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Fan G, Zhao M, Pang H, Li X, Bu S, Wang J, Liu Y, Jiang Y. Low and high-order topological disruption of functional networks in multiple system atrophy with freezing of gait: A resting-state study. Neurobiol Dis 2024; 195:106504. [PMID: 38615913 DOI: 10.1016/j.nbd.2024.106504] [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: 02/08/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE Freezing of gait (FOG), a specific survival-threatening gait impairment, needs to be urgently explored in patients with multiple system atrophy (MSA), which is characterized by rapid progression and death within 10 years of symptom onset. The objective of this study was to explore the topological organisation of both low- and high-order functional networks in patients with MAS and FOG. METHOD Low-order functional connectivity (LOFC) and high-order functional connectivity FC (HOFC) networks were calculated and further analysed using the graph theory approach in 24 patients with MSA without FOG, 20 patients with FOG, and 25 healthy controls. The relationship between brain activity and the severity of freezing symptoms was investigated in patients with FOG. RESULTS Regarding global topological properties, patients with FOG exhibited alterations in the whole-brain network, dorsal attention network (DAN), frontoparietal network (FPN), and default network (DMN), compared with patients without FOG. At the node level, patients with FOG showed decreased nodal centralities in sensorimotor network (SMN), DAN, ventral attention network (VAN), FPN, limbic regions, hippocampal network and basal ganglia network (BG), and increased nodal centralities in the FPN, DMN, visual network (VIN) and, cerebellar network. The nodal centralities of the right inferior frontal sulcus, left lateral amygdala and left nucleus accumbens (NAC) were negatively correlated with the FOG severity. CONCLUSION This study identified a disrupted topology of functional interactions at both low and high levels with extensive alterations in topological properties in MSA patients with FOG, especially those associated with damage to the FPN. These findings offer new insights into the dysfunctional mechanisms of complex networks and suggest potential neuroimaging biomarkers for FOG in patients with MSA.
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Affiliation(s)
- Guoguang Fan
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
| | - Mengwan Zhao
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Huize Pang
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Xiaolu Li
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Shuting Bu
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Juzhou Wang
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Yu Liu
- Department of radiology, the first hospital of China medical University,Shenyang, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China
| | - Yueluan Jiang
- MR Research Collaboration, Siemens Healthineers, Beijing 7 Wangjing Zhonghuan Nanlu, Chaoyang District, Beijing 100102, PR China.
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Cronin P, Collins LM, Sullivan AM. Impacts of gait freeze on quality of life in Parkinson's disease, from the perspectives of patients and their carers. Ir J Med Sci 2024:10.1007/s11845-024-03673-x. [PMID: 38639839 DOI: 10.1007/s11845-024-03673-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The World Health Organisation (WHO) reports that morbidity and mortality due to Parkinson's disease (PD) are increasing faster than for other neurodegenerative conditions. People with Parkinson's (PwP) present with a variety of motor symptoms, such as tremor, bradykinesia, and rigidity. Freezing of gait (FoG) is a significant motor symptom that manifests as temporary episodes of inability to move one's feet, despite the intention to walk. AIMS This study examined the impact of FoG on quality of life (QoL) within an Irish cohort of PwP, from the perspectives of both PwP and their carers, using validated questionnaires that had been adapted for online use. METHODS PwP and their carers were recruited by outreach to the Irish Parkinson's Community. Anonymous online questionnaires were distributed, which combined a demographic survey with several clinically validated surveys, including Freezing of Gait Questionnaire (FoG-Q), Parkinson's Disease Questionnaire 8 (PDQ-8), and Parkinson's Disease Carer Questionnaire (PDQ-C). RESULTS There was a strong correlation (p < 0.001) between severity of FoG and lower QoL among PwP. Significant correlation was also found between FoG severity and several motor symptoms, such as postural instability and difficulty with balance, and non-motor symptoms, such as cognitive changes and pain/discomfort. FoG severity correlated with disease progression. Significant correlation was also found between FoG and symptoms, as assessed from the perspective of the patients' carers. CONCLUSIONS This study shows that FoG is a significant detriment to the QoL of PwP, from the perspectives of patients and carers. This method of assessing FoG and QoL using online questionnaires has potential to enhance the reach and flexibility of this type of research. These findings will inform future studies on larger cohorts and highlight unmet clinical needs in PwP.
