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Bologna M, Guerra A, Colella D, Birreci D, Costa D, Cannavacciuolo A, Angelini L, Paparella G, Antonini A, Berardelli A, Fabbrini G. Objective assessment of the effects of opicapone in Parkinson's disease through kinematic analysis. Neurol Sci 2024; 45:2035-2046. [PMID: 38091213 PMCID: PMC11021230 DOI: 10.1007/s10072-023-07233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Opicapone (OPC) is a third-generation, selective peripheral COMT inhibitor that improves peripheral L-DOPA bioavailability and reduces OFF time and end-of-dose motor fluctuations in Parkinson's disease (PD) patients. OBJECTIVES In this study, we objectively assessed the effects of adding OPC to L-DOPA on bradykinesia in PD through kinematic analysis of finger movements. METHODS We enrolled 20 treated patients with PD and motor fluctuations. Patients underwent two experimental sessions (L-DOPA, L-DOPA + OPC), separated by at least 1 week. In each session, patients were clinically evaluated and underwent kinematic movement analysis of repetitive finger movements at four time points: (i) before their usual morning dose of L-DOPA (T0), (ii) 30 min (T1), (iii) 1 h and 30 min (T2), and (iv) 3 h and 30 min after the L-DOPA intake (T3). RESULTS Movement velocity and amplitude of finger movements were higher in PD patients during the session with OPC compared to the session without OPC at all the time points tested. Importantly, the variability of finger movement velocity and amplitude across T0-T3 was significantly lower in the L-DOPA + OPC than L-DOPA session. CONCLUSIONS This study is the first objective assessment of the effects of adding OPC to L-DOPA on bradykinesia in patients with PD and motor fluctuations. OPC, in addition to the standard dopaminergic therapy, leads to significant improvements in bradykinesia during clinically relevant periods associated with peripheral L-DOPA dynamics, i.e., the OFF state in the morning, delayed-ON, and wearing-OFF periods.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy.
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy.
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, 00185, Rome, Italy
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
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Luiz LMD, Marques IA, Folador JP, Andrade AO. Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease. Neurologia 2024; 39:345-352. [PMID: 38616062 DOI: 10.1016/j.nrleng.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.
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Affiliation(s)
- L M D Luiz
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil.
| | - I A Marques
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - J P Folador
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - A O Andrade
- Centre for Innovation and Technology Assessment in Health, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
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Spooner RK, Bahners BH, Schnitzler A, Florin E. Time-resolved quantification of fine hand movements as a proxy for evaluating bradykinesia-induced motor dysfunction. Sci Rep 2024; 14:5340. [PMID: 38438484 PMCID: PMC10912452 DOI: 10.1038/s41598-024-55862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
Bradykinesia is a behavioral manifestation that contributes to functional dependencies in later life. However, the current state of bradykinesia indexing primarily relies on subjective, time-averaged categorizations of motor deficits, which often yield poor reliability. Herein, we used time-resolved analyses of accelerometer recordings during standardized movements, data-driven factor analyses, and linear mixed effects models (LMEs) to quantitatively characterize general, task- and therapy-specific indices of motor impairment in people with Parkinson's disease (PwP) currently undergoing treatment for bradykinesia. Our results demonstrate that single-trial, accelerometer-based features of finger-tapping and rotational hand movements were significantly modulated by divergent therapeutic regimens. Further, these features corresponded well to current gold standards for symptom monitoring, with more precise predictive capacities of bradykinesia-specific declines achieved when considering kinematic features from diverse movement types together, rather than in isolation. Herein, we report data-driven, sample-specific kinematic profiles of diverse movement types along a continuous spectrum of motor impairment, which importantly, preserves the temporal scale for which biomechanical fluctuations in motor deficits evolve in humans. Therefore, this approach may prove useful for tracking bradykinesia-induced motor decline in aging populations the future.
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Affiliation(s)
- Rachel K Spooner
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
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de Graaf D, Araújo R, Derksen M, Zwinderman K, de Vries NM, IntHout J, Bloem BR. The sound of Parkinson's disease: A model of audible bradykinesia. Parkinsonism Relat Disord 2024; 120:106003. [PMID: 38219529 DOI: 10.1016/j.parkreldis.2024.106003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Evaluation of bradykinesia is based on five motor tasks from the MDS-UPDRS. Visually scoring these motor tasks is subjective, resulting in significant interrater variability. Recent observations suggest that it may be easier to hear the characteristic features of bradykinesia, such as the decrement in sound intensity or force of repetitive movements. The objective is to evaluate whether audio signals derived during four MDS-UPDRS tasks can be used to detect and grade bradykinesia, using two machine learning models. METHODS 54 patients with Parkinson's disease and 28 healthy controls were filmed while executing the bradykinesia motor tasks. Several features were extracted from the audio signal, including number of taps, speed, sound intensity, decrement and freezes. For each motor task, two supervised machine learning models were trained, Logistic Regression (LR) and Support Vector Machine (SVM). RESULTS Both classifiers were able to separate patients from controls reasonably well for the leg agility task, area under the receiver operating characteristic curve (AUC): 0.92 (95%CI: 0.78-0.99) for LR and 0.93 (0.81-1.00) for SVM. Also, models were able to differentiate less severe bradykinesia from severe bradykinesia, particularly for the pronation-supination motor task, with AUC: 0.90 (0.62-1.00) for LR and 0.82 (0.45-0.97) for SVM. CONCLUSION This audio-based approach discriminates PD from healthy controls with moderate-high accuracy and separated individuals with less severe bradykinesia from those with severe bradykinesia. Sound analysis may contribute to the identification and monitoring of bradykinesia.
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Affiliation(s)
- Debbie de Graaf
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.
| | - Rui Araújo
- Department of Neurology, Centro Hospitalar Universitário São João, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Koos Zwinderman
- Academic Medical Center, Department of Cardiology, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Nienke M de Vries
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Department for Health Evidence Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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Kinugawa K, Mano T, Fujimura S, Takatani T, Miyasaka T, Sugie K. Bradykinesia and rigidity modulated by functional connectivity between the primary motor cortex and globus pallidus in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1537-1545. [PMID: 37612469 DOI: 10.1007/s00702-023-02688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
The mechanisms underlying motor fluctuations in patients with Parkinson's disease (PD) are currently unclear. Regional brain stimulation reported the changing of motor symptoms, but the correlation with functional connectivity (FC) in the brain network is not fully understood. Hence, our study aimed to explore the relationship between motor symptom severity and FC using resting-state functional magnetic resonance imaging (rsfMRI) in the "on" and "off" states of PD. In 26 patients with sporadic PD, FC was assessed using rsfMRI, and clinical severity was analyzed using the motor part of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part III) in the on and off states. Correlations between FC values and MDS-UPDRS Part III scores were assessed using Pearson's correlation coefficient. The correlation between FC and motor symptoms differed in the on and off states. FC between the ipsilateral precentral gyrus (PreCG) and globus pallidus (GP) correlated with the total MDS-UPDRS Part III scores and those for bradykinesia/rigidity in the off state. Lateralization analysis indicated that FC between the PreCG and GP correlated with the contralateral total MDS-UPDRS Part III scores and those for bradykinesia/rigidity in the off state. Aberrant FC in cortico-striatal circuits correlated with the severity of motor symptoms in PD. Cortico-striatal hyperconnectivity, particularly in motor pathways involving PreCG and GP, is related to motor impairments in PD. These findings may facilitate our understanding of the mechanisms underlying motor symptoms in PD and aid in developing treatment strategies such as brain stimulation for motor impairment.
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Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
- Department of Rehabilitation Medicine, Nara Prefecture General Medical Center, Nara, Japan.
| | - Shigekazu Fujimura
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | | | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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Vijayakumari AA, Mandava N, Hogue O, Fernandez HH, Walter BL. A novel MRI-based volumetric index for monitoring the motor symptoms in Parkinson's disease. J Neurol Sci 2023; 453:120813. [PMID: 37742348 DOI: 10.1016/j.jns.2023.120813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Conventional MRI scans have limited usefulness in monitoring Parkinson's disease as they typically do not show any disease-specific brain abnormalities. This study aimed to identify an imaging biomarker for tracking motor symptom progression by using a multivariate statistical approach that can combine gray matter volume information from multiple brain regions into a single score specific to each PD patient. METHODS A cohort of 150 patients underwent MRI at baseline and had their motor symptoms tracked for up to 10 years using MDS-UPDRS-III, with motor symptoms focused on total and subscores, including rigidity, bradykinesia, postural instability, and gait disturbances, resting tremor, and postural-kinetic tremor. Gray matter volume extracted from MRI data was summarized into a patient-specific summary score using Mahalanobis distance, MGMV. MDS-UPDRS-III's progression and its association with MGMV were modeled via linear mixed-effects models over 5- and 10-year follow-up periods. RESULTS Over the 5-year follow-up, there was a significant increase (P < 0.05) in MDS-UPDRS-III total and subscores, except for postural-kinetic tremor. Over the 10-year follow-up, all MDS-UPDRS-III scores increased significantly (P < 0.05). A higher baseline MGMV was associated with a significant increase in MDS-UPDRS-III total, bradykinesia, postural instability and gait disturbances, and resting tremor (P < 0.05) over the 5-year follow-up, but only with total, bradykinesia, and postural instability and gait disturbances during the 10-year follow-up (P < 0.05). CONCLUSIONS Higher MGMV scores were linked to faster motor symptom progression, suggesting it could be a valuable marker for clinicians monitoring Parkinson's disease over time.
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Affiliation(s)
- Anupa A Vijayakumari
- Center for Neurological Restoration, Neurological Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nymisha Mandava
- Department of Quantitative Health Sciences, Lerner Research Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Benjamin L Walter
- Center for Neurological Restoration, Neurological Institute, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA.
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Colella D, Passaretti M, Frantellizzi V, Silvia De Feo M, Cannavacciuolo A, Angelini L, Birreci D, Costa D, Paparella G, Guerra A, De Vincentis G, Berardelli A, Bologna M. Subtle changes in central dopaminergic tone underlie bradykinesia in essential tremor. Neuroimage Clin 2023; 40:103526. [PMID: 37847966 PMCID: PMC10587600 DOI: 10.1016/j.nicl.2023.103526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION In this research, our primary objective was to explore the correlation between basal ganglia dopaminergic neurotransmission, assessed using 123I-FP-CIT (DAT-SPECT), and finger movements abnormalities in patients with essential tremor (ET) and Parkinson's disease (PD). METHODS We enrolled 16 patients with ET, 17 with PD, and 18 healthy controls (HC). Each participant underwent comprehensive clinical evaluations, kinematic assessments of finger tapping. ET and PD patients underwent DAT-SPECT imaging. The DAT-SPECT scans were subjected to both visual and semi-quantitative analysis using DaTQUANT®. We then investigated the correlations between the clinical, kinematic, and DAT-SPECT data, in patients. RESULTS Our findings confirm that individuals with ET exhibited slower finger tapping than HC. Visual evaluation of radiotracer uptake in both striata demonstrated normal levels within the ET patient cohort, while PD patients displayed reduced uptake. However, there was notable heterogeneity in the quantification of uptake within the striata among ET patients. Additionally, we found a correlation between the amount of radiotracer uptake in the striatum and movement velocity during finger tapping in patients. Specifically, lower radioligand uptake corresponded to decreased movement velocity (ET: coef. = 0.53, p-adj = 0.03; PD: coef. = 0.59, p-adj = 0.01). CONCLUSION The study's findings suggest a potential link between subtle changes in central dopaminergic tone and altered voluntary movement execution, in ET. These results provide further insights into the pathophysiology of ET. However, longitudinal studies are essential to determine whether the slight reduction in dopaminergic tone observed in ET patients represents a distinct subtype of the disease or could serve as a predictor for the clinical progression into PD.
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Affiliation(s)
- Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Massimiliano Passaretti
- Department of Human Neurosciences, Sapienza University of Rome, Italy; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzilli (IS), Italy.
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Herz DM, Brown P. Moving, fast and slow: behavioural insights into bradykinesia in Parkinson's disease. Brain 2023; 146:3576-3586. [PMID: 36864683 PMCID: PMC10473574 DOI: 10.1093/brain/awad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
The debilitating symptoms of Parkinson's disease, including the hallmark slowness of movement, termed bradykinesia, were described more than 100 years ago. Despite significant advances in elucidating the genetic, molecular and neurobiological changes in Parkinson's disease, it remains conceptually unclear exactly why patients with Parkinson's disease move slowly. To address this, we summarize behavioural observations of movement slowness in Parkinson's disease and discuss these findings in a behavioural framework of optimal control. In this framework, agents optimize the time it takes to gather and harvest rewards by adapting their movement vigour according to the reward that is at stake and the effort that needs to be expended. Thus, slow movements can be favourable when the reward is deemed unappealing or the movement very costly. While reduced reward sensitivity, which makes patients less inclined to work for reward, has been reported in Parkinson's disease, this appears to be related mainly to motivational deficits (apathy) rather than bradykinesia. Increased effort sensitivity has been proposed to underlie movement slowness in Parkinson's disease. However, careful behavioural observations of bradykinesia are inconsistent with abnormal computations of effort costs due to accuracy constraints or movement energetic expenditure. These inconsistencies can be resolved when considering that a general disability to switch between stable and dynamic movement states can contribute to an abnormal composite effort cost related to movement in Parkinson's disease. This can account for paradoxical observations such as the abnormally slow relaxation of isometric contractions or difficulties in halting a movement in Parkinson's disease, both of which increase movement energy expenditure. A sound understanding of the abnormal behavioural computations mediating motor impairment in Parkinson's disease will be vital for linking them to their underlying neural dynamics in distributed brain networks and for grounding future experimental studies in well-defined behavioural frameworks.
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Affiliation(s)
- Damian M Herz
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Peter Brown
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3TH, UK
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Simonet C, Mahlknecht P, Marini K, Seppi K, Gill A, Bestwick JP, Lees AJ, Giovannoni G, Schrag A, Noyce AJ. The Emergence and Progression of Motor Dysfunction in Individuals at Risk of Parkinson's Disease. Mov Disord 2023; 38:1636-1644. [PMID: 37317903 DOI: 10.1002/mds.29496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND PREDICT-PD is a United Kingdom population-based study aiming to stratify individuals for future Parkinson's disease (PD) using a risk algorithm. METHODS A randomly selected, representative sample of participants in PREDICT-PD were examined using several motor assessments, including the motor section of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-III, at baseline (2012) and after an average of 6 years of follow-up. We checked for new PD diagnoses in participants seen at baseline and examined the association between risk scores and incident sub-threshold parkinsonism, motor decline (increasing ≥5 points in MDS-UPDRS-III) and single motor domains in the MDS-UPDRS-III. We replicated analyses in two independent datasets (Bruneck and Parkinson's Progression Markers Initiative [PPMI]). RESULTS After 6 years of follow-up, the PREDICT-PD higher-risk group (n = 33) had a greater motor decline compared with the lower-risk group (n = 95) (30% vs. 12.5%, P = 0.031). Two participants (both considered higher risk at baseline) were given a diagnosis of PD during follow-up, with motor signs emerging between 2 and 5 years before diagnosis. A meta-analysis of data from PREDICT-PD, Bruneck, and PPMI showed an association between PD risk estimates and incident sub-threshold parkinsonism (odds ratio [OR], 2.01 [95% confidence interval (CI), 1.55-2.61]), as well as new onset bradykinesia (OR, 1.69 [95% CI, 1.33-2.16]) and action tremor (OR, 1.61 [95% CI, 1.30-1.98]). CONCLUSIONS Risk estimates using the PREDICT-PD algorithm were associated with the occurrence of sub-threshold parkinsonism, including bradykinesia and action tremor. The algorithm could also identify individuals whose motor examination experience a decline over time. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Marini
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aneet Gill
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Blizard Institute, Queen Mary University, London, United Kingdom
| | - Anette Schrag
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Guerra A, D'Onofrio V, Ferreri F, Bologna M, Antonini A. Objective measurement versus clinician-based assessment for Parkinson's disease. Expert Rev Neurother 2023; 23:689-702. [PMID: 37366316 DOI: 10.1080/14737175.2023.2229954] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Although clinician-based assessment through standardized clinical rating scales is currently the gold standard for quantifying motor impairment in Parkinson's disease (PD), it is not without limitations, including intra- and inter-rater variability and a degree of approximation. There is increasing evidence supporting the use of objective motion analyses to complement clinician-based assessment. Objective measurement tools hold significant potential for improving the accuracy of clinical and research-based evaluations of patients. AREAS COVERED The authors provide several examples from the literature demonstrating how different motion measurement tools, including optoelectronics, contactless and wearable systems allow for both the objective quantification and monitoring of key motor symptoms (such as bradykinesia, rigidity, tremor, and gait disturbances), and the identification of motor fluctuations in PD patients. Furthermore, they discuss how, from a clinician's perspective, objective measurements can help in various stages of PD management. EXPERT OPINION In our opinion, sufficient evidence supports the assertion that objective monitoring systems enable accurate evaluation of motor symptoms and complications in PD. A range of devices can be utilized not only to support diagnosis but also to monitor motor symptom during the disease progression and can become relevant in the therapeutic decision-making process.
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Affiliation(s)
- Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | | | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
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Bologna M, Espay AJ, Fasano A, Paparella G, Hallett M, Berardelli A. Redefining Bradykinesia. Mov Disord 2023; 38:551-557. [PMID: 36847357 PMCID: PMC10387192 DOI: 10.1002/mds.29362] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Alberto J. Espay
- Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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12
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Kiesmann M, Martin RE, Sauleau E, Bulubas I, Fleury MC, Perisse J, Kaltenbach G, Schmitt E. Diagnosis of vascular parkinsonism: A new tool for gait hypokinesia occurring in older persons. Parkinsonism Relat Disord 2023; 109:105360. [PMID: 36921515 DOI: 10.1016/j.parkreldis.2023.105360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Reliable diagnosis of vascular parkinsonism (VaP) in the presence of a gait hypokinesia is an issue that is encountered in geriatrics. The EVAMAR-AGEX study was focusing on the phenomenon of recurrent falls in older persons (OP) with this parkinsonian gait. The present study is focusing on the diagnosis of VaP-related parkinsonian gait by developing a diagnostic guidance model adapted to OP. METHODS Data from baseline and the 2-year follow-up visit were used to carry out univariate analysis and calculation of odds ratios, allowing to identify relevant variables to include in the diagnostic guidance model. To evaluate the model, confusion matrices were created, evaluating true positive, false negative, false positive and true negative incidences, sensitivity and specificity, and negative and positive predictive values. RESULTS 79 patients included 58% male; average age 81.24 years. VaP diagnosis according to Zijlmans criteria occurred in 28%; neurodegenerative parkinsonian syndromes in 72%. A 4-criteria model was established to facilitate diagnostic: lack of prior hallucinations, lack of movement disorders tremor excluded, no cognitive fluctuations, and ≥75 years of age at diagnosis. In combination of 4/4 criteria, all of them were required to disclose a specificity of 91% in the diagnosis of VaP. In combination of 3/4, in case of negative test, a negative predictive value for VaP diagnosis of 0.97 was obtained. CONCLUSION The challenge of our tool is both to be able to rule out what is probably not a VaP and to argue what makes a VaP diagnosis probable in OP.
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Affiliation(s)
- Michèle Kiesmann
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Erik Sauleau
- Biostatistical Laboratory, iCube - CNRS UMR 7357, Department of Public Health, Methods in Clinical Research, University of Strasbourg, Strasbourg, France
| | - Irina Bulubas
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Marie Céline Fleury
- Neurology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Jérémie Perisse
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Georges Kaltenbach
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Elise Schmitt
- Geriatric Department, University Hospitals of Strasbourg, Strasbourg, France; EA-3072, University of Strasbourg, Strasbourg, France.
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13
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Paparella G, Cannavacciuolo A, Angelini L, Costa D, Birreci D, Alunni Fegatelli D, Guerra A, Berardelli A, Bologna M. May Bradykinesia Features Aid in Distinguishing Parkinson's Disease, Essential Tremor, And Healthy Elderly Individuals? J Parkinsons Dis 2023; 13:1047-1060. [PMID: 37522221 PMCID: PMC10578222 DOI: 10.3233/jpd-230119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Bradykinesia is the hallmark feature of Parkinson's disease (PD); however, it can manifest in other conditions, including essential tremor (ET), and in healthy elderly individuals. OBJECTIVE Here we assessed whether bradykinesia features aid in distinguishing PD, ET, and healthy elderly individuals. METHODS We conducted simultaneous video and kinematic recordings of finger tapping in 44 PD patients, 69 ET patients, and 77 healthy elderly individuals. Videos were evaluated blindly by expert neurologists. Kinematic recordings were blindly analyzed. We calculated the inter-raters agreement and compared data among groups. Density plots assessed the overlapping in the distribution of kinematic data. Regression analyses and receiver operating characteristic curves determined how the kinematics influenced the likelihood of belonging to a clinical score category and diagnostic group. RESULTS The inter-rater agreement was fair (Fleiss K = 0.32). Rater found the highest clinical scores in PD, and higher scores in ET than healthy elderly individuals (p < 0.001). In regard to kinematic analysis, the groups showed variations in movement velocity, with PD presenting the slowest values and ET displaying less velocity than healthy elderly individuals (all ps < 0.001). Additionally, PD patients showed irregular rhythm and sequence effect. However, kinematic data significantly overlapped. Regression analyses showed that kinematic analysis had high specificity in differentiating between PD and healthy elderly individuals. Nonetheless, accuracy decreased when evaluating subjects with intermediate kinematic values, i.e., ET patients. CONCLUSION Despite a considerable degree of overlap, bradykinesia features vary to some extent in PD, ET, and healthy elderly individuals. Our findings have implications for defining bradykinesia and categorizing patients.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome,Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), University of Padua, Padua, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
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14
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Vignoud G, Desjardins C, Salardaine Q, Mongin M, Garcin B, Venance L, Degos B. Video-Based Automated Assessment of Movement Parameters Consistent with MDS-UPDRS III in Parkinson's Disease. J Parkinsons Dis 2022; 12:2211-2222. [PMID: 35964204 PMCID: PMC9661322 DOI: 10.3233/jpd-223445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Among motor symptoms of Parkinson's disease (PD), including rigidity and resting tremor, bradykinesia is a mandatory feature to define the parkinsonian syndrome. MDS-UPDRS III is the worldwide reference scale to evaluate the parkinsonian motor impairment, especially bradykinesia. However, MDS-UPDRS III is an agent-based score making reproducible measurements and follow-up challenging. OBJECTIVE Using a deep learning approach, we developed a tool to compute an objective score of bradykinesia based on the guidelines of the gold-standard MDS-UPDRS III. METHODS We adapted and applied two deep learning algorithms to detect a two-dimensional (2D) skeleton of the hand composed of 21 predefined points, and transposed it into a three-dimensional (3D) skeleton for a large database of videos of parkinsonian patients performing MDS-UPDRS III protocols acquired in the Movement Disorder unit of Avicenne University Hospital. RESULTS We developed a 2D and 3D automated analysis tool to study the evolution of several key parameters during the protocol repetitions of the MDS-UPDRS III. Scores from 2D automated analysis showed a significant correlation with gold-standard ratings of MDS-UPDRS III, measured with coefficients of determination for the tapping (0.609) and hand movements (0.701) protocols using decision tree algorithms. The individual correlations of the different parameters measured with MDS-UPDRS III scores carry meaningful information and are consistent with MDS-UPDRS III guidelines. CONCLUSION We developed a deep learning-based tool to precisely analyze movement parameters allowing to reliably score bradykinesia for parkinsonian patients in a MDS-UPDRS manner.
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Affiliation(s)
- Gaëtan Vignoud
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
- INRIA Paris, MAMBA (Modelling and Analysis in Medical and Biological Applications), Paris, France
| | - Clément Desjardins
- APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis (HUPSSD), Department of Neurology, Sorbonne Paris Nord, NS-PARK/FCRIN network, Bobigny, France
| | - Quentin Salardaine
- APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis (HUPSSD), Department of Neurology, Sorbonne Paris Nord, NS-PARK/FCRIN network, Bobigny, France
| | - Marie Mongin
- APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis (HUPSSD), Department of Neurology, Sorbonne Paris Nord, NS-PARK/FCRIN network, Bobigny, France
| | - Béatrice Garcin
- APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis (HUPSSD), Department of Neurology, Sorbonne Paris Nord, NS-PARK/FCRIN network, Bobigny, France
| | - Laurent Venance
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
| | - Bertrand Degos
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, Université PSL, Paris, France
- APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis (HUPSSD), Department of Neurology, Sorbonne Paris Nord, NS-PARK/FCRIN network, Bobigny, France
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15
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Bange M, Gonzalez-Escamilla G, Lang NSC, Ding H, Radetz A, Herz DM, Schöllhorn WI, Muthuraman M, Groppa S. Gait Abnormalities in Parkinson's Disease Are Associated with Extracellular Free-Water Characteristics in the Substantia Nigra. J Parkinsons Dis 2022; 12:1575-1590. [PMID: 35570500 DOI: 10.3233/jpd-223225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gait impairments are common in Parkinson's disease (PD). The pathological mechanisms are complex and not thoroughly elucidated, thus quantitative and objective parameters that closely relate to gait characteristics are critically needed to improve the diagnostic assessments and monitor disease progression. The substantia nigra is a relay structure within basal ganglia brainstem loops that is centrally involved in gait modulation. OBJECTIVE We tested the hypothesis that quantitative gait biomechanics are related to the microstructural integrity of the substantia nigra and PD-relevant gait abnormalities are independent from bradykinesia-linked speed reductions. METHODS Thirty-eight PD patients and 33 age-matched control participants walked on a treadmill at fixed speeds. Gait parameters were fed into a principal component analysis to delineate relevant features. We applied the neurite orientation dispersion and density imaging (NODDI) model on diffusion-weighted MR-images to calculate the free-water content as an advanced marker of microstructural integrity of the substantia nigra and tested its associations with gait parameters. RESULTS Patients showed increased duration of stance phase, load response, pre-swing, and double support time, as well as reduced duration of single support and swing time. Gait rhythmic alterations associated positively with the free-water content in the right substantia nigra in PD, indicating that patients with more severe neurodegeneration extend the duration of stance phase, load response, and pre-swing. CONCLUSION The results provide evidence that gait alterations are not merely a byproduct of bradykinesia-related reduced walking speed. The data-supported association between free-water and the rhythmic component highlights the potential of substantia nigra microstructure imaging as a measure of gait-dysfunction and disease-progression.
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Affiliation(s)
- Manuel Bange
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Nadine Sandra Claudia Lang
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hao Ding
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Angela Radetz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Damian Marc Herz
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- MRC Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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16
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Muthuraman M, Palotai M, Jávor-Duray B, Kelemen A, Koirala N, Halász L, Erőss L, Fekete G, Bognár L, Deuschl G, Tamás G. Frequency-specific network activity predicts bradykinesia severity in Parkinson's disease. Neuroimage Clin 2021; 32:102857. [PMID: 34662779 PMCID: PMC8526781 DOI: 10.1016/j.nicl.2021.102857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/15/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Bradykinesia has been associated with beta and gamma band interactions in the basal ganglia-thalamo-cortical circuit in Parkinson's disease. In this present cross-sectional study, we aimed to search for neural networks with electroencephalography whose frequency-specific actions may predict bradykinesia. METHODS Twenty Parkinsonian patients treated with bilateral subthalamic stimulation were first prescreened while we selected four levels of contralateral stimulation (0: OFF, 1-3: decreasing symptoms to ON state) individually, based on kinematics. In the screening period, we performed 64-channel electroencephalography measurements simultaneously with electromyography and motion detection during a resting state, finger tapping, hand grasping tasks, and pronation-supination of the arm, with the four levels of contralateral stimulation. We analyzed spectral power at the low (13-20 Hz) and high (21-30 Hz) beta frequency bands and low (31-60 Hz) and high (61-100 Hz) gamma frequency bands using the dynamic imaging of coherent sources. Structural equation modelling estimated causal relationships between the slope of changes in network beta and gamma activities and the slope of changes in bradykinesia measures. RESULTS Activity in different subnetworks, including predominantly the primary motor and premotor cortex, the subthalamic nucleus predicted the slopes in amplitude and speed while switching between stimulation levels. These subnetwork dynamics on their preferred frequencies predicted distinct types and parameters of the movement only on the contralateral side. DISCUSSION Concurrent subnetworks affected in bradykinesia and their activity changes in the different frequency bands are specific to the type and parameters of the movement; and the primary motor and premotor cortex are common nodes.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders, Imaging and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marcell Palotai
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Andrea Kelemen
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Nabin Koirala
- Movement Disorders, Imaging and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Haskins Laboratories, New Haven, USA
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Fekete
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary.
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17
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Ray S, Padmanabha H, Mahale R, Mailankody P, Arunachal G. DNAJC6 mutation causing cranial-onset dystonia with tremor dominant levodopa non-responsive parkinsonism: A novel phenotype. Parkinsonism Relat Disord 2021; 89:1-3. [PMID: 34175496 DOI: 10.1016/j.parkreldis.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
DNAJC6 mutation causes two types of phenotypes: slowly progressive parkinsonism with levodopa response and rapidly progressive parkinsonism with additional manifestations like intellectual disability, epilepsy etc. We report a new phenotype wherein an adolescent girl developed blepharospasm followed by jaw opening, lingual and cervical dystonia followed by tremors of limbs (rest and action) with rigidity, bradykinesia. The dystonia-parkinsonism phenotype has not been described. She had novel homozygous missense mutation in DNAJC6 gene.
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Affiliation(s)
| | | | - Rohan Mahale
- Department of Neurology, NIMHANS, Bengaluru, India.
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18
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Blakemore RL, Pascoe MJ, Horne KL, Livingston L, Young BN, Elias B, Goulden M, Grenfell S, Myall DJ, Pitcher TL, Dalrymple-Alford JC, Le Heron CJ, Anderson TJ, MacAskill MR. Higher perceived stress and exacerbated motor symptoms in Parkinson's disease during the COVID-19 lockdown in New Zealand. N Z Med J 2021; 134:44-51. [PMID: 34239144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS Stress plays a key role in Parkinson's disease (PD) by acting on the dopaminergic system and worsening patients' motor function. The impact of New Zealand's strict lockdown measures to contain COVID-19 on perceived stress and PD motor symptoms remains unknown. Here we examined the relationship between perceived levels of stress, changes in physical activity levels and PD motor symptoms during lockdown. METHODS During lockdown, 134 participants with PD and 49 controls completed a survey assessing perceived stress, self-reported changes in PD motor symptoms and physical activity duration and intensity prior to and during lockdown. RESULTS Perceived stress was higher in PD than controls, and in those reporting a worsening of tremor, balance/gait, dyskinesia and bradykinesia compared to those indicating no change during the COVID-19 lockdown. These effects were not modulated by physical activity. CONCLUSIONS Reducing stressors may be an important adjunct treatment strategy to improve motor function in PD.
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Affiliation(s)
- Rebekah L Blakemore
- PhD; New Zealand Brain Research Institute, Christchurch, New Zealand; School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, University of Otago, Dunedin, New Zealand
| | - Maddie J Pascoe
- BSc; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Kyla-Louise Horne
- PhD; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa Centre of Research Excellence
| | - Leslie Livingston
- BA (Hons); New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Bob N Young
- MSc; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Beth Elias
- MA; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Marie Goulden
- BN PGCert; New Zealand Brain Research Institute, Christchurch, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa Centre of Research Excellence
| | - Sophie Grenfell
- MSc; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Daniel J Myall
- PhD; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Toni L Pitcher
- New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa Centre of Research Excellence
| | - John C Dalrymple-Alford
- PhD; New Zealand Brain Research Institute, Christchurch, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa Centre of Research Excellence; School of Psychology, University of Canterbury, New Zealand
| | - Campbell J Le Heron
- FRACP, DPhil; Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Tim J Anderson
- FRACP, MD; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Michael R MacAskill
- PhD; Department of Medicine, University of Otago, Christchurch, New Zealand; Brain Research New Zealand - Rangahau Roro Aotearoa Centre of Research Excellence; Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
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19
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Anand V, Bilal E, Ho B, Rice JJ. Towards motor evaluation of Parkinson's Disease Patients using wearable inertial sensors. AMIA Annu Symp Proc 2021; 2020:203-212. [PMID: 33936392 PMCID: PMC8075509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parkinson's disease (PD) patients require frequent office visits where they are assessed for health state changes using Unified Parkinson's Disease Rating Scale (UPDRS). Inertial wearable sensor devices present a unique opportunity to supplement these assessments with continuous monitoring. In this work, we analyze kinematic features from sensor devices located on feet, wrists, lumbar and sternum for 35 PD subjects as they performed walk trials in two clinical visits, one for each of their self-reported ON and OFF motor states. Our results show that a few features related to subject's whole-body turns and pronation-supination motor events can accurately infer cardinal features of PD like bradykinesia and posture instability and gait disorder (PIGD). In addition, these features can be measured from only two sensors, one located on the affected wrist and one on the lumbar region, thus potentially reducing patient burden of wearing sensors while supporting continuous monitoring in out of office settings.
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Affiliation(s)
- Vibha Anand
- IBM T.J Watson Research Center, Cambridge, MA
| | - Erhan Bilal
- IBM T.J Watson Research Center, Yorktown, New York, New York
| | - Bryan Ho
- Department of Neurology, Tufts Medical Center, Boston, MA
| | - John J Rice
- IBM T.J Watson Research Center, Yorktown, New York, New York
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20
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Huang P, Chen X, Hu X, Zhou Q, Lin L, Jiang S, Fu H, Xiong Y, Zeng H, Fang M, Chen C, Deng Y. Experimentally Induced Sepsis Causes Extensive Hypomyelination in the Prefrontal Cortex and Hippocampus in Neonatal Rats. Neuromolecular Med 2020; 22:420-436. [PMID: 32638208 DOI: 10.1007/s12017-020-08602-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/17/2020] [Indexed: 02/05/2023]
Abstract
Neonatal sepsis is associated with cognitive deficit in the later life. Axonal myelination plays a pivotal role in neurotransmission and formation of learning and memory. This study aimed to explore if systemic lipopolysaccharide (LPS) injection would induce hypomyelination in the prefrontal cortex and hippocampus in developing septic neonatal rats. Sprague-Dawley rats (1-day old) were injected with LPS (1 mg/kg) intraperitoneally. By electron microscopy, axonal hypomyelination was evident in the subcortical white matter and hippocampus. The expression of myelin proteins including CNPase, MBP, PLP and MAG was downregulated in both areas of the brain at 7, 14 and 28 days after LPS injection. The frequency of MBP and PLP-positive oligodendrocyte was significantly reduced using in situ hybridization in the cerebral cortex and hippocampus at the corresponding time points after LPS injection, whereas the expression of NG2 and PDGFRα was noticeably increased. In tandem with this was reduction of Olig1 and Olig2 expressions which are involved in differentiation/maturation of OPCs. Expression of NFL, NFM, and NFH was significantly downregulated, indicating that axon development was disrupted after LPS injection. Morris Water Maze behavioral test, Open field test, Rotarod test, and Pole test were used to evaluate neurological behaviors of 28 days rats. The rats in the LPS group showed the impairment of motor coordination, balance, memory, and learning ability and represented bradykinesia and anxiety-like behavior. The present results suggest that following systemic LPS injection, differentiation/maturation of OPCs was affected which may be attributed to the inhibition of transcription factors Olig1 and Olig2 expression resulting in impairment to axonal development. It is suggested that this would ultimately lead to axonal hypomyelination in the prefrontal cortex and hippocampus, which may be associated with neurological deficits in later life.
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Affiliation(s)
- Peixian Huang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Xuan Chen
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
- Shantou University Medical College, Shantou, 515063, Guangdong, China
| | - Xiaoli Hu
- Department of Operative Dentistry and Endodontics, Guanghua School and Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, 510055, Guangdong, China
| | - Qiuping Zhou
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
- South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Lanfen Lin
- Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Shuqi Jiang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
- South China University of Technology, Guangzhou, 510641, Guangdong, China
| | - Hui Fu
- Wuhan University School of Basic Medical Sciences, Wuhan, 430072, Hubei, China
| | - Yajie Xiong
- Wuhan University School of Basic Medical Sciences, Wuhan, 430072, Hubei, China
| | - Hongke Zeng
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Ming Fang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Yiyu Deng
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.
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21
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Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Giulio Guagliumi
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Aurelio Sonzogni
- Pathology Unit(A.S.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Irene Pescetelli
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Dario Pellegrini
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
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Abstract
RATIONALE Methicillin-resistant Staphylococcus aureus (MRSA) has been established as an important cause of severe community-acquired pneumonia (CAP) with very high mortality. Panton-Valentine leukocidin (PVL) producing MRSA has been reported to be associated with necrotizing pneumonia and worse outcome. The incidence of community-acquired MRSA (CA-MRSA) pneumonia is very low, as only a few CA-MRSA pneumonia cases were reported in the last few years. We present a case of severe CAP caused by PVL-positive MRSA with ensuing septic shock. PATIENT CONCERNS A 68-year-old male with no concerning medical history had developed a fever that reached 39.0°C, a productive cough that was sustained for 5 days, and hypodynamia. He was treated with azithromycin and alexipyretic in a nearby clinic for 2 days in which the symptoms were alleviated. However, 1 day later, the symptoms worsened, and he was taken to a local Chinese medicine hospital for traditional medicine treatment. However, his clinical condition deteriorated rapidly, and he then developed dyspnea and hemoptysis. DIAGNOSIS CA-MRSA pneumonia and septic shock. The sputum culture showed MRSA. Polymerase chain reaction of MRSA isolates was positive for PVL genes. INTERVENTIONS Mechanical ventilation, fluid resuscitation, and antibiotic therapy were performed. Antibiotic therapy included mezlocillin sodium/sulbactam sodium, linezolid, and oseltamivir. OUTCOMES He died after 12 hours of treatment. LESSONS This is a report of severe pneumonia due to PVL-positive CA-MRSA in a healthy adult. CA-MRSA should be considered a pathogen of severe CAP, especially when combined with septic shock in previously healthy individuals.
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Affiliation(s)
- Huan Xia
- Department of Respiratory Medicine
| | | | - Ming Xiu
- Department of Intensive Care Unit Group One, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dan Li
- Department of Respiratory Medicine
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Di Lazzaro G, Ricci M, Al-Wardat M, Schirinzi T, Scalise S, Giannini F, Mercuri NB, Saggio G, Pisani A. Technology-Based Objective Measures Detect Subclinical Axial Signs in Untreated, de novo Parkinson's Disease. JPD 2020; 10:113-122. [PMID: 31594252 DOI: 10.3233/jpd-191758] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Technology-based objective measures (TOMs) recently gained relevance to support clinicians in the assessment of motor function in Parkinson's disease (PD), although limited data are available in the early phases. OBJECTIVE To assess motor performances of a population of newly diagnosed, drug free PD patients using wearable inertial sensors and to compare them to healthy controls (HC) and differentiate different PD subtypes [tremor dominant (TD), postural instability gait disability (PIGD), and mixed phenotype (MP)]. METHODS We enrolled 65 subjects, 36 newly diagnosed, drug-free PD patients and 29 HCs. PD patients were clinically defined as tremor dominant, postural instability-gait difficulties or mixed phenotype. All 65 subjects performed seven MDS-UPDRS III motor tasks wearing inertial sensors: rest tremor, postural tremor, rapid alternating hand movement, foot tapping, heel-to-toe tapping, Timed-Up-and-Go test (TUG) and pull test. The most relevant motor tasks were found combining ReliefF ranking and Kruskal- Wallis feature-selection methods. We used these features, linked to the relevant motor tasks, to highlight differences between PD from HC, by means of Support Vector Machine (SVM) classifier. Furthermore, we adopted SVM to support the relevance of each motor task on the classification accuracy, excluding one task at time. RESULTS Motion analysis distinguished PD from HC with an accuracy as high as 97%, based on SVM performed with measured features from tremor and bradykinesia items, pull test and TUG. Heel-to-toe test was the most relevant, followed by TUG and Pull Test. CONCLUSIONS In this pilot study, we demonstrate that the SVM algorithm successfully distinguishes de novo drug-free PD patients from HC. Surprisingly, pull test and TUG tests provided relevant features for obtaining high SVM classification accuracy, differing from the report of the experienced examiner. The use of TOMs may improve diagnostic accuracy for these patients.
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Affiliation(s)
- Giulia Di Lazzaro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariachiara Ricci
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Mohammad Al-Wardat
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simona Scalise
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Franco Giannini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Nicola B Mercuri
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, IRCCS, Rome, Italy
| | - Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, IRCCS, Rome, Italy
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Warabi T, Furuyama H, Kato M. Gait bradykinesia: difficulty in switching posture/gait measured by the anatomical y-axis vector of the sole in Parkinson's disease. Exp Brain Res 2019; 238:139-151. [PMID: 31822932 DOI: 10.1007/s00221-019-05704-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
This study in Parkinson's disease examined how spatiotemporal parameters in gait bradykinesia link to difficulty in terminating posture and initiating gait locomotion. 41 idiopathic Parkinson's disease patients and 15 age-matched healthy subjects participated in this study. After the patients fixated on a visual-fixation-target, gait was triggered by visual or vocal cue-stimulus. The LED instructed subjects to quickly achieve their own comfortable walking speed on a level floor. The posterior-anterior force of the y-axis vectors of sole relating to soleus and tibialis-anterior EMGs were examined. Step-gain was defined as the duration of the swing-phase relative that of the contralateral stance-phase. Dynamic-ratio was defined as the duration the fore-foot phase relative to that of the ipsilateral stance-phase as forward-oriented movement in each step. The pause in tonic soleus EMG was defined as the off-latency of posture (termination) and the onset of a tibialis-anterior EMG-burst as the on-latency of gait. In Parkinson's disease, soleus off-latencies were prolonged, whereas tibialis-anterior on-latencies were less prolonged. Unsynchronized off/on-latency differences correlated with spatiotemporal parameters of dynamic-ratios, step-gains, gait-initiation, and gait speed in gait bradykinesia. Delayed EMG off-latencies correlated with prolonged motor-latencies in gait bradykinesia as delayed initial backward body-shift. A delayed and deficient initial backward body-shift of y-axis vector was linked to each difficulty in terminating posture and initiating gait, changing to random gait akinesia. Gait bradykinesia in Parkinson's disease stemmed from unsynchronized off/on-latency EMG activities, linking to each difficulty in terminating posture and initiating gait synergic movement through an initial backward body-shift.
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Affiliation(s)
- Tateo Warabi
- Clinical Brain Research Laboratory, Department of Neurology, Toyokura Memorial Hall, Sapporo Yamanoue Hospital, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan.
| | - Hiroyasu Furuyama
- Clinical Brain Research Laboratory, Department of Neurology, Toyokura Memorial Hall, Sapporo Yamanoue Hospital, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan
| | - Masamichi Kato
- Clinical Brain Research Laboratory, Department of Neurology, Toyokura Memorial Hall, Sapporo Yamanoue Hospital, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan
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25
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Qin L, Chen Z, Yang L, Shi H, Wu H, Zhang B, Zhang W, Xu Q, Huang F, Wu X. Luteolin-7-O-glucoside protects dopaminergic neurons by activating estrogen-receptor-mediated signaling pathway in MPTP-induced mice. Toxicology 2019; 426:152256. [PMID: 31381935 DOI: 10.1016/j.tox.2019.152256] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/23/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that is characterized by the degeneration of dopaminergic neurons in substantia nigra (SN). Accumulating evidences implicate the beneficial role of estrogen in the therapy of PD. METHODS In the present study, the protective function of luteolin-7-O-glucoside (LUT-7G), a natural flavonoid, was investigated in 1-methyl-4-phenylpyridinium (MPP+) treated SH-SY5Y cells and 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) induced mice. RESULTS Pre-treatment of LUT-7G increased the viability and reduced the apoptosis of SH-SY5Y cells treated by MPP+. At molecular level, the Bcl-2/Bax ratio was increased, while the expression of cleaved caspase 3 was markedly lessened. Moreover, LUT-7G increased the expression of estrogen receptor (ER), ERα and ERβ, and enhanced the activation of ERK1/2/STAT3/c-Fos that could be abolished by ER antagonists. Furthermore, in vivo experiment indicated that pre-treatment of LUT-7G improved the bradykinesia, and enhanced the muscle strength as well as the balancing capacity of mice treated with MPTP. And LUT-7G prevented the injury of TH positive cells in substantia nigra and increased TH positive nerve fibers in striatum. In addition, pre-treatment of LUT-7G also significantly diminished the MPTP-induced gliosis in substantia nigra. CONCLUSIONS LUT-7G effectively protected dopaminergic neurons against MPP+ or MPTP-induced toxicity, probably by activating the ER-mediated signaling pathway. Our findings explore the therapeutic potential of LUT-7G for PD therapy.
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Affiliation(s)
- Liyue Qin
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziyu Chen
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu Yang
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hailian Shi
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wu
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Beibei Zhang
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weiqi Zhang
- Laboratory of Molecular Psychiatry, Department of Psychiatry, University of Münster, Münster, Germany
| | - Qi Xu
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Huang
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Xiaojun Wu
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Center for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Liu Y, Chen J, Hu C, Ma Y, Ge D, Miao S, Xue Y, Li L. Vision-Based Method for Automatic Quantification of Parkinsonian Bradykinesia. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1952-1961. [PMID: 31502982 DOI: 10.1109/tnsre.2019.2939596] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Non-volitional discontinuation of motion, namely bradykinesia, is a common motor symptom among patients with Parkinson's disease (PD). Evaluating bradykinesia severity is an important part of clinical examinations on PD patients in both diagnosis and monitoring phases. However, subjective evaluations from different clinicians often show low consistency. The research works that explore objective quantification of bradykinesia are mostly based on highly-integrated sensors. Although these sensor-based methods demonstrate applaudable performance, it is unrealistic to promote them for wide use because the special devices they require are far from popularized in daily lives. In this paper, we take advantage of computer vision and machine learning technologies, proposing a vision-based method to automatically and objectively quantify bradykinesia severity. Three bradykinesia-related items are investigated in our study: finger tapping, hand clasping and hand pro/supination. In our method, human pose estimation technology is utilized to extract kinematic characteristics and supervised-learning-based classifiers are employed to generate score ratings. Clinical experiment on 60 patients shows that the scoring accuracy of our method over 360 examination videos is 89.7%, which is competitive with other related works. The devices our method requires are only a camera for instrumentation and a laptop for data processing. Therefore, our method can produce reliable assessment results on Parkinsonian bradykinesia with minimal device requirement, showing great potential of realizing long-term remote monitoring on patients' condition.
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27
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Del Felice A, Castiglia L, Formaggio E, Cattelan M, Scarpa B, Manganotti P, Tenconi E, Masiero S. Personalized transcranial alternating current stimulation (tACS) and physical therapy to treat motor and cognitive symptoms in Parkinson's disease: A randomized cross-over trial. Neuroimage Clin 2019; 22:101768. [PMID: 30921609 PMCID: PMC6439208 DOI: 10.1016/j.nicl.2019.101768] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/22/2019] [Accepted: 03/10/2019] [Indexed: 02/06/2023]
Abstract
Abnormal cortical oscillations are markers of Parkinson's Disease (PD). Transcranial alternating current stimulation (tACS) can modulate brain oscillations and possibly impact on behaviour. Mapping of cortical activity (prevalent oscillatory frequency and topographic scalp distribution) may provide a personalized neurotherapeutic target and guide non-invasive brain stimulation. This is a cross-over, double blinded, randomized trial. Electroencephalogram (EEG) from participants with PD referred to Specialist Clinic, University Hospital, were recorded. TACS frequency and electrode position were individually defined based on statistical comparison of EEG power spectra maps with normative data from our laboratory. Stimulation frequency was set according to the EEG band displaying higher power spectra (with beta excess on EEG map, tACS was set at 4 Hz; with theta excess, tACS was set at 30 Hz). Participants were randomized to tACS or random noise stimulation (RNS), 5 days/week for 2-weeks followed by ad hoc physical therapy. EEG, motor (Unified Parkinson's Disease Rating Scale-motor: UPDRS III), neuropsychological (frontal, executive and memory tests) performance and mood were measured before (T0), after (T1) and 4-weeks after treatment (T2). A linear model with random effects and Wilcoxon test were used to detect differences. Main results include a reduction of beta rhythm in theta-tACS vs. RNS group at T1 over right sensorimotor area (p = .014) and left parietal area (p = .010) and at T2 over right sensorimotor area (p = .004) and left frontal area (p = .039). Bradykinesia items improved at T1 (p = .002) and T2 (p = .047) compared to T0 in the tACS group. In the tACS group the Montréal Cognitive Assessment (MoCA) improved at T2 compared with T1 (p = .049). Individualized tACS in PD improves motor and cognitive performance. These changes are associated with a reduction of excessive fast EEG oscillations.
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Affiliation(s)
- Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani 3, 35128 Padova, Italy.
| | - Leonora Castiglia
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani 3, 35128 Padova, Italy.
| | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani 3, 35128 Padova, Italy.
| | - Manuela Cattelan
- Department of Statistical Sciences, University of Padova, via C. Battisti 241, 35121 Padova, Italy.
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, via C. Battisti 241, 35121 Padova, Italy.
| | - Paolo Manganotti
- Neurology Section, Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
| | - Elena Tenconi
- Department of Neuroscience, Psychiatric Clinic, University of Padova, Via Giustiniani 3, 35128 Padova, Italy.
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani 3, 35128 Padova, Italy.
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Abstract
The diagnosis of Parkinson disease (PD) is based on the presence of bradykinesia and either resting tremor or rigidity and there should be no features from the history or examination to suggest an alternative cause of parkinsonism. In addition to the motor manifestations of PD, there is a long list of nonmotor symptoms, several of which occur before motor signs and are considered "prodromal" PD. These are classified as neuropsychiatric, autonomic, sleep, and sensory. There are many medical options for the treatment of PD but levodopa remains the mainstay. Deep brain stimulation and other advanced therapies are also available.
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Affiliation(s)
- Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street, 3rd Floor, Baltimore, MD 21201, USA.
| | - Joseph M Savitt
- Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street, 3rd Floor, Baltimore, MD 21201, USA
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Abstract
Despite the clinical impact of motor symptoms such as agitation or retardation on the course of depression, these symptoms are poorly understood. Novel developments in the field of instrumentation and mobile devices allow for dimensional and continuous recording of motor behavior in various settings, particularly outside the laboratory. Likewise, the use of novel assessments enables to combine multimodal neuroimaging with behavioral measures in order to investigate the neural correlates of motor dysfunction in depression. The research domain criteria (RDoC) framework will soon include a motor domain that will provide a framework for studying motor dysfunction in mood disorders. In addition, new studies within this framework will allow investigators to study motor symptoms across different stages of depression as well as other psychiatric diagnoses. Finally, the introduction of the RDoC motor domain will help test how motor symptoms integrate with the original five RDoC domains (negative valence, positive valence, cognitive, social processes, and arousal/regulation).
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Affiliation(s)
- S Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern,Bern,Switzerland
| | - J A Bernard
- Department of Psychological and Brain Sciences,Texas A&M Institute for Neuroscience, Texas A & M University,College Station, TX,USA
| | - V A Mittal
- Department of Psychology, Department of Psychiatry,Northwestern University,Evanston, IL,USA
| | - S A Shankman
- Department of Psychiatry,Northwestern University,Evanston, IL,USA
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Ohara N, Hirokawa M, Kobayashi M, Ikeda Y, Yoneoka Y, Seki Y, Akiyama K, Tani T, Terajima K, Ozawa T. Reversible Non-parkinsonian Bradykinesia with Impaired Frontal Lobe Function as the Predominant Manifestation of Adrenal Insufficiency. Intern Med 2018; 57:3399-3406. [PMID: 30101905 PMCID: PMC6306535 DOI: 10.2169/internalmedicine.1101-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 69-year-old Japanese man with a history of suprasellar surgery and irradiation developed bradykinesia and mild fatigue without muscle weakness, myalgia, pyramidal or extrapyramidal signs, parkinsonian symptoms, or ataxia. An endocrinological work-up revealed anterior hypopituitarism associated with secondary adrenal insufficiency. Higher brain function tests indicated an impaired frontal lobe function. The patient's bradykinesia, fatigue, and frontal lobe dysfunction improved within 2 weeks after the initiation of corticosteroid replacement therapy. To our knowledge, this is the first reported case of adrenal insufficiency manifesting as non-parkinsonian bradykinesia. Physicians should consider reversible non-parkinsonian bradykinesia associated with frontal lobe dysfunction as an unusual manifestation of adrenal insufficiency.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Mayuko Hirokawa
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Michi Kobayashi
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Yohei Ikeda
- Department of Radiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Takashi Tani
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Kenshi Terajima
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Tetsutaro Ozawa
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
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31
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Lee SH, Lee MJ, Lyoo CH, Cho H, Lee MS. Impaired finger dexterity and nigrostriatal dopamine loss in Parkinson's disease. J Neural Transm (Vienna) 2018; 125:1333-1339. [PMID: 29971496 DOI: 10.1007/s00702-018-1901-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/29/2018] [Indexed: 11/28/2022]
Abstract
Impaired finger dexterity occurs in Parkinson's disease (PD) and has been considered a limb-kinetic apraxia associated with primary sensory cortical dysfunction. To study the role of nigrostriatal dopamine loss and elementary parkinsonian motor deficits in impaired finger dexterity of PD. Thirty-two right-handed untreated PD patients and 30 right-handed healthy controls were included. All patients underwent [18F] FP-CIT positron emission tomography studies. We examined the associations among unilateral coin rotation (CR) score, Unified Parkinson's Disease Rating Scale (UPDRS) subscores for bradykinesia and rigidity of the corresponding arm, and contralateral regional striatal dopamine transporter (DAT) uptake. We also measured the effect of oral levodopa dose on CR scores and UPDRS subscores. PD patients performed worse than controls on the CR task. Unilateral arm UPDRS bradykinesia scores were associated with DAT uptake in the contralateral putamen. The left CR score was associated with left arm bradykinesia and rigidity scores and DAT uptake in the right posterior putamen, whereas no such associations were found for the right CR score. There was a significant effect of handedness on the association of putamen DAT uptake with CR scores, but not with UPDRS subscores. An oral levodopa challenge improved CR scores and UPDRS subscores on both sides. Impaired finger dexterity in PD is related to elementary parkinsonian motor deficits and nigrostriatal dopamine loss. Impaired dominant hand dexterity associated with nigrostriatal dopamine loss seems to be compensated to some extent by the dominant cerebral cortex specialized for controlling precise finger movements.
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Affiliation(s)
- S H Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M J Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - C H Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - H Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea
| | - M S Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonjuro 211, Gangnam-gu, Seoul, South Korea.
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Galazky I, Kaufmann J, Lorenzl S, Ebersbach G, Gandor F, Zaehle T, Specht S, Stallforth S, Sobieray U, Wirkus E, Casjens F, Heinze HJ, Kupsch A, Voges J. Deep brain stimulation of the pedunculopontine nucleus for treatment of gait and balance disorder in progressive supranuclear palsy: Effects of frequency modulations and clinical outcome. Parkinsonism Relat Disord 2018; 50:81-86. [PMID: 29503154 DOI: 10.1016/j.parkreldis.2018.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/08/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Imke Galazky
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Clinic and Policlinic for Palliative Care, Klinikum der Universität München, Ludwig Maximilians University, Munich, Germany; Department of Neurology, Agatharied University Hospital, Hausham, Germany
| | - Georg Ebersbach
- Neurological Specialist Hospital for Movement Disorders/Parkinson, Beelitz-Heilstätten, Germany
| | - Florin Gandor
- Neurological Specialist Hospital for Movement Disorders/Parkinson, Beelitz-Heilstätten, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sylke Specht
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sabine Stallforth
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Uwe Sobieray
- German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Edyta Wirkus
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Franziska Casjens
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Behavioural Neurology, Leibniz Institute of Neurobiology, Brenneckestr. 6, 39120 Magdeburg, Germany
| | - Andreas Kupsch
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; NEUROLOGY MOVES, Academic Neurological Practice, Bismarckstrasse 45-47, 10627 Berlin, Germany
| | - Jürgen Voges
- German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Behavioural Neurology, Leibniz Institute of Neurobiology, Brenneckestr. 6, 39120 Magdeburg, Germany; Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
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Garcia-Ruiz PJ, Feliz-Feliz CE, Maycas-Cepeda T, Del Val-Fernandez J. [Amimia in Parkinson's disease. Significance and correlation with the clinical features]. Rev Neurol 2018; 66:45-48. [PMID: 29323400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Reduced facial expression or amimia is one of the most typical characteristics of Parkinson's disease (PD). Despite being described in classic texts, its significance, physiopathology and correlation with motor and non-motor symptoms is largely unknown. PATIENTS AND METHODS We have studied facial bradykinesia in a group of 84 de novo PD patients prospectively evaluated for five years. We also studied the relationship of facial bradykinesia with depression in a subgroup of 30 patients. RESULTS Baseline and follow-up assessments were performed with the Unified Parkinson's Disease Rating Scale (UPDRS). Baseline facial bradykinesia was rated according to item 19 of UPDRS. Baseline facial bradykinesia correlated with total and motor baseline UPDRS. In addition, baseline bradykinesia correlated with total and motor UPDRS at five years. However baseline bradykinesia did not influence the presence of motor (motor fluctuation, dyskinesias and freezing of gait) or non-motor complications (delusion, behavior abnormalities and dementia) at five years. Finally a subgroup of 30 patients completed the self-report version of the Quick Inventory of Depressive Symptoms (QIDS-SR16) questionnaire, facial bradykinesia did not correlate with QIDS-SR16 scores. CONCLUSION Our study suggests that baseline facial bradykinesia correlates with general baseline situation in PD and even might predict the motor and functional status at five years.
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Mota IA, Coriolano MDG, Lins OG. Bereitschaftspotential preceding eyelid blinks in Parkinson's disease. Arq Neuropsiquiatr 2017; 75:539-545. [PMID: 28813084 DOI: 10.1590/0004-282x20170109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Abstract
METHODS Ten PD patients in stages 1 and 2 of the Hoehn & Yahr classification were compared to 18 healthy controls. Artifact-free EEG segments of two seconds preceding the onset of the blink potential were averaged and analyzed, and the statistical significance of the measured amplitudes were evaluated by analysis of variance models. RESULTS The presence of a BP in the PD patients was demonstrated. The mean amplitudes at 0 ms were respectively 0.6 µV and 3.3 µV for the BP patients and the normal controls, respectively. CONCLUSIONS The BP amplitudes were significantly smaller in PD patients than normal participants. The amplitudes of the BP were not modified by levodopa.
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Affiliation(s)
- Isabella Araújo Mota
- Hospital Universitário Lauro Wanderley, Ambulatório de Neurologia, João Pessoa PB, Brasil
| | | | - Otávio Gomes Lins
- Universidade Federal de Pernambuco, Departamento de Neuropsiquiatria, Recife PE, Brasil
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Yunusova Y, Kearney E, Kulkarni M, Haworth B, Baljko M, Faloutsos P. Game-Based Augmented Visual Feedback for Enlarging Speech Movements in Parkinson's Disease. J Speech Lang Hear Res 2017; 60:1818-1825. [PMID: 28655041 DOI: 10.1044/2017_jslhr-s-16-0233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/08/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this pilot study was to demonstrate the effect of augmented visual feedback on acquisition and short-term retention of a relatively simple instruction to increase movement amplitude during speaking tasks in patients with dysarthria due to Parkinson's disease (PD). METHOD Nine patients diagnosed with PD, hypokinetic dysarthria, and impaired speech intelligibility participated in a training program aimed at increasing the size of their articulatory (tongue) movements during sentences. Two sessions were conducted: a baseline and training session, followed by a retention session 48 hr later. At baseline, sentences were produced at normal, loud, and clear speaking conditions. Game-based visual feedback regarding the size of the articulatory working space (AWS) was presented during training. RESULTS Eight of nine participants benefited from training, increasing their sentence AWS to a greater degree following feedback as compared with the baseline loud and clear conditions. The majority of participants were able to demonstrate the learned skill at the retention session. CONCLUSIONS This study demonstrated the feasibility of augmented visual feedback via articulatory kinematics for training movement enlargement in patients with hypokinesia due to PD. SUPPLEMENTAL MATERIALS https://doi.org/10.23641/asha.5116840.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, CanadaSunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Ontario, CanadaUniversity Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Elaine Kearney
- Department of Speech-Language Pathology, University of Toronto, Ontario, CanadaUniversity Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Madhura Kulkarni
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Ontario, CanadaUniversity Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Brandon Haworth
- University Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Electrical Engineering & Computer Science, York University, Toronto, Ontario, Canada
| | - Melanie Baljko
- University Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Electrical Engineering & Computer Science, York University, Toronto, Ontario, Canada
| | - Petros Faloutsos
- University Health Network: Toronto Rehabilitation Institute, Toronto, Ontario, CanadaDepartment of Electrical Engineering & Computer Science, York University, Toronto, Ontario, Canada
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Abstract
The clinical diagnosis of Parkinson's disease (PD) is centered on a specific motor syndrome that is characterized by the presence of bradykinesia, plus rest tremor, muscle rigidity, or both. Recently, novel criteria for diagnosing PD have been released that rehearse the motor syndrome as the core feature of PD. Beyond these three main symptoms, other motor features might be present in PD including gait difficulties and postural instability. Moreover, patients with PD usually develop motor complications 5-10 years into their disease. These motor complications are the strongest predictor of PD pathology and are in fact used clinically to support the diagnosis. Ancillary investigations are usually of little utility and to perform only in selected cases, which remarks the importance of the clinical examination for making the diagnosis of PD or suspect other condition that can be masquerading it.
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Affiliation(s)
- Roberto Erro
- Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy; Institute of Neurology, UCL, London, United Kingdom.
| | - Maria Stamelou
- University of Athens Medical School, Hospital Attikon, Athens, Greece; HYGEIA Hospital, Athens, Greece; Philipps University, Marburg, Germany
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Abstract
INTRODUCTION This review on micrographia aims to draw the clinician's attention to non-Parkinsonian etiologies, provide clues to differential diagnosis, and summarize current knowledge on the phenomenology, etiology, and mechanisms underlying micrographia. METHODS A systematic review of the existing literature was performed. RESULTS Micrographia, namely small sized handwriting has long been attributed to Parkinson's disease. However, it has often been observed as part of the clinical picture of additional neurodegenerative disorders, sometimes antedating the motor signs, or following focal basal ganglia lesions without any accompanying parkinsonism, suggesting that bradykinesia and rigidity are not sine-qua-non for the development of this phenomenon. Therefore, micrographia in a patient with no signs of parkinsonism may prompt the clinician to perform imaging in order to exclude a focal basal ganglia lesion. Dopaminergic etiology in this and other cases is doubtful, since levodopa ameliorates letter stroke size only partially, and only in some patients. Parkinsonian handwriting is often characterized by lack of fluency, slowness, and less frequently by micrographia. Deviations from kinematic laws of motion that govern normal movement, including the lack of movement smoothness and inability to scale movement amplitude to the desired size, may reflect impairments in motion planning, possible loss of automaticity and reduced movement vigor. CONCLUSIONS The etiology, neuroanatomy, mechanisms and models of micrographia are discussed. Dysfunction of the basal ganglia circuitry induced by neurodegeneration or disruption by focal damage give rise to micrographia.
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Affiliation(s)
- Rivka Inzelberg
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Meir Plotnik
- Department of Pharmacology and Physiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel; Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
| | - Naama Kadmon Harpaz
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
| | - Tamar Flash
- Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel.
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Tosto G, Monsell SE, Hawes SE, Mayeux R. Pattern of extrapyramidal signs in Alzheimer's disease. J Neurol 2015; 262:2548-56. [PMID: 26338814 PMCID: PMC4776751 DOI: 10.1007/s00415-015-7886-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
Patients with Alzheimer's disease (AD) often develop extrapyramidal signs (EPS), which increase in frequency as the disease progresses. We aimed to investigate the patterns of presentation of EPS in AD and their correlation with clinical and neuropathological features. 4284 subjects diagnosed with AD from the National Alzheimer's Coordinating Center (NACC) database with at least one abnormal Unified Parkinson's Disease Rating Scale (UPDRS) assessment were included. Individuals were assigned to a discovery sample and a sensitivity analysis sample (moderate and mild dementia, respectively) and a subset of subjects provided neuropathological data (n = 284). Individuals from the Washington Heights and Inwood Columbia Aging Project (WHICAP) served as validation sample. Patterns of presentation of EPS were identified employing categorical principal component analysis (CATPCA). Six principal components were identified in both mild and moderate AD samples: (I) hand movements, alternating movements, finger tapping, leg agility ("limbs bradykinesia"); (II) posture, postural instability, arising from chair, gait and body bradykinesia/hypokinesia ("axial"); (III) limb rigidity ("rigidity"); (IV) postural tremor; (V) resting tremor; (VI) speech and facial expression. Similar results were obtained in the WHICAP cohort. Individuals with hallucinations, apathy, aberrant night behaviors and more severe dementia showed higher axial and limb bradykinesia scores. "Limb bradykinesia" component was associated with a neuropathological diagnosis of Lewy body disease and "axial" component with reduced AD-type pathology. Patterns of EPS in AD show distinct clinical and neuropathological correlates; they share a pattern of presentation similar to that seen in Parkinson's disease, suggesting common pathogenic mechanisms across neurodegenerative diseases.
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Affiliation(s)
- Giuseppe Tosto
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sarah E Monsell
- National Alzheimer's Coordinating Center, University of Washington, Seattle, USA
| | - Stephen E Hawes
- National Alzheimer's Coordinating Center, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Richard Mayeux
- The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
- Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA.
- , 630 W. 168th St., P&S Box 16, New York, NY, 10032, USA.
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Abstract
Background:Age-related brain changes may contribute to axial features in Parkinson's disease (PD).Objectives:To determine if ventricular volume and white matter high signal changes (WMC) are related to motor signs in PD and controls independent of age.Methods:Patients were rated with the Unified Parkinson's Disease Rating Scale (subscore A: tremor, rigidity, bradykinesia, and facial expression; subscore B: speech and axial impairment). Steps and time taken to walk 9.144 meters were measured. Total ventricular volume (TVV) and intracranial volume (ICV) were measured on T1-weighted MRI using manual tracing software. WMC were rated on axial T2-weighted, dual-echo or FLAIR MR images using a visual scale.Results:TVV (cm3) (PD: 36.48 ± 15.93; controls: 32.16 ± 14.20, p = 0.21) and WMC did not differ between groups (PD: 3.7 ± 4.2; controls: 3.2 ± 3.1, p = 0.55). Age correlated positively with ICV-corrected TVV and WMC in PD (cTVV: r = 0.48, p = 0.003; WMC: r=0.42, p=0.01) and controls (cTVV: r = 0.31, p = 0.04; WMC: r=0.44, p=0.003). Subscore B (r = 0.42, p = 0.01) but not subscore A (r = 0.25, p = 0.14) correlated with cTVV in PD. Steps and walking time correlated with cTVV and WMC in PD; cadence correlated with cTVV and steps with WMC in controls. Age-adjustment eliminated correlations.Conclusion:Subscore B, but not subscore A correlated positively with ventricular volume in PD, though this association was accounted for by age. Age-related brain change super-imposed on PD may contribute to axial features.
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Affiliation(s)
- Hernish J Acharya
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
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Smits EJ, Tolonen AJ, Cluitmans L, van Gils M, Conway BA, Zietsma RC, Leenders KL, Maurits NM. Standardized handwriting to assess bradykinesia, micrographia and tremor in Parkinson's disease. PLoS One 2014; 9:e97614. [PMID: 24854199 PMCID: PMC4031150 DOI: 10.1371/journal.pone.0097614] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To assess whether standardized handwriting can provide quantitative measures to distinguish patients diagnosed with Parkinson's disease from age- and gender-matched healthy control participants. Design Exploratory study. Pen tip trajectories were recorded during circle, spiral and line drawing and repeated character ‘elelelel’ and sentence writing, performed by Parkinson patients and healthy control participants. Parkinson patients were tested after overnight withdrawal of anti-Parkinsonian medication. Setting University Medical Center Groningen, tertiary care, the Netherlands. Participants Patients with Parkinson's disease (n = 10; mean age 69.0 years; 6 male) and healthy controls (n = 10; mean age 68.1 years; 6 male). Interventions Not applicable. Main Outcome Measures Movement time and velocity to detect bradykinesia and the size of writing to detect micrographia. A rest recording to investigate the presence of a rest-tremor, by frequency analysis. Results Mean disease duration in the Parkinson group was 4.4 years and the patients were in modified Hoehn-Yahr stages 1–2.5. In general, Parkinson patients were slower than healthy control participants. Median time per repetition, median velocity and median acceleration of the sentence task and median velocity of the elel task differed significantly between Parkinson patients and healthy control participants (all p<0.0014). Parkinson patients also wrote smaller than healthy control participants and the width of the ‘e’ in the elel task was significantly smaller in Parkinson patients compared to healthy control participants (p<0.0014). A rest-tremor was detected in the three patients who were clinically assessed as having rest-tremor. Conclusions This study shows that standardized handwriting can provide objective measures for bradykinesia, tremor and micrographia to distinguish Parkinson patients from healthy control participants.
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Affiliation(s)
- Esther J. Smits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | | | - Luc Cluitmans
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Bernard A. Conway
- The Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | | | - Klaus L. Leenders
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
PURPOSE OF REVIEW The different parkinsonian conditions can be challenging to separate clinically. This review highlights the important clinical features that guide the diagnosis of Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD). Strategies for treatment and disease management are also discussed. RECENT FINDINGS Over the past decade there has been an increasing recognition of the broad clinical presentations of the neurodegenerative forms of parkinsonism. Nonmotor symptoms in these diseases, including psychiatric, cognitive, autonomic, and gastrointestinal dysfunction, appear to have a major impact on quality of life and disability. PSP and CBD are now considered pathologic diagnoses, with several different and varied clinical phenotypes, that overlap and share features with PD and frontotemporal dementia syndromes. PD is distinguished by its excellent response to dopaminergic medications that is maintained over many years, in contrast to the response seen in patients with MSA and PSP. New diagnostic criteria have been proposed for CBD. No new therapeutic interventions have emerged for PSP, MSA, or CBD. Infusional therapies and deep brain stimulation surgery are established therapies for advanced PD. SUMMARY The "parkinsonian syndromes" encompass a number of nosologic entities that are grouped together on the basis of their shared clinical features but are separated on the basis of their different pathologies. Overall, the consideration of clinical signs, mode of disease onset, and nature of disease progression are all important to make a timely and definitive diagnosis.
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Kojovic M, Mir P, Trender-Gerhard I, Schneider SA, Pareés I, Edwards MJ, Bhatia KP, Jahanshahi M. Motivational modulation of bradykinesia in Parkinson's disease off and on dopaminergic medication. J Neurol 2014; 261:1080-9. [PMID: 24687892 PMCID: PMC4057625 DOI: 10.1007/s00415-014-7315-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/27/2014] [Accepted: 03/12/2014] [Indexed: 11/27/2022]
Abstract
Motivational influence on bradykinesia in Parkinson’s disease may be observed in situations of emotional and physical stress, a phenomenon known as paradoxical kinesis. However, little is known about motivational modulation of movement speed beyond these extreme circumstances. In particular, it is not known if motivational factors affect movement speed by improving movement preparation/initiation or execution (or both) and how this effect relates to the patients’ medication state. In the present study, we tested if provision of motivational incentive through monetary reward would speed-up movement initiation and/or execution in Parkinson’s disease patients and if this effect depended on dopaminergic medication. We studied the effect of monetary incentive on simple reaction time in 11 Parkinson’s disease patients both “off” and “on” dopaminergic medication and in 11 healthy participants. The simple reaction time task was performed across unrewarded and rewarded blocks. The initiation time and movement time were quantified separately. Anticipation errors and long responses were also recorded. The prospect of reward improved initiation times in Parkinson’s disease patients both “off” and “on” dopaminergic medication, to a similar extent as in healthy participants. However, for “off” medication, this improvement was associated with increased frequency of anticipation errors, which were eliminated by dopamine replacement. Dopamine replacement had an additional, albeit small effect, on reward-related improvement of movement execution. Motivational strategies are helpful in overcoming bradykinesia in Parkinson’s disease. Motivational factors may have a greater effect on bradykinesia when patients are “on” medication, as dopamine appears to be required for overcoming speed-accuracy trade-off and for improvement of movement execution. Thus, medication status should be an important consideration in movement rehabilitation programmes for patients with Parkinson’s disease.
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Affiliation(s)
- Maja Kojovic
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
- Department of Neurology, University of Ljubljana, Ljubljana, Slovenia
| | - Pablo Mir
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, CIBERNED, Seville, Spain
| | - Iris Trender-Gerhard
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
- Genetic Medicine Department, University of Manchester, Manchester, UK
| | - Susanne A. Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Isabel Pareés
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
| | - Mark J. Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG UK
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Vitório R, Lirani-Silva E, Baptista AM, Barbieri FA, dos Santos PCR, Teixeira-Arroyo C, Gobbi LTB. Disease severity affects obstacle crossing in people with Parkinson's disease. Gait Posture 2014; 40:266-9. [PMID: 24671005 DOI: 10.1016/j.gaitpost.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 02/21/2014] [Accepted: 03/03/2014] [Indexed: 02/02/2023]
Abstract
The current study evaluated the effects of disease severity on the control of obstacle crossing in people with idiopathic Parkinson's disease (PD). Forty-five subjects participated in the study, including 15 patients with mild PD (classified as stage 1 to 1.5 of the Hoehn and Yahr Rating Scale), 15 patients with moderate PD (classified as stage 2 to 3 of the Hoehn and Yahr Rating Scale), and 15 neurologically healthy individuals. Groups were matched by sex, age, body mass, and body height. The obstacle crossing task required participants to walk along a pathway and step over an obstacle (half of the knee height, positioned in the middle of the pathway). Patients were tested in a typically medicated state. Kinematic data were recorded using an optoelectronic tridimensional system. The outcome measures included spatiotemporal measures of obstacle avoidance. There were no significant differences between patients with mild PD and healthy individuals. Patients with moderate PD exhibited shorter distances for leading toe clearance and leading foot placement after the obstacle than did healthy individuals. Patients with moderate PD tended to exhibit a lower leading horizontal mean velocity during obstacle crossing than did healthy individuals. We found significant negative relationships between obstacle crossing measures and disease severity (score on the motor section of the Unified Parkinson's Disease Rating Scale). These findings suggest that disease severity affects locomotor behavior during obstacle crossing in PD. Specifically, obstacle avoidance was not affected in the early stages of PD; however, bradykinesia and hypometria influenced obstacle crossing in patients with moderate PD.
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Affiliation(s)
- Rodrigo Vitório
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil.
| | - Ellen Lirani-Silva
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | - André Macari Baptista
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | - Fabio Augusto Barbieri
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | | | - Claudia Teixeira-Arroyo
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil; Centro Universitário UNIFAFIBE, 325 Prof. Orlando França de Carvalho Street, Bebedouro, São Paulo State 14701-070, Brazil
| | - Lilian Teresa Bucken Gobbi
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
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Allali G, Verghese J, Mahoney JR. Contributions of mild parkinsonian signs to gait performance in the elderly. Age (Dordr) 2014; 36:9678. [PMID: 24981115 PMCID: PMC4150913 DOI: 10.1007/s11357-014-9678-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/18/2014] [Indexed: 05/20/2023]
Abstract
Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in non-demented community-dwelling older adults without idiopathic Parkinson's disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44 ± 6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β = .20, p < .01) was associated with bradykinesia, whereas cardiovascular disease (β = .15, p < .05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.
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Affiliation(s)
- Gilles Allali
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
- />Department of Clinical Neurosciences, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Joe Verghese
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
| | - Jeannette R. Mahoney
- />Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY USA
- />Albert Einstein College of Medicine, Yeshiva University, 1165 Morris Park Avenue, Room 304, Bronx, NY 10461 USA
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Sundal C, Fujioka S, Van Gerpen JA, Wider C, Nicholson AM, Baker M, Shuster EA, Aasly J, Spina S, Ghetti B, Roeber S, Garbern J, Tselis A, Swerdlow RH, Miller BB, Borjesson-Hanson A, Uitti RJ, Ross O, Stoessl JA, Rademakers R, Josephs KA, Dickson DW, Broderick D, Wszolek ZK. Parkinsonian features in hereditary diffuse leukoencephalopathy with spheroids (HDLS) and CSF1R mutations. Parkinsonism Relat Disord 2013; 19:869-77. [PMID: 23787135 PMCID: PMC3977389 DOI: 10.1016/j.parkreldis.2013.05.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 04/24/2013] [Accepted: 05/06/2013] [Indexed: 12/12/2022]
Abstract
Atypical Parkinsonism associated with white matter pathology has been described in cerebrovascular diseases, mitochondrial cytopathies, osmotic demyelinating disorders, leukoencephalopathies leukodystrophies, and others. Hereditary diffuse leukoencephalopathy with spheroids (HDLS) is an autosomal dominant disorder with symptomatic onset in midlife and death within a few years after symptom onset. Neuroimaging reveals cerebral white matter lesions that are pathologically characterized by non-inflammatory myelin loss, reactive astrocytosis, and axonal spheroids. Most cases are caused by mutations in the colony-stimulating factor 1 receptor (CSF1R) gene. We studied neuropathologically verified HDLS patients with CSF1R mutations to assess parkinsonian features. Ten families were evaluated with 16 affected individuals. During the course of the illness, all patients had at least some degree of bradykinesia. Fifteen patients had postural instability, and seven had rigidity. Two patients initially presented with parkinsonian gait and asymmetrical bradykinesia. These two patients and two others exhibited bradykinesia, rigidity, postural instability, and tremor (two with resting) early in the course of the illness. Levodopa/carbidopa therapy in these four patients provided no benefit, and the remaining 12 patients were not treated. The mean age of onset for all patients was about 45 years (range, 18-71) and the mean disease duration was approximately six years (range, 3-11). We also reviewed HDLS patients published prior to the CSF1R discovery for the presence of parkinsonian features. Out of 50 patients, 37 had gait impairments, 8 rigidity, 7 bradykinesia, and 5 resting tremor. Our report emphasizes the presence of atypical Parkinsonism in HDLS due to CSF1R mutations.
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Affiliation(s)
- Christina Sundal
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Matt Baker
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Jan Aasly
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Salvatore Spina
- Department of Pathology and Laboratory Medicine and Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine and Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, USA
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - James Garbern
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Alex Tselis
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Russell H. Swerdlow
- Department of Neurology, University of Kansas School of Medicine, Kansas City, USA
| | - Bradley B. Miller
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Anne Borjesson-Hanson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ryan J. Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Owen Ross
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - John A. Stoessl
- Pacific Parkinson’s Research Centre, University of British Columbia & Vancouver Coastal Health, Vancouver, BC, Canada
| | - Rosa Rademakers
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Daniel Broderick
- Department of Neuroradiology, Mayo Clinic Florida, Jacksonville, FL, USA
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Picillo M, Amboni M, Erro R, Vitale C, Longo K, Pellecchia MT, Cozzolino A, Moccia M, Allocca R, Barone P. Segmental progression of cardinal motor symptoms in Parkinson's disease: a pilot study suggesting a practical approach to rate disease course in the early stages. Parkinsonism Relat Disord 2013; 19:1143-8. [PMID: 24041938 DOI: 10.1016/j.parkreldis.2013.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/10/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022]
Abstract
Little is known about the anatomical progression over the body segments of extrapyramidal signs in Parkinson's disease (PD); furthermore a great unmet need is the availability of instruments able to detect disease progression, even in the early phase. The purpose of this study is to demonstrate that assessing topographical distribution of the cardinal motor features of PD may significantly improve the evaluation of disease progression in the early stages. Forty-four drug-naïve PD patients were included in the study. Presence or absence of bradykinesia, rest tremor and rigidity was derived from Unified Parkinson's disease rating scale part III (UPDRS-III) in five different anatomical segments: axial, right and left upper- and lower-limbs. Based on this approach, four new scores were computed evaluating the anatomical spread of the cardinal motor symptoms of PD on the five body segments over a 18-month follow-up period. The four new scores included: the Bradykinesia Segmental Score, the Tremor Segmental Score, the Rigidity Segmental Score, measuring the occurrence of each motor symptom in different segments and the Combined Segmental Score evaluating the occurrence of any motor symptom in different anatomical regions. Data were analyzed using a repeated measures analysis of variance. The Combined Segmental Score showed a significant progression over time whereas the Hoehn and Yahr and the UPDRS-III scores did not. We suggest that a simple approach evaluating the anatomical distribution of motor symptoms and their progression over the body segments may be a useful complement to the classical rating tools to assess progression in early PD.
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Affiliation(s)
- Marina Picillo
- Department of Neurological Sciences, University Federico II, Naples, Italy
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Takekawa K. [Case of acute pain of herpes zoster with preceding immobility of the shoulder]. Masui 2012; 61:752-754. [PMID: 22860307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 62-year-old-man treated for nephrotic syndrome with steroid developed acute pain of herpes zoster after immobility of the shoulder. Steroids might have suppressed the first symptoms of pain. But immobility probably appeared as VZV infection developing to spinal ventral root. Suprascapular nerve block was effective for severe pain of the right arm. Sympathetic nerve contained in suprascapular nerve might have been blocked. Sympathetically maintained pain may occur when primary afferent neurons are excited by inflammation due to VZV infection. Pain was abolished 17 weeks after the onset of rash using blocks three times and amitriptyrin and valproic acid. Immobility was resolved seven months after the onset of rash.
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Wolfsegger T, Rotaru I, Topakian R, Pichler R, Sonnberger M, Aichner FT, Schwameder H. [A biomechanical analysis of cyclical hand motor function: a pilot study in different Parkinsonian syndromes]. Nervenarzt 2012; 83:766-771. [PMID: 22349627 DOI: 10.1007/s00115-011-3464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Clinical assessment of hand bradykinesia in Parkinson's disease (PD) focuses mainly on the frequency, amplitude and rhythm of movements, thereby subjectively evaluating the correct performance of hand movements. The aim of the study was to quantify hand bradykinesia with kinematic data in different Parkinsonian syndromes. PATIENTS AND METHODS This retrospective study compared patients with idiopathic PD (IPD, n = 18), atypical Parkinson's syndrome (APS, n = 17), secondary Parkinson's syndrome (SPS, n = 18) and healthy controls (C, n = 18). All patients were receiving the best medical treatment. Hand movements were recorded using an ultrasound-system (Zebris®, Isny, Germany). Subjects were asked to perform pronation/supination of the forearm (diadochokinesis), flexion/extension of the hand (hand tapping) and tapping of the index finger. Mean amplitude, mean frequency and mean variability of movements were determined. RESULTS APS patients had significant complex hand movement disability with reduced amplitude and frequency in combination with increased motion variability in all movement tasks. The key disturbance in the IPD group concerned the rhythm in hand tapping and index finger tapping in combination with moderately reduced velocity and range of motion in all conditions. The cyclical hand movement characteristics in SPS patients showed movement slowness with normal amplitude and variability in all motor conditions. CONCLUSION Our results suggest that computerized quantitative analysis of cyclical hand movements can characterize and identify different representations of hand bradykinesia in different Parkinsonian disorders and hence may help clinicians to accurately assess therapeutic targets and outcome of interventions.
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Affiliation(s)
- T Wolfsegger
- Abteilung für Neurologie - Labor für Bewegungsanalyse, Landes-Nervenklinik Wagner-Jauregg, Universitätslehrkrankenhaus, Wagner-Jauregg-Weg 15, 4020 Linz, Österreich.
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Murashko NK. [Stages of kinetotherapy and therapeutic massage for long time bedridden patients]. Lik Sprava 2012:122-125. [PMID: 23350130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Rehabilitation of stroke patients, is a complex chain of consistently conducted medical and social measures aimed at rehabilitation, health or possible adaptation to self-service in the presence of a persistent neurological defect. Already in acute stroke patient needs not only to drug therapy and care, but also in the emotional and psychological support for the type of "cautious optimism." It should be explained to the patient a temporary, reversible nature of its existing motor and other violations. With relatives patient should discuss the real situation, prognosis, rehabilitation opportunities, the need for hospitalization or appropriate treatment at home, put them in front of clear objectives for the near future. Activity and the amount of rehabilitation expanded in young children with satisfactory prognosis, consideration being given to their professional and social status.
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