterized by three main motor symptoms: bradykinesia, rigidity and tremor. PD is also associated with diverse non-motor symptoms that may develop in parallel or precede motor dysfunctions, ranging from autonomic system dysfunctions and impaired sensory perception to cognitive deficits and depression. Here, we examine the role of the progressive loss of dopaminergic transmission in behaviors related to the non-motor symptoms of PD in a mouse model of the disease (the TIF-IADATCreERT2 strain). We found that in the period from 5 to 12 weeks after the induction of a gradual loss of dopaminergic neurons, mild motor symptoms became detectable, including changes in the distance between paws while standing as well as the swing speed and step sequence. Male mutant mice showed no apparent changes in olfactory acuity, no anhedonia-like behaviors, and normal learning in an instrumental task; however, a pronounced increase in the number of operant responses performed was noted. Similarly, female mice with progressive dopaminergic neuron degeneration showed normal learning in the probabilistic reversal learning task and no loss of sweet-taste preference, but again, a robustly higher number of choices were performed in the task. In both males and females, the higher number of instrumental responses did not affect the accuracy or the fraction of rewarded responses. Taken together, these data reveal discrete, dopamine-dependent non-motor symptoms that emerge in the early stages of dopaminergic neuron degeneration.
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Affiliation(s)
- Anna Radlicka-Borysewska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Judyta Jabłońska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Michał Lenarczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Łukasz Szumiec
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Zofia Harda
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Monika Bagińska
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Justyna Barut
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kreiner
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Daniel K. Wójcik
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Laboratory of Neuroinformatics, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland
| | - Jan Rodriguez Parkitna
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
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Devraj R, Elkouzi A, Tracey MR. Real-World Experiences of Parkinson's Disease OFF Time and Role of Demographics. J Patient Cent Res Rev 2024; 11:8-17. [PMID: 38596350 PMCID: PMC11000704 DOI: 10.17294/2330-0698.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose OFF periods are episodes when Parkinson's disease (PD) medications work suboptimally, with symptoms returning and impacting quality of life. We aimed to characterize OFF periods using patient-reported frequency, severity, and duration, as well as determine these characteristics' associations with demographics. Methods A retrospective cohort study using Fox Insight Data Exploration Network (Fox DEN) database was conducted. Eligible patients had PD and were >18 years. The experience of OFF periods was characterized by frequency (number of episodes/day), duration (duration/episode), and severity (impact on activities). Significance level was Bonferroni-corrected for multivariate analyses. Results From a population of 6,757 persons with PD, 88% were non-Hispanic Whites (mean age: 66 ± 8.8 years); 52.7% were males versus 47.3% females; mean PD duration was 5.7 ± 5.2; and 51% experienced OFF periods. Subsequent analyses were limited to non-Hispanic Whites, as they constituted a large majority of the participants and were the subgroup that had the sample size to derive reliable inferences. The analyses showed that 67% experienced 1-2 episodes/day, 90% experienced >15-minute episodes, and 55% reported slight-mild severity/episode. Lower age was associated with a higher frequency (incidence rate ratio [IRR]: 0.992; P<0.001) and severity (odds ratio [OR]: 0.985; P=0.001) of OFF episodes. Income of <$35,000 was associated with 15.1% more episodes/day (IRR: 1.15, p<0.001) and 66.5% higher odds of a severe episode (OR: 1.66; P<0.001). Females experienced 7.5% more episodes compared to males (IRR: 1.075; P=0.003). Longer PD duration was associated with 1.3% more episodes/day (IRR: 1.013; P<0.001) and 10% higher odds of a severe episode (OR: 1.10; P<0.001). Conclusions Lower age, income <$35,000, longer PD duration, female gender, and being unemployed are associated with a higher frequency and severity of OFF periods with no associations for duration/episode among non-Hispanic Whites with PD. In time-constrained clinic environments, clinicians should tailor OFF periods management counseling to vulnerable demographic groups to enhance care delivery.(J Patient Cent Res Rev. 2024;11:8-17.).
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Affiliation(s)
- Radhika Devraj
- Department of Pharmaceutical Sciences, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL
| | - Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL
| | - Marlon R. Tracey
- Department of Economics and Finance, Southern Illinois University Edwardsville School of Business, Edwardsville, IL
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Tamilselvam YK, Jog M, Patel RV. Robot-assisted investigation of sensorimotor control in Parkinson's disease. Sci Rep 2023; 13:4751. [PMID: 36959273 PMCID: PMC10036530 DOI: 10.1038/s41598-023-31299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
Sensorimotor control (SMC) is a complex function that involves sensory, cognitive, and motor systems working together to plan, update and execute voluntary movements. Any abnormality in these systems could lead to deficits in SMC, which would negatively impact an individual's ability to execute goal-directed motions. Recent studies have shown that patients diagnosed with Parkinson's disease (PD) have dysfunctions in sensory, motor, and cognitive systems, which could give rise to SMC deficits. However, SMC deficits in PD and how they affect a patient's upper-limb movements have not been well understood. The objective of the study was to investigate SMC deficits in PD and how they affect the planning and correction of upper-limb motions. This was accomplished using a robotic manipulandum equipped with a virtual-reality system. Twenty age-matched healthy controls and fifty-six PD patients (before and after medication) completed an obstacle avoidance task under dynamic conditions (target and obstacles in moving or stationary form, with and without mechanical perturbations). Kinematic information from the robot was used to extract eighteen features that evaluated the SMC functions of the participants. The findings show that the PD patients before medication were 32% slower, reached 16% fewer targets, hit 41% more obstacles, and were 26% less efficient than the control participants, and the difference in these features was statistically significant under dynamic conditions. In addition to the motor deficits, the PD patients also showed deficits in handling high cognitive loads and interpreting sensory cues. Further, the PD patients after medication exhibited worse sensory and cognitive performance than before medication under complex testing conditions. The PD patients also showed deficits in following the computational models leading to poor motor planning.
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Affiliation(s)
- Yokhesh K Tamilselvam
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario (UWO), London, ON, N6A 5B9, Canada.
- Department of Electrical and Computer Engineering, University of Western Ontario (UWO), London, ON, N6A 5B9, Canada.
| | - Mandar Jog
- Department of Electrical and Computer Engineering, University of Western Ontario (UWO), London, ON, N6A 5B9, Canada
- Department of Clinical Neurological Sciences, UWO, and the London Movement Disorders Centre, London, ON, Canada
| | - Rajni V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), University of Western Ontario (UWO), London, ON, N6A 5B9, Canada
- Department of Electrical and Computer Engineering, University of Western Ontario (UWO), London, ON, N6A 5B9, Canada
- Department of Clinical Neurological Sciences, UWO, London, ON, Canada
- Department of Surgery, UWO, London, ON, Canada
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4
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Askari A, Greif TR, Lam J, Maher AC, Persad CC, Patil PG. Decline of verbal fluency with lateral superior frontal gyrus penetration in subthalamic nucleus deep brain stimulation for Parkinson disease. J Neurosurg 2022; 137:729-734. [PMID: 35090137 DOI: 10.3171/2021.11.jns211528] [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: 06/24/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Verbal fluency (VF) decline is a well-recognized adverse cognitive outcome following subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson disease (PD). The mechanisms underlying VF decline, whether from stimulation, lesioning, or both, remain unclear. This study aims to investigate the unique effects of DBS lead trajectory on VF beyond previously reported effects of active contact location. METHODS The study population included 56 patients with idiopathic PD who underwent bilateral STN DBS. Phonemic and semantic VF scores were compared pre- and postoperatively. Features of the electrode trajectory were measured on postoperative imaging, including distance from the falx cerebri, distance from the superior frontal sulcus, and caudate nucleus penetration. The authors used t-tests, Pearson's correlation, and multiple linear regression analyses to examine the relationship between VF change and demographic, disease, and electrode trajectory variables. RESULTS The laterality of entry within the left superior frontal gyrus (SFG) predicted greater phonemic VF decline (sr2 = 0.28, p < 0.001) after controlling for active contact location. VF change did not differ by the presence of caudate nucleus penetration in either hemisphere (p > 0.05). CONCLUSIONS Lateral penetration of the SFG in the left hemisphere is associated with worsening phonemic VF and has greater explanatory power than active contact location. This may be explained by lesioning of the lateral SFG-Broca area pathway, which is implicated in language function.
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Affiliation(s)
| | - Taylor R Greif
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
| | | | - Amanda C Maher
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
| | - Carol C Persad
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
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Aretouli E, Chondrogiorgi M, Dede O, Koutsonida M, Lafi C, Konstantinopoulou E, Kulisevsky J, Kosmidis MH, Konitsiotis S. The Parkinson's Disease-Cognitive Rating Scale: Greek Normative Data, Clinical Utility and Cultural Considerations. J Geriatr Psychiatry Neurol 2022; 35:680-688. [PMID: 34663111 DOI: 10.1177/08919887211049110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Parkinson's Disease-Cognitive Rating Scale (PD-CRS) is a comprehensive screening procedure for the evaluation of cognitive impairment in patients with Parkinson's disease (PD). OBJECTIVES In the present study we adjusted the PD-CRS for the Greek population, developed normative data and examined its clinical utility for the assessment of cognitive functioning in Greek PD patients. In addition, the correlation of clinical characteristics with cognitive performance in PD patients was examined. METHODS Three hundred four community-dwelling healthy adults and 59 patients with PD, completed the adapted PD-CRS. RESULTS Healthy adults outperformed the PD patients on the total, the cortical and subcortical scores of the PD-CRS. Normative data indicated effects of both education and age on the PD-CRS. The optimal total PD-CRS cutoff score for the identification of cognitive impairment in a heterogeneous sample of PD patients, with regard to the severity of cognitive difficulties, was 79, yielding a modest sensitivity and specificity. Clinical characteristics of the patients (i.e., disease duration and functional disease burden) were related to poor performance on the PD-CRS. CONCLUSIONS The Greek version of the PD-CRS is a useful instrument for the assessment of cognition in PD. Future prospective studies should examine its clinical utility to identify PD-cognitive subtypes (i.e., PD patients with mild cognitive impairment), to monitor cognitive changes, as well as its predictive accuracy for subsequent dementia.
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Affiliation(s)
- Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece.,School of the Social Sciences, University of Ioannina, Ioannina, Epirus, Greece
| | - Maria Chondrogiorgi
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Epirus, Greece
| | - Olga Dede
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Myrto Koutsonida
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Chrysi Lafi
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Eleni Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece.,2nd Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Jaime Kulisevsky
- Department of Neurology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
| | - Spiridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Epirus, Greece
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Renftle D, Becker S, Brockmann K, Gasser T, Michaelis K, Solbrig S, Sulzer P, Johnen A, Liepelt-Scarfone I. Evaluation of the Dementia Apraxia Test in Parkinson's Disease Patients. Dement Geriatr Cogn Disord 2022; 51:271-278. [PMID: 35850108 DOI: 10.1159/000525618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ideomotor apraxia, a disorder of skilled movements affecting limbs and/or face, can be seen in patients with Parkinson's disease (PD), yet tests of apraxia in PD are rare. The aim of this project was to evaluate the psychometric properties and validity of the Dementia Apraxia Test (DATE) in a PD sample. METHODS 118 PD patients were included. Besides DATE performance, motor and non-motor burden, cognition, and activity of daily living (ADL) function were assessed. Patients were classified as cognitively impaired (n = 41) or non-cognitively impaired (n = 77). RESULTS Interrater reliability of the DATE (sub-)scores between video ratings and on-site ratings by the investigator was good (0.81 ≤ rk ≤ 0.87). Items were mostly easy to perform, especially the buccofacial apraxia items, which had also low discriminatory power. DATE scores were associated with cognition and ADL function. DATE performance was confounded by motor impairment and patients' age; however, when analysed for both cognitive groups separately, the correlation between DATE and motor performance was not significant. DISCUSSION/CONCLUSION The DATE seems to be an objective and predominantly valid apraxia screening tool for PD patients, with a few items needing revision. Due to the potential effect of motor impairment and age, standardized scores adjusting for these confounders are needed.
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Affiliation(s)
- Daniela Renftle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Thomas Gasser
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Patricia Sulzer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Andreas Johnen
- Clinic of Neurology with Translational Neurology, University Hospital Münster, Münster, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
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Wu Z, Hong R, Li S, Peng K, Lin A, Gao Y, Jin Y, Su X, Zhi H, Guan Q, Pan L, Jin L. Technology-based therapy-response evaluation of axial motor symptoms under daily drug regimen of patients with Parkinson’s disease. Front Aging Neurosci 2022; 14:901090. [PMID: 35992587 PMCID: PMC9389404 DOI: 10.3389/fnagi.2022.901090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
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 (rs = 0.345, P = 0.022; rs = 0.382, P = 0.010; rs = 0.314, P = 0.038; rs = 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.
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Affiliation(s)
- Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ronghua Hong
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangfang Li
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kangwen Peng
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ao Lin
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yichen Gao
- IFLYTEK Suzhou Research Institute, E4, Artificial Intelligence Industrial Park, Suzhou Industrial Park, Suzhou, China
| | - Yue Jin
- IFLYTEK Suzhou Research Institute, E4, Artificial Intelligence Industrial Park, Suzhou Industrial Park, Suzhou, China
| | - Xiaoyun Su
- IFLYTEK Suzhou Research Institute, E4, Artificial Intelligence Industrial Park, Suzhou Industrial Park, Suzhou, China
| | - Hongping Zhi
- IFLYTEK Suzhou Research Institute, E4, Artificial Intelligence Industrial Park, Suzhou Industrial Park, Suzhou, China
| | - Qiang Guan
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lizhen Pan
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Clinical Research Center for Aging and Medicine, Shanghai, China
- *Correspondence: Lingjing Jin,
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Virameteekul S, Phokaewvarangkul O, Bhidayasiri R. Profiling the most elderly parkinson's disease patients: Does age or disease duration matter? PLoS One 2021; 16:e0261302. [PMID: 34937068 PMCID: PMC8694485 DOI: 10.1371/journal.pone.0261302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite our ageing populations, elderly patients are underrepresented in clinical research, and ageing research is often separate from that of Parkinson's disease (PD). To our knowledge, no previous study has focused on the most elderly ('old-old', age ≥ 85 years) patients with PD to reveal how age directly influences PD clinical progression. OBJECTIVE We compared the clinical characteristics and pharmacological profiles, including complications of levodopa treatment, disease progression, disabilities, and comorbidities of the old-old with those of comparable younger ('young-old', age 60-75 years) PD patients. In addition, within the old-old group, we compared those with a short disease duration (< 10 years at the time of diagnosis) to those with a long disease duration ≥10 years to investigate whether prognosis was related to disease progression or aging. METHODS This single-centre, case-control study compared 60 old-old to 92 young-old PD patients, matched for disease duration. Patients in the old-old group were also divided equally (30:30) into two subgroups (short and long disease duration) with the same mean age. We compared the groups based on several clinical measures using a conditional logistic regression. RESULTS By study design, there were no differences between age groups when comparing disease duration, however, the proportion of men decreased with age (p = 0.002). At a comparable length of PD duration of 10 years, the old-old PD patients predominantly had significantly greater postural instability and gait disturbance (p = 0.006), higher motor scope of the Unified Parkinson's Disease Rating Scale (UPDRS-III, p<0.0001), and more advanced Hoehn & Yahr (H&Y) stage (p<0.0001). The Non-Motor Symptoms Questionnaire (NMSQuest) score was also significantly higher among the old-old (p<0.0001) compared to the young-old patients. Moreover, the distribution of NMS also differed between ages, with features of gastrointestinal problems (p<0.0001), urinary problems (p = 0.004), sleep disturbances and fatigue (p = 0.032), and cognitive impairment (p<0.0001) significantly more common in the old-old group, whereas sexual problems (p = 0.012), depression, and anxiety (p = 0.032) were more common in the young-old. No differences were found in visual hallucinations, cerebrovascular disease, and miscellaneous domains. While young-old PD patients received higher levodopa equivalent daily doses (p<0.0001) and developed a significant greater rate of dyskinesia (p = 0.002), no significant difference was observed in the rate of wearing-off (p = 0.378). Old-old patients also had greater disability, as measured by the Schwab and England scale (p<0.0001) and had greater milestone frequency specifically for dementia (p<0.0001), wheelchair placement (p<0.0001), nursing home placement (p = 0.019), and hospitalisation in the past 1 year (p = 0.05). Neither recurrent falls (p = 0.443) nor visual hallucinations (p = 0.607) were documented significantly more often in the old-old patients. CONCLUSIONS Age and disease duration were independently associated with clinical presentation, course, and progression of PD. Age was the main predictor, but disease duration also had a strong effect, suggesting that factors of the ageing process beyond the disease process itself cause PD in the most elderly to be more severe.
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Affiliation(s)
- Sasivimol Virameteekul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Faculty of Medicine, Department of Medicine, Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Bhatt M, Mahana B, Ko JH, Kolesar TA, Kanitkar A, Szturm T. Computerized Dual-Task Testing of Gait Visuomotor and Cognitive Functions in Parkinson's Disease: Test-Retest Reliability and Validity. Front Hum Neurosci 2021; 15:706230. [PMID: 34335213 PMCID: PMC8320846 DOI: 10.3389/fnhum.2021.706230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mobility and cognitive impairments in Parkinson's disease (PD) often coexist and are prognostic of adverse health events. Consequently, assessment and training that simultaneously address both gait function and cognition are important to consider in rehabilitation and promotion of healthy aging. For this purpose, a computer game-based rehabilitation treadmill platform (GRP) was developed for dual-task (DT) assessment and training. OBJECTIVE The first objective was to establish the test-retest reliability of the GRP assessment protocol for DT gait, visuomotor and executive cognitive function in PD patients. The second objective was to examine the effect of task condition [single task (ST) vs. DT] and disease severity (stage 2 vs. stage 3) on gait, visuomotor and cognitive function. METHODS Thirty individuals aged 55 to 70 years, diagnosed with PD; 15 each at Hoehn and Yahr scale stage 2 (PD-2) and 3 (PD-3) performed a series of computerized visuomotor and cognitive game tasks while sitting (ST) and during treadmill walking (DT). A treadmill instrumented with a pressure mat was used to record center of foot pressure and compute the average and coefficient of variation (COV) of step time, step length, and drift during 1-min, speed-controlled intervals. Visuomotor and cognitive game performance measures were quantified using custom software. Testing was conducted on two occasions, 1 week apart. RESULTS With few exceptions, the assessment protocol showed moderate to high intraclass correlation coefficient (ICC) values under both ST and DT conditions for the spatio-temporal gait measures (average and COV), as well as the visuomotor tracking and cognitive game performance measures. A significant decline in gait, visuomotor, and cognitive game performance measures was observed during DT compared to ST conditions, and in the PD-3 compared to PD-2 groups. CONCLUSION The high to moderate ICC values along with the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable DT interference (DTI) effects over time. The use of interactive digital media provides a flexible method to produce and evaluate DTI for a wide range of executive cognitive activities. This also proves to be a sensitive tool for tracking disease progression. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT03232996.
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Affiliation(s)
- Mayank Bhatt
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Bhuvan Mahana
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Tiffany A. Kolesar
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Anuprita Kanitkar
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
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Mehta S, Lal V. Exploring the Relationship between Bradykinesia and Cognitive Impairment in Parkinson's Disease. Neurol India 2021; 69:609-610. [PMID: 34169852 DOI: 10.4103/0028-3886.319239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sahil Mehta
- Department of Neurology, PGIMER, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, PGIMER, Chandigarh, India
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11
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Szturm T, Kolesar TA, Mahana B, Goertzen AL, Hobson DE, Marotta JJ, Strafella AP, Ko JH. Changes in Metabolic Activity and Gait Function by Dual-Task Cognitive Game-Based Treadmill System in Parkinson's Disease: Protocol of a Randomized Controlled Trial. Front Aging Neurosci 2021; 13:680270. [PMID: 34149399 PMCID: PMC8211751 DOI: 10.3389/fnagi.2021.680270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 01/22/2023] Open
Abstract
Balance and gait impairments, and consequently, mobility restrictions and falls are common in Parkinson’s disease (PD). Various cognitive deficits are also common in PD and are associated with increased fall risk. These mobility and cognitive deficits are limiting factors in a person’s health, ability to perform activities of daily living, and overall quality of life. Community ambulation involves many dual-task (DT) conditions that require processing of several cognitive tasks while managing or reacting to sudden or unexpected balance challenges. DT training programs that can simultaneously target balance, gait, visuomotor, and cognitive functions are important to consider in rehabilitation and promotion of healthy active lives. In the proposed multi-center, randomized controlled trial (RCT), novel behavioral positron emission tomography (PET) brain imaging methods are used to evaluate the molecular basis and neural underpinnings of: (a) the decline of mobility function in PD, specifically, balance, gait, visuomotor, and cognitive function, and (b) the effects of an engaging, game-based DT treadmill walking program on mobility and cognitive functions. Both the interactive cognitive game tasks and treadmill walking require continuous visual attention, and share spatial processing functions, notably to minimize any balance disturbance or gait deviation/stumble. The ability to “walk and talk” normally includes activation of specific regions of the prefrontal cortex (PFC) and the basal ganglia (site of degeneration in PD). The PET imaging analysis and comparison with healthy age-matched controls will allow us to identify areas of abnormal, reduced activity levels, as well as areas of excessive activity (increased attentional resources) during DT-walking. We will then be able to identify areas of brain plasticity associated with improvements in mobility functions (balance, gait, and cognition) after intervention. We expect the gait-cognitive training effect to involve re-organization of PFC activity among other, yet to be identified brain regions. The DT mobility-training platform and behavioral PET brain imaging methods are directly applicable to other diseases that affect gait and cognition, e.g., cognitive vascular impairment, Alzheimer’s disease, as well as in aging.
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Affiliation(s)
- Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tiffany A Kolesar
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Bhuvan Mahana
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Andrew L Goertzen
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas E Hobson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit, E. J. Safra Parkinson Disease Program, Neurology Division/Department of Medicine, Toronto Western Hospital, Krembil Brain Institute, University Health Network (UHN), Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, ON, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
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Kundu D, Dubey VK. Purines and Pyrimidines: Metabolism, Function and Potential as Therapeutic Options in Neurodegenerative Diseases. Curr Protein Pept Sci 2021; 22:170-189. [PMID: 33292151 DOI: 10.2174/1389203721999201208200605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/01/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
Various neurodegenerative disorders have various molecular origins but some common molecular mechanisms. In the current scenario, there are very few treatment regimens present for advanced neurodegenerative diseases. In this context, there is an urgent need for alternate options in the form of natural compounds with an ameliorating effect on patients. There have been individual scattered experiments trying to identify potential values of various intracellular metabolites. Purines and Pyrimidines, which are vital molecules governing various aspects of cellular biochemical reactions, have been long sought as crucial candidates for the same, but there are still many questions that go unanswered. Some critical functions of these molecules associated with neuromodulation activities have been identified. They are also known to play a role in foetal neurodevelopment, but there is a lacuna in understanding their mechanisms. In this review, we have tried to assemble and identify the importance of purines and pyrimidines, connecting them with the prevalence of neurodegenerative diseases. The leading cause of this class of diseases is protein misfolding and the formation of amyloids. A direct correlation between loss of balance in cellular homeostasis and amyloidosis is yet an unexplored area. This review aims at bringing the current literature available under one umbrella serving as a foundation for further extensive research in this field of drug development in neurodegenerative diseases.
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Affiliation(s)
- Debanjan Kundu
- School of Biochemical Engineering, Indian Institute of Technology BHU, Varanasi, UP - 221005, India
| | - Vikash Kumar Dubey
- School of Biochemical Engineering, Indian Institute of Technology BHU, Varanasi, UP - 221005, India
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13
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Sousa NMF, Macedo RC, Brucki SMD. Cross-sectional associations between cognition and mobility in Parkinson's disease. Dement Neuropsychol 2021; 15:105-111. [PMID: 33907603 PMCID: PMC8049584 DOI: 10.1590/1980-57642021dn15-010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cross-sectional studies show an association of decline in mental flexibility and
inhibitory control with reduced gait speed and falls, as well as divided
attention deficit and difficulty in initiating gait.
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Affiliation(s)
- Nariana Mattos Figueiredo Sousa
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil.,Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Roberta Correa Macedo
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
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14
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Cognitive effects of theta frequency bilateral subthalamic nucleus stimulation in Parkinson's disease: A pilot study. Brain Stimul 2021; 14:230-240. [PMID: 33418095 DOI: 10.1016/j.brs.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is significant evidence for cognitive decline following deep brain stimulation (DBS). Current stimulation paradigms utilize gamma frequency stimulation for optimal motor benefits; however, little has been done to optimize stimulation parameters for cognition. Recent evidence implicates subthalamic nucleus (STN) theta oscillations in executive function, and theta oscillations are well-known to relate to episodic memory, suggesting that theta frequency stimulation could potentially improve cognition in Parkinson's disease (PD). OBJECTIVE To evaluate the acute effects of theta frequency bilateral STN stimulation on executive function in PD versus gamma frequency and off, as well as investigate the differential effects on episodic versus nonepisodic verbal fluency. METHODS Twelve patients (all males, mean age 60.8) with bilateral STN DBS for PD underwent a double-blinded, randomized cognitive testing during stimulation at (1) 130-135 Hz (gamma), (2) 10 Hz (theta) and (3) off. Executive functions and processing speed were evaluated using verbal fluency tasks (letter, episodic category, nonepisodic category, and category switching), color-word interference task, and random number generation task. Performance at each stimulation frequency was compared within subjects. RESULTS Theta frequency significantly improved episodic category fluency compared to gamma, but not compared to off. There were no significant differences between stimulation frequencies in other tests. CONCLUSION In this pilot trial, our results corroborate the role of theta oscillations in episodic retrieval, although it is unclear whether this reflects direct modulation of the medial temporal lobe and whether similar effects can be found with more canonical memory paradigms. Further work is necessary to corroborate our findings and investigate the possibility of interleaving theta and gamma frequency stimulation for concomitant motor and cognitive effects.
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15
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Le H, Zeng W, Zhang H, Li J, Wu X, Xie M, Yan X, Zhou M, Zhang H, Wang M, Hong G, Shen J. Mean Apparent Propagator MRI Is Better Than Conventional Diffusion Tensor Imaging for the Evaluation of Parkinson's Disease: A Prospective Pilot Study. Front Aging Neurosci 2020; 12:563595. [PMID: 33192458 PMCID: PMC7541835 DOI: 10.3389/fnagi.2020.563595] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Mean apparent propagator (MAP) MRI is a novel diffusion imaging method to map tissue microstructure. The purpose of this study was to evaluate the diagnostic value of the MAP MRI in Parkinson’s disease (PD) in comparison with conventional diffusion tensor imaging (DTI). Methods 23 PD patients and 22 age- and gender-matched healthy controls were included. MAP MRI and DTI were performed on a 3T MR scanner with a 20-channel head coil. The MAP metrics including mean square displacement (MSD), return to the origin probability (RTOP), return to the axis probability (RTAP), and return to the plane probability (RTPP), and DTI metrics including fractional anisotropy (FA), and mean diffusivity (MD), were measured in subcortical gray matter and compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of all the metrics. The association between the diffusion metrics and disease severity was assessed by Pearson correlation analysis. Results For MAP MRI, the mean values of MSD in the bilateral caudate, pallidum, putamen, thalamus and substantia nigra (SN) were higher in PD patients than in healthy controls (pFDR ≤ 0.001); the mean values of the zero displacement probabilities (RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus were lower in PD patients (pFDR < 0.001). For DTI, only FA in the bilateral SN was significantly higher in PD patients than those in the controls (pFDR < 0.001). ROC analysis showed that the areas under the curves of MAP MRI metrics (MSD, RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus (range, 0.85–0.94) were greater than those of FA and MD of DTI (range, 0.55–0.69) in discriminating between PD patients and healthy controls. RTAP in the ipsilateral pallidum (r = −0.56, pFDR = 0.027), RTOP in the bilateral and contralateral putamen (r = −0.58, pFDR = 0.019; r = −0.57, pFDR = 0.024) were negatively correlated with UPDRS III motor scores. Conclusion MAP MRI outperformed the conventional DTI in the diagnosis of PD and evaluation of the disease severity.
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Affiliation(s)
- Hongbo Le
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.,Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weike Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huihong Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianing Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Wu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Minxiong Zhou
- College of Medical Imaging, Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Science, Shanghai, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Mengzhu Wang
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Guobin Hong
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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16
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Júlio F, Ribeiro MJ, Morgadinho A, Sousa M, van Asselen M, Simões MR, Castelo-Branco M, Januário C. Cognition, function and awareness of disease impact in early Parkinson's and Huntington's disease. Disabil Rehabil 2020; 44:921-939. [PMID: 32620060 DOI: 10.1080/09638288.2020.1783001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose: Patients with Parkinson's and Huntington's Disease (PD and HD) present impairments in cognitively challenging everyday activities. This study contrasts these two basal ganglia disorders on the ability to perform daily life- like tasks and their level of awareness regarding the disease impact on function.Methods: 19 controls, 10 early-onset PD, 20 early stage PD, and 15 early manifest HD patients were compared in the "EcoKitchen," a virtual reality task with increasing executive load, the "Behavioural Assessment of Dysexecutive Syndrome battery - BADS," and "The Adults and Older Adults Functional Assessment Inventory - IAFAI," a self-report functional questionnaire. The EcoKitchen clinical correlates were investigated.Results: All clinical groups presented slower EcoKitchen performance than controls, however, only HD patients showed decreased accuracy. HD and PD patients exhibited reduced BADS scores compared to the other study participants. Importantly, on the IAFAI, PD patients signalled more physically related incapacities and HD patients indicated more cognitively related incapacities. Accordingly, the EcoKitchen performance was significantly associated with PD motor symptom severity.Conclusions: Our findings suggest differential disease impact on cognition and function across PD and HD patients, with preserved awareness regarding disease- related functional sequelae. These observations have important implications for clinical management, research and rehabilitation.Implications for rehabilitationPatients with early stage Parkinson's and Huntington's disease have diagnosis-specific impairments in the performance of executively demanding everyday activities and, yet, show preserved awareness about the disease impact on their daily life.An active involvement of patients in the rehabilitation process should be encouraged, as their appraisal of the disease effects can help on practical decisions about meaningful targets for intervention, vocational choices, quality-of-life issues and/or specific everyday skills to boost.The EcoKitchen, a non-immersive virtual reality task, can detect and quantify early deficits in everyday-like tasks and is therefore a valuable tool for assessing the effects of rehabilitation strategies on the functional cognition of these patients.Rehabilitation efforts in the mild stages of Parkinson's and Huntington's disease should be aware of greater time needs from the patients in the performance of daily life tasks, target executive skills, and give a more prominent role to patients in symptoms report and management.
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Affiliation(s)
- Filipa Júlio
- University of Coimbra, Faculty of Psychology and Education Sciences, Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Maria J Ribeiro
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | | | - Mário Sousa
- Coimbra University Hospital, Coimbra, Portugal
| | - Marieke van Asselen
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Mário R Simões
- University of Coimbra, Faculty of Psychology and Education Sciences, Coimbra, Portugal.,University of Coimbra, Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Coimbra, Portugal
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal.,University of Coimbra, Institute of Nuclear Sciences Applied to Health (ICNAS), Coimbra, Portugal.,University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - Cristina Januário
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal.,Coimbra University Hospital, Coimbra, Portugal.,University of Coimbra, Faculty of Medicine, Coimbra, Portugal
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17
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Association Between Motor Subtype and Visuospatial and Executive Function in Mild-Moderate Parkinson Disease. Arch Phys Med Rehabil 2020; 101:1580-1589. [PMID: 32540135 DOI: 10.1016/j.apmr.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING Assessments took place at Emory University. PARTICIPANTS Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.
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Lang S, Ismail Z, Kibreab M, Kathol I, Sarna J, Monchi O. Common and unique connectivity at the interface of motor, neuropsychiatric, and cognitive symptoms in Parkinson's disease: A commonality analysis. Hum Brain Mapp 2020; 41:3749-3764. [PMID: 32476230 PMCID: PMC7416059 DOI: 10.1002/hbm.25084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023] Open
Abstract
Parkinson's disease (PD) is characterized by overlapping motor, neuropsychiatric, and cognitive symptoms. Worse performance in one domain is associated with worse performance in the other domains. Commonality analysis (CA) is a method of variance partitioning in multiple regression, used to separate the specific and common influence of collinear predictors. We apply, for the first time, CA to the functional connectome to investigate the unique and common neural connectivity underlying the interface of the symptom domains in 74 non-demented PD subjects. Edges were modeled as a function of global motor, cognitive, and neuropsychiatric scores. CA was performed, yielding measures of the unique and common contribution of the symptom domains. Bootstrap confidence intervals were used to determine the precision of the estimates and to directly compare each commonality coefficient. The overall model identified a network with the caudate nucleus as a hub. Neuropsychiatric impairment accounted for connectivity in the caudate-dorsal anterior cingulate and caudate-right dorsolateral prefrontal-right inferior parietal circuits, while caudate-medial prefrontal connectivity reflected a unique effect of both neuropsychiatric and cognitive impairment. Caudate-precuneus connectivity was explained by both unique and shared influence of neuropsychiatric and cognitive symptoms. Lastly, posterior cortical connectivity reflected an interplay of the unique and common effects of each symptom domain. We show that CA can determine the amount of variance in the connectome that is unique and shared amongst motor, neuropsychiatric, and cognitive symptoms in PD, thereby improving our ability to interpret the data while gaining novel insight into networks at the interface of these symptom domains.
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Affiliation(s)
- Stefan Lang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Center for Brain and Mental Health Research, University of Calgary, Calgary, Alberta, Canada
| | - Mekale Kibreab
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Iris Kathol
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Justyna Sarna
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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Domain specific cognitive impairment in Parkinson’s patients with mild cognitive impairment. J Clin Neurosci 2020; 75:99-105. [DOI: 10.1016/j.jocn.2020.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
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20
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Güntekin B, Aktürk T, Yıldırım E, Yılmaz NH, Hanoğlu L, Yener G. Abnormalities in auditory and visual cognitive processes are differentiated with theta responses in patients with Parkinson's disease with and without dementia. Int J Psychophysiol 2020; 153:65-79. [PMID: 32339563 DOI: 10.1016/j.ijpsycho.2020.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
The research on the abnormalities of event-related oscillations in Parkinson's disease (PD) was mostly studied with cognitively normal patients. The present study aims to show the adverse effects of cognitive decline in PD patients via the EEG-Brain Oscillations approach by comparing the electrophysiological responses in two modalities, i.e. auditory, and visual in which PD group show deficit. We conducted a study in which we analyzed event-related theta power and phase-locking during auditory and visual oddball paradigm. Cognitively normal PD (PDCN) patients (N = 15), PD with mild cognitive impairment (PDMCI) patients (N = 22), PD dementia (PDD) patients (N = 11) and healthy controls (HC) (N = 17) were included in the study. Neuropsychological assessments were applied to all participants. There was a gradual decrease in scores of neuropsychological tests (HC, PDCN, PDMCI, PDD, respectively). Most of the neuropsychological test scores of the participants were highly correlated with the theta power and theta phase locking values, especially over frontal-central areas. HC had higher theta phase-locking and power in comparison to PDMCI and PDD. The differentiation between HC and PDCN was specific to frontal-central areas. Theta power and theta phase-locking were decreased overall locations in PDMCI and PDD both during visual and auditory oddball paradigms compared with PDCN. The results indicate that theta responses in PD patients decreased gradually as the cognitive decline increased. We can conclude that complex abnormalities in their neurotransmitter and neuronal signal systems that occur with the progression of the disease could be responsible for these results.
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Affiliation(s)
- Bahar Güntekin
- Istanbul Medipol University, School of Medicine, Department of Biophysics, Istanbul, Turkey; REMER, Clinical Electrophysiology, Neuroimaging and Neuromodulation Lab., Istanbul Medipol University, Istanbul, Turkey.
| | - Tuba Aktürk
- Istanbul Medipol University, Vocational School, Program of Electroneurophysiology, Istanbul, Turkey; Istanbul Medipol University, Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Turkey
| | - Ebru Yıldırım
- Istanbul Medipol University, Vocational School, Program of Electroneurophysiology, Istanbul, Turkey; Istanbul Medipol University, Graduate School of Health Sciences, Department of Neuroscience, Istanbul, Turkey
| | - Nesrin Helvacı Yılmaz
- Istanbul Medipol University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Lütfü Hanoğlu
- REMER, Clinical Electrophysiology, Neuroimaging and Neuromodulation Lab., Istanbul Medipol University, Istanbul, Turkey; Istanbul Medipol University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Görsev Yener
- Dokuz Eylül University Medical School, Department of Neurology, Izmir, Turkey; Dokuz Eylül University, Brain Dynamics Multidisciplinary Research Center, Izmir, Turkey
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Stern RB, d'Alencar MS, Uscapi YL, Gubitoso MD, Roque AC, Helene AF, Piemonte MEP. Goalkeeper Game: A New Assessment Tool for Prediction of Gait Performance Under Complex Condition in People With Parkinson's Disease. Front Aging Neurosci 2020; 12:50. [PMID: 32194393 PMCID: PMC7064547 DOI: 10.3389/fnagi.2020.00050] [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] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with Parkinson's disease (PD) display poorer gait performance when walking under complex conditions than under simple conditions. Screening tests that evaluate gait performance changes under complex walking conditions may be valuable tools for early intervention, especially if allowing for massive data collection. Objectives: To investigate the use of the Goalkeeper Game (GG) to predict impairment in gait performance under complex conditions in people with Parkinson's disease (PPD) and compare its predictive power with the one of the Montreal Cognitive Assessment (MoCA) test. Methods: 74 PPD (HY stages: 23 in stage 1; 31 in stage 2; 20 in stage 3), without dementia (MoCA cut-off 21), tested in ON period with dopaminergic medication were submitted to single individual cognitive/motor evaluation sessions. MoCA and GG were used to assess cognition, and the dynamic gait index (DGI) test was used to assess gait performance under complex condition. GG test resulted in 9 measures extracted via a statistical model. The predictive power of the GG measures and the MoCA score with respect to gait performance, as assessed by DGI, were compared. Results: The predictive models based on GG obtained a better score of prediction (65%) then MoCA (56%) for DGI scores (at a 50% specificity). Conclusion: GG is a novel tool for noninvasive screening that showed a superior predictive power in assessing gait performance under complex condition in people with PD than the well-established MoCa test.
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Affiliation(s)
- Rafael B. Stern
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Matheus Silva d'Alencar
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Yanina L. Uscapi
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Marco D. Gubitoso
- Department of Computer Science, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Antonio C. Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - André F. Helene
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Maria Elisa Pimentel Piemonte
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
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Sousa NMF, Macedo RC. Relationship between cognitive performance and mobility in patients with Parkinson's disease: A cross-sectional study. Dement Neuropsychol 2019; 13:403-409. [PMID: 31844493 PMCID: PMC6907702 DOI: 10.1590/1980-57642018dn13-040006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gait disorders may be associated with cognitive impairment, and slow speed
predicts cognitive impairment and dementia. Objective: To investigate the
relationships between cognitive function and gait performance in patients with
Parkinson’s disease (PD) who attended a hospital neurorehabilitation program.
Methods: Descriptive and inferential statistics (Pearson’s correlation) were
used for data analysis. The cognitive functions were evaluated through Digit
Span, Mental Control, Trail Making Test, Phonemic Verbal Fluency Task, and
Addenbrooke’s Cognitive Examination III. The motor function was assessed through
10-meter walk test, Mini BESTest and Timed Up and Go Test. Results: A total of
65 patients were included in this study. Of these, 66.15% were males, mean age
was 61.14 (8.39) years, mean educational was 12 (8) years, disease progression
time was 5.45 (4.37) years. 64.61% were in stages I and II of the Hoehn and Yahr
stage. The correlation analyses showed that balance skills are significantly
correlated with the ability to switch attention between two tasks and
visuospatial function. The function mobility showed a significant correlation
with cognitive tests. Conclusion: Data suggest the importance of the aspects of
switch attention and mental flexibility in gait, evidencing the greater
difficulty for double tasks.
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Affiliation(s)
| | - Roberta Correa Macedo
- Rede SARAH de Hospitais de Reabilitação Ringgold standard institution - Reabilitação Neurológica, Salvador, BA, Brazil
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Lin WC, Huang YC, Leong CP, Chen MH, Chen HL, Tsai NW, Tso HH, Chen PC, Lu CH. Associations Between Cognitive Functions and Physical Frailty in Patients With Parkinson's Disease. Front Aging Neurosci 2019; 11:283. [PMID: 31736737 PMCID: PMC6831640 DOI: 10.3389/fnagi.2019.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Parkinson’s disease (PD) is a neurodegenerative disease manifested by both motor and non-motor dysfunctions and co-existence of cognitive impairment and physical frailty is common. Given that research in this area is limited, a better understanding of associated factors with physical frailty could provide a focused screening method and facilitate early intervention in PD. Methods: Seventy-six patients with idiopathic PD were recruited and Fried’s criteria of physical frailty were used to group all participants. Comprehensive cognitive tests and clinical characteristics were measured, and univariate and multivariate analysis was performed to explore the relationship between clinical factors or neuropsychological functions. Results: Twenty-nine patients with PD (38%) exhibited physical frailty. Compared to PD patients without frailty, PD patients with frailty were older in age and demonstrated worse disease severity and poorer cognitive functions, including attention, executive function, memory, speech and language, and visuospatial function (p < 0.05). Further, stepwise logistic regression analysis revealed that disease severity by the Unified Parkinson’s Disease Rating Scale (UPDRS) total score (OR: 1.065; 95% CI: 1.033–1.099) and executive function (OR: 0.724; 95% CI: 0.581–0.877) were independent risk factors for predicting physical frailty (p = 0.003 and 0.002). The best cut-off points are 46 in UPDRS (sensitivity: 62.1%; specificity: 91.5%). Conclusions: Executive function impairment is an independent risk factor for the development of physical frailty with disease progression. Awareness of such comorbidity might provide a screening tool to facilitate investigation in their underlying etiology and early intervention for frailty prevention.
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Affiliation(s)
- Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Hsin Tso
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Gaprielian P, Scott SH, Lowrey C, Reid S, Pari G, Levy R. Integrated robotics platform with haptic control differentiates subjects with Parkinson's disease from controls and quantifies the motor effects of levodopa. J Neuroeng Rehabil 2019; 16:124. [PMID: 31655612 PMCID: PMC6815040 DOI: 10.1186/s12984-019-0598-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 02/01/2023] Open
Abstract
Background The use of integrated robotic technology to quantify the spectrum of motor symptoms of Parkinson’s Disease (PD) has the potential to facilitate objective assessment that is independent of clinical ratings. The purpose of this study is to use the KINARM exoskeleton robot to (1) differentiate subjects with PD from controls and (2) quantify the motor effects of dopamine replacement therapies (DRTs). Methods Twenty-six subjects (Hoehn and Yahr mean 2.2; disease duration 0.5 to 15 years) were evaluated OFF (after > 12 h of their last dose) and ON their DRTs with the Unified Parkinson’s Disease Rating Scale (UPDRS) and the KINARM exoskeleton robot. Bilateral upper extremity bradykinesia, rigidity, and postural stability were quantified using a repetitive movement task to hit moving targets, a passive stretch task, and a torque unloading task, respectively. Performance was compared against healthy age-matched controls. Results Mean hand speed was 41% slower and 25% fewer targets were hit in subjects with PD OFF medication than in controls. Receiver operating characteristic (ROC) area for hand speed was 0.94. The torque required to stop elbow movement during the passive stretch task was 34% lower in PD subjects versus controls and resulted in an ROC area of 0.91. The torque unloading task showed a maximum displacement that was 29% shorter than controls and had an ROC area of 0.71. Laterality indices for speed and end total torque were correlated to the most affected side. Hand speed laterality index had an ROC area of 0.80 against healthy controls. DRT administration resulted in a significant reduction in a cumulative score of parameter Z-scores (a measure of global performance compared to healthy controls) in subjects with clinically effective levodopa doses. The cumulative score was also correlated to UPDRS scores for the effect of DRT. Conclusions Robotic assessment is able to objectively quantify parkinsonian symptoms of bradykinesia, rigidity and postural stability similar to the UPDRS. This integrated testing platform has the potential to aid clinicians in the management of PD and help assess the effects of novel therapies.
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Affiliation(s)
- Pauline Gaprielian
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Catherine Lowrey
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Stuart Reid
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Giovanna Pari
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada.,Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Ron Levy
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, K7L 3N6, Canada. .,Department of Surgery, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
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25
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Barbosa ENBE, Charchat-Fichman H. Systematic review of neuropsychological instruments used in subthalamic nucleus deep brain stimulation in Parkinson´s disease patients. Dement Neuropsychol 2019; 13:162-171. [PMID: 31285790 PMCID: PMC6601304 DOI: 10.1590/1980-57642018dn13-020004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/06/2019] [Indexed: 12/28/2022] Open
Abstract
In addition to drug treatment, surgical intervention represents an alternative to PD patients with motor deficits. The most common intervention is subthalamic nucleus deep brain stimulation (STN-DBS). It is extremely important to perform a neuropsychological assessment in patients with STN-DBS, not only to identify losses related to the disease, but also to compare influence on cognition both pre and postoperatively. OBJECTIVE the objective of this systematic review was to investigate the instruments frequently used in studies related to STN-DBS in PD patients. METHODS articles were retrieved from Medline/Pubmed databases published in the 2007-2017 period using PRISMA criteria. RESULTS after analyzing 27 articles, the absence of a specific evaluation protocol for PD with STN-DBS was evident. CONCLUSION non-motor symptoms are not given due importance in neuropsychological assessments. It is crucial to acknowledge that these symptoms have a major impact on the quality of life of patients. Greater engagement in assessing these aspects is required, in order to bridge the gaps in research.
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26
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Lang S, Hanganu A, Gan LS, Kibreab M, Auclair‐Ouellet N, Alrazi T, Ramezani M, Cheetham J, Hammer T, Kathol I, Sarna J, Monchi O. Network basis of the dysexecutive and posterior cortical cognitive profiles in Parkinson's disease. Mov Disord 2019; 34:893-902. [DOI: 10.1002/mds.27674] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Stefan Lang
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
| | - Alexandru Hanganu
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
- Centre de RechercheInstitut Universitaire de Gériatrie de Montréal Montreal QC Canada
| | - Liu Shi Gan
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
| | - Mekale Kibreab
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
| | - Noémie Auclair‐Ouellet
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- McGill University School of Communication Sciences and Disorders Montreal Canada
| | - Tazrina Alrazi
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
| | - Mehrafarin Ramezani
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
| | - Jenelle Cheetham
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
| | - Tracy Hammer
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
| | - Iris Kathol
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
| | - Justyna Sarna
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
| | - Oury Monchi
- Cumming School of MedicineHotchkiss Brain Institute Calgary AB Canada
- Department of Clinical Neurosciences and Department of RadiologyUniversity of Calgary Calgary AB Canada
- Centre de RechercheInstitut Universitaire de Gériatrie de Montréal Montreal QC Canada
- Department of NeurologyMontreal General Hospital Montreal QC Canada
- Department of Radiology, Radio‐Oncology, and Nuclear MedicineUniversité de Montréal Montreal QC Canada
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27
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Gul A, Yousaf J. Effect of levodopa on frontal-subcortical and posterior cortical functioning in patients with Parkinson's disease. Singapore Med J 2018; 60:414-417. [PMID: 30246215 DOI: 10.11622/smedj.2018116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is associated with cognitive decline but little is known about frontal-subcortical and posterior cortical cognitive functioning in patients with PD. The present study was designed to: (a) compare frontal and posterior cognitive functioning between patients with PD and healthy controls; (b) determine the effect of levodopa (L-dopa) on frontal-subcortical and posterior cortical cognitive functions; and (c) identify predictors of cognitive functions in patients with PD. METHODS 50 patients diagnosed with PD from April 2016 to May 2017 at Civil Hospital, Bahawal Victoria Hospital, Bahawalpur, and Nishter Hospital Multan, Pakistan, and 50 healthy individuals from the community participated in our study. Patients had two testing sessions - first, at the time of diagnosis before taking L-dopa medication to determine baseline scores; and second, after at least three months of L-dopa medication. Participants completed the Parkinson's Disease-Cognitive Rating Scale. RESULTS Patients with PD showed impaired performance on frontal-subcortical and posterior cortical functions in contrast with the control group. L-dopa medication had beneficial effects on frontal-subcortical and posterior cortical functioning in patients with PD. Disease duration was a significant predictor of cognitive performance in patients with PD. CONCLUSION L-dopa medication improves frontal-subcortical and posterior cortical cognitive functioning in patients with PD. Disease duration is a marker of cognitive decline in PD.
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Affiliation(s)
- Amara Gul
- Department of Applied Psychology, The Islamia University of Bahawalpur, Pakistan
| | - Javed Yousaf
- Department of Applied Psychology, The Islamia University of Bahawalpur, Pakistan
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Hussain R, Zubair H, Pursell S, Shahab M. Neurodegenerative Diseases: Regenerative Mechanisms and Novel Therapeutic Approaches. Brain Sci 2018; 8:E177. [PMID: 30223579 PMCID: PMC6162719 DOI: 10.3390/brainsci8090177] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 12/12/2022] Open
Abstract
Regeneration refers to regrowth of tissue in the central nervous system. It includes generation of new neurons, glia, myelin, and synapses, as well as the regaining of essential functions: sensory, motor, emotional and cognitive abilities. Unfortunately, regeneration within the nervous system is very slow compared to other body systems. This relative slowness is attributed to increased vulnerability to irreversible cellular insults and the loss of function due to the very long lifespan of neurons, the stretch of cells and cytoplasm over several dozens of inches throughout the body, insufficiency of the tissue-level waste removal system, and minimal neural cell proliferation/self-renewal capacity. In this context, the current review summarized the most common features of major neurodegenerative disorders; their causes and consequences and proposed novel therapeutic approaches.
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Affiliation(s)
- Rashad Hussain
- Center for Translational Neuromedicine, University of Rochester, NY 14642, USA.
| | - Hira Zubair
- Department of Animal Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
| | - Sarah Pursell
- Center for Translational Neuromedicine, University of Rochester, NY 14642, USA.
| | - Muhammad Shahab
- Department of Animal Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
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Nobis L, Schindlbeck K, Ehlen F, Tiedt H, Rewitzer C, Duits AA, Klostermann F. Theory of mind performance in Parkinson’s disease is associated with motor and cognitive functions, but not with symptom lateralization. J Neural Transm (Vienna) 2017; 124:1067-1072. [DOI: 10.1007/s00702-017-1739-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 05/24/2017] [Indexed: 12/01/2022]
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30
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Discriminating cognitive status in Parkinson's disease through functional connectomics and machine learning. Sci Rep 2017; 7:45347. [PMID: 28349948 PMCID: PMC5368610 DOI: 10.1038/srep45347] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022] Open
Abstract
There is growing interest in the potential of neuroimaging to help develop non-invasive biomarkers in neurodegenerative diseases. In this study, connection-wise patterns of functional connectivity were used to distinguish Parkinson’s disease patients according to cognitive status using machine learning. Two independent subject samples were assessed with resting-state fMRI. The first (training) sample comprised 38 healthy controls and 70 Parkinson’s disease patients (27 with mild cognitive impairment). The second (validation) sample included 25 patients (8 with mild cognitive impairment). The Brainnetome atlas was used to reconstruct the functional connectomes. Using a support vector machine trained on features selected through randomized logistic regression with leave-one-out cross-validation, a mean accuracy of 82.6% (p < 0.002) was achieved in separating patients with mild cognitive impairment from those without it in the training sample. The model trained on the whole training sample achieved an accuracy of 80.0% when used to classify the validation sample (p = 0.006). Correlation analyses showed that the connectivity level in the edges most consistently selected as features was associated with memory and executive function performance in the patient group. Our results demonstrate that connection-wise patterns of functional connectivity may be useful for discriminating Parkinson’s disease patients according to the presence of cognitive deficits.
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Olchik MR, Ayres A, Ghisi M, Schuh AFS, Rieder CRM. The impact of cognitive performance on quality of life in individuals with Parkinson's disease. Dement Neuropsychol 2016; 10:303-309. [PMID: 29213473 PMCID: PMC5619269 DOI: 10.1590/s1980-5764-2016dn1004008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Evidence points to the occurrence of cognitive impairment in all stages of
PD, constituting a frequent and debilitating symptom, due to high impact on
quality of life and mortality of patients. Objective To correlate cognitive performance with quality of life in PD. Methods The sample was drawn from a Movement Disorders Clinic of a reference hospital
in Porto Alegre. Inclusion criteria were: PD diagnosis, according to the
United Kingdom Parkinson's Disease Society Brain Bank criteria for
idiopathic PD (Hughes et al. 1992) and patient consent to participate.
Patients with other neurological pathologies and those submitted to deep
brain stimulation were excluded. The evaluation consisted of a cognitive
testing battery (composed of eight tests for assessing cognitive
performance), and a questionnaire on quality of life (PDQ-39) and depression
(BDI). Results The sample comprised 85 individuals with PD, with a mean age of 62.9 years
(±10.7), mean disease duration of 10.4 years (±5.7), and mean
educational level of four years (±4.3). There was a significant
relationship between total score on the PDQ and all cognitive tests, showing
that poor cognitive performance was correlated with poor quality of life.
Moreover, a significant correlation was observed between cognitive tests and
depression, H&Y, education level, and age. Conclusion It may be concluded that the individuals with PD in this sample showed a
correlation between poorer quality of life and worse cognitive performance.
Poor performance was also correlated with more advanced stage, older age,
low level of education and depression.
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Affiliation(s)
- Maira Rozenfeld Olchik
- PhD. Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, RS, Brazil
| | - Annelise Ayres
- MD. Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | - Marcieli Ghisi
- MD. Speech Therapy Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Pinto S, Cardoso R, Sadat J, Guimarães I, Mercier C, Santos H, Atkinson-Clement C, Carvalho J, Welby P, Oliveira P, D'Imperio M, Frota S, Letanneux A, Vigario M, Cruz M, Martins IP, Viallet F, Ferreira JJ. Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark). BMJ Open 2016; 6:e012885. [PMID: 27856480 PMCID: PMC5128890 DOI: 10.1136/bmjopen-2016-012885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). METHODS AND ANALYSIS Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. ETHICS AND DISSEMINATION The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. TRIAL REGISTRATION NUMBER NCT02753192, Pre-results.
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Affiliation(s)
- Serge Pinto
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Rita Cardoso
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
| | - Jasmin Sadat
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Isabel Guimarães
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Speech Therapy Department, Escola Superior de Saude do Alcoitão, Alcabideche, Portugal
| | - Céline Mercier
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Helena Santos
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Cyril Atkinson-Clement
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Joana Carvalho
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Pauline Welby
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Pedro Oliveira
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Mariapaola D'Imperio
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Sónia Frota
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Alban Letanneux
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
| | - Marina Vigario
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Marisa Cruz
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Isabel Pavão Martins
- Neurology Department, Faculty of Medicine, Language Research Laboratory, University of Lisbon, Lisbon, Portugal
| | - François Viallet
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Joaquim J Ferreira
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
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33
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Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, Ding G, Wen G, Namba H, Xia Y. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev 2016; 68:741-772. [PMID: 27375277 DOI: 10.1016/j.neubiorev.2016.06.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan; Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan.
| | - Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, Shanghai, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Katsuaki Suzuki
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Norio Mori
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Yilin Yang
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Fei Hua
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Guanghong Ding
- Shanghai Key laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
| | - Guoqiang Wen
- Department of Neurology, Hainan General Hospital, Haikou, Hainan, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Ying Xia
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, TX 77030, USA.
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34
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Kwon DY, Koh SB, Lee JH, Park HK, Kim HJ, Shin HW, Youn J, Park KW, Choi SA, Kim SJ, Choi SM, Park JY, Jeon BS, Kim JY, Chung SJ, Lee CS, Park JH, Ahn TB, Kim WC, Kim HS, Cheon SM, Kim HT, Lee JY, Kim JS, Kim EJ, Kim JM, Lee KS, Kim JS, Kim MJ, Baik JS, Park KJ, Kim HJ, Park MY, Kang JH, Song SK, Kim YD, Yun JY, Lee HW, Oh HG, Cho J, Song IU, Sohn YH, Lee PH, Kim JW. The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group. J Clin Neurol 2016; 12:393-402. [PMID: 27819413 PMCID: PMC5063863 DOI: 10.3988/jcn.2016.12.4.393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. Methods We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. Results In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. Conclusions The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.
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Affiliation(s)
- Do Young Kwon
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Seong Beom Koh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Kyung Park
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Han Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kun Woo Park
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Sun Ah Choi
- Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Sang Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Seong Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Yun Park
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Beom S Jeon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Neurology, College of Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, University of Ulsan College of Medicine, Asan Hospital, Seoul, Korea
| | - Chong Sik Lee
- Department of Neurology, University of Ulsan College of Medicine, Asan Hospital, Seoul, Korea
| | - Jeong Ho Park
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Tae Beom Ahn
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won Chan Kim
- Department of Neurology, CHA University College of Medicine, Seongnam, Korea
| | - Hyun Sook Kim
- Department of Neurology, CHA University College of Medicine, Seongnam, Korea
| | - Sang Myung Cheon
- Department of Neurology, Dong-A University Medical Centre, Busan, Korea
| | - Hee Tae Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Jee Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Ji Sun Kim
- Department of Neurology, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Daejeon, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jong Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Jeong Kim
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Jong Sam Baik
- Department of Neurology, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Ki Jong Park
- Department of Neurology, Gyeongsang National University School of Medicine, Busan, Korea
| | - Hee Jin Kim
- Department of Neurology, Konkuk University School of Medicine, Daejeon, Korea
| | - Mee Young Park
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Hoon Kang
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Sook Kun Song
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Yong Duk Kim
- Department of Neurology, Konyang University Hospital, Daejeon, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Ho Won Lee
- Department of Neurology, School of Medicine, Kyungpook National Univeristy, Daegu, Korea
| | - Hyung Geun Oh
- Department of Neurology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Jinwhan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Uk Song
- Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Medical Centre, Busan, Korea.
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