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Affiliation(s)
- Padraig Cronin
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland
| | - Lucy M Collins
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland
| | - Aideen M Sullivan
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland.
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland.
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Wang Y, Yu L, Mao H, Chen X, Hu P, Ge Y, Liu Y, Zhang J, Cheng H. Deep Brain Stimulation Modulates the Visual Pathway to Improve Freezing of Gait in Parkinson's Disease Patients. World Neurosurg 2024:S1878-8750(24)00618-1. [PMID: 38636635 DOI: 10.1016/j.wneu.2024.04.055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the involvement of the visual cortex in improving freezing of gait (FoG) after subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients using whole-brain seed-based functional connectivity. METHODS A total of 66 PD patients with FoG who underwent bilateral STN-DBS were included in our study. Patients were divided into a FoG responder group and an FoG nonresponder group according to whether FoG improved 1 year after DBS. We compared the differences in clinical characteristics, brain structural imaging, and seed-based functional connectivity between the 2 groups. The locations of active contacts were further analyzed. RESULTS All PD patients benefited from STN-DBS. No significant differences in the baseline characteristics or brain structures were found between the 2 groups. Seed-based functional connectivity analysis revealed that better connectivity in bilateral primary visual areas was associated with better clinical improvement in FoG (P < 0.05 familywise error corrected). Further analysis revealed that this disparity was associated with the location of the active contacts within the rostral region of the sensorimotor subregion in the FoG responder group, in contrast to the findings in the FoG nonresponder group. CONCLUSIONS This study suggested that DBS in the rostral region of the STN sensorimotor subregion may alleviate FoG by strengthening functional connectivity in primary visual areas, which has significant implications for guiding surgical strategies for FoG in the future.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Liangchen Yu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Ge
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Liu
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Jiarui Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China.
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Murueta-Goyena A, Muiño O, Gómez-Esteban JC. Prognostic factors for falls in Parkinson's disease: a systematic review. Acta Neurol Belg 2024; 124:395-406. [PMID: 38015306 DOI: 10.1007/s13760-023-02428-2] [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: 09/02/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Falls represent a critical concern in Parkinson's disease (PD), contributing to increased morbidity and reduced quality of life. PURPOSE We conducted a systematic review to assess the prognostic factors associated with falls in PD, aiming to provide a comprehensive overview of relevant demographic and clinical parameters, and aid neurologists in identifying subsets of PD patients most susceptible to falls and associated injuries. METHODS PubMed and Web of Science databases were searched for prospective studies assessing factors associated with falls in ambulatory PD patients across different settings, from inception to August 2023. Data extraction was conducted using CHARMS-PF checklist and risk of bias was assessed with QUIPS tool. PRISMA guidelines were followed. RESULTS The initial search yielded 155 references. Thirty-four studies, involving a total of 3454 PD patients, were included in the final analysis. The mean pooled age was 67.6 years, and 45.1% were women. PD patients presented mild motor impairment (UPDRS III score 27.8) with mean pooled disease duration of 5.7 years. Gait and balance disorders and history of prior falls emerged as the most consistent predictors of falls across studies. Disease duration, disease severity, dysautonomic symptoms, freezing of gait, frontal cognitive functions, and PD medication dosages yielded inconsistent findings. Conversely, dyskinesias, age, sex, and depression were unrelated to future falls in PD. Logistic regression models were most commonly employed to identify factors significantly associated with falls in PD. Substantial heterogeneity prevailed in the inclusion of confounding factors. CONCLUSION The evidence suggests that previous history of falls, gait disorders, and poor balance are robust prognostic markers for falls in PD.
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Affiliation(s)
- Ane Murueta-Goyena
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Barrio Sarriena S/N, 48940, Leioa, Bizkaia, Spain.
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
| | - Oier Muiño
- Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Juan Carlos Gómez-Esteban
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Barrio Sarriena S/N, 48940, Leioa, Bizkaia, Spain
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Osakidetza, Barakaldo, Bizkaia, Spain
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Hou W, Wu F, Wang Y, Li W, Cheng Y, Zhu Z, Liang S, Liu P, Yu Y, Wu J. Predicting slight freezing of gait in Parkinson's disease with anticipatory postural adjustments and limits of stability. Parkinsonism Relat Disord 2024; 123:106949. [PMID: 38564831 DOI: 10.1016/j.parkreldis.2024.106949] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Gait initiation (GI) includes automatic and voluntary movements. However, research on their impact on the first step in patients with Parkinson's disease (PD) and their relationship to freezing of gait (FOG) is lacking. We examined the effects of automatic movements (anticipatory postural adjustments [APAs]) and voluntary movements (limits of stability [LOS]) on the first step (first-step duration and first-step range of motion), along with their early recognition and prediction of slight FOG. METHODS Twenty-three patients with PD and slight freezing (PD + FOG) and 25 non-freezing patients with PD (PD-FOG) were tested while off medications and compared with 24 healthy controls (HC). All participants completed a 7-m Stand and Walk Test (7 m SAW) and wore inertial sensors to quantify the APAs and first step. LOS was quantified by dynamic posturography in different directions using a pressure platform. We compared differences among all three groups, analysed correlations, and evaluated their predictive value for slight FOG. RESULTS In PD + FOG, APAs and LOS were worse than those in the PD-FOG and HC groups (p < 0.001), and the first step was worse than that in HC (p < 0.001). APAs were correlated mainly with the first-step duration. APAs and LOS were correlated with the first-step range of motion. APAs have been recognized as independent predictors of FOG, and their combination with LOS enhances predictive sensitivity. CONCLUSION APAs and LOS in patients with PD directly affect the first step during GI. In addition, the combination of APAs and LOS helped predict slight FOG.
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Affiliation(s)
- Weijia Hou
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Fan Wu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yue Wang
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Weihua Li
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yuanyuan Cheng
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Zhizhong Zhu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Peipei Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, 300350, China
| | - Yang Yu
- Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, 300350, China.
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, 300350, China.
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Taniguchi S, Marumoto K, Kajiyama Y, Revankar G, Inoue M, Yamamoto H, Kayano R, Mizuta E, Takahashi R, Shirahata E, Saeki C, Ozono T, Kimura Y, Ikenaka K, Mochizuki H. The validation of a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q). Neurol Sci 2024:10.1007/s10072-024-07405-y. [PMID: 38383749 DOI: 10.1007/s10072-024-07405-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study aimed to develop a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q) and investigate its validity and reliability. METHODS After translating the NFOG-Q according to a standardised protocol, 56 patients with Parkinson's disease (PD) were administered it. Additionally, the MDS-UPDRS parts II and III, Hoehn and Yahr (H&Y) stage, and number of falls over 1 month were evaluated. Spearman's correlation coefficients (rho) were used to determine construct validity, and Cronbach's alpha (α) was used to examine reliability. RESULTS The interquartile range of the NFOG-Q scores was 10.0-25.3 (range 0-29). The NFOG-Q scores were strongly correlated with the MDS-UPDRS part II, items 2.12 (walking and balance), 2.13 (freezing), 3.11 (freezing of gait), and 3.12 (postural stability) and the postural instability and gait difficulty score (rho = 0.515-0.669), but only moderately related to the MDS-UPDRS item 3.10 (gait), number of falls, disease duration, H&Y stage, and time of the Timed Up-and-Go test (rho = 0.319-0.434). No significant correlations were observed between age and the time of the 10-m walk test. The internal consistency was excellent (α = 0.96). CONCLUSIONS The Japanese version of the NFOG-Q is a valid and reliable tool for assessing the severity of freezing in patients with PD.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kohei Marumoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Yuta Kajiyama
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Gajanan Revankar
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Michiko Inoue
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Hiroshi Yamamoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Rika Kayano
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Eiji Mizuta
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Ryuichi Takahashi
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Emi Shirahata
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Chizu Saeki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tatsuhiko Ozono
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuyoshi Kimura
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kensuke Ikenaka
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Yang PK, Filtjens B, Ginis P, Goris M, Nieuwboer A, Gilat M, Slaets P, Vanrumste B. Freezing of gait assessment with inertial measurement units and deep learning: effect of tasks, medication states, and stops. J Neuroeng Rehabil 2024; 21:24. [PMID: 38350964 PMCID: PMC10865632 DOI: 10.1186/s12984-024-01320-1] [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: 05/09/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Freezing of gait (FOG) is an episodic and highly disabling symptom of Parkinson's Disease (PD). Traditionally, FOG assessment relies on time-consuming visual inspection of camera footage. Therefore, previous studies have proposed portable and automated solutions to annotate FOG. However, automated FOG assessment is challenging due to gait variability caused by medication effects and varying FOG-provoking tasks. Moreover, whether automated approaches can differentiate FOG from typical everyday movements, such as volitional stops, remains to be determined. To address these questions, we evaluated an automated FOG assessment model with deep learning (DL) based on inertial measurement units (IMUs). We assessed its performance trained on all standardized FOG-provoking tasks and medication states, as well as on specific tasks and medication states. Furthermore, we examined the effect of adding stopping periods on FOG detection performance. METHODS Twelve PD patients with self-reported FOG (mean age 69.33 ± 6.02 years) completed a FOG-provoking protocol, including timed-up-and-go and 360-degree turning-in-place tasks in On/Off dopaminergic medication states with/without volitional stopping. IMUs were attached to the pelvis and both sides of the tibia and talus. A temporal convolutional network (TCN) was used to detect FOG episodes. FOG severity was quantified by the percentage of time frozen (%TF) and the number of freezing episodes (#FOG). The agreement between the model-generated outcomes and the gold standard experts' video annotation was assessed by the intra-class correlation coefficient (ICC). RESULTS For FOG assessment in trials without stopping, the agreement of our model was strong (ICC (%TF) = 0.92 [0.68, 0.98]; ICC(#FOG) = 0.95 [0.72, 0.99]). Models trained on a specific FOG-provoking task could not generalize to unseen tasks, while models trained on a specific medication state could generalize to unseen states. For assessment in trials with stopping, the agreement of our model was moderately strong (ICC (%TF) = 0.95 [0.73, 0.99]; ICC (#FOG) = 0.79 [0.46, 0.94]), but only when stopping was included in the training data. CONCLUSION A TCN trained on IMU signals allows valid FOG assessment in trials with/without stops containing different medication states and FOG-provoking tasks. These results are encouraging and enable future work investigating automated FOG assessment during everyday life.
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Affiliation(s)
- Po-Kai Yang
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
| | - Benjamin Filtjens
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Pieter Ginis
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Maaike Goris
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Alice Nieuwboer
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Moran Gilat
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Peter Slaets
- Intelligent Mobile Platforms Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Bart Vanrumste
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
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Palmisano C, Farinelli V, Camuncoli F, Favata A, Pezzoli G, Frigo CA, Isaias IU. Dynamic evaluation of spine kinematics in individuals with Parkinson's disease and freezing of gait. Gait Posture 2024; 108:199-207. [PMID: 37993298 DOI: 10.1016/j.gaitpost.2023.10.017] [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: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Freezing of gait (FoG) is an episodic failure of gait exposing people with Parkinson's disease (PD) to a high risk of falling. Despite growing evidence of the interconnection between impaired trunk control and FoG, a detailed description of spinal kinematics during walking is still lacking in this population. RESEARCH QUESTION Do spinal alterations impact gait performance in individuals with PD and FoG? METHODS We analyzed kinematic data of 47 PD participants suffering (PD-FOG, N = 24) or not suffering from FoG (PD-NFOG, N = 23) and 15 healthy controls (HCO) during quiet standing and unperturbed walking. We estimated the main spinal variables (i.e., spinal length, lordosis and kyphosis angles, trunk inclination), the pelvis angles, and the shoulder-pelvis angles during gait and standing. We studied differences across conditions and groups and the relationships between postural and gait parameters using linear regression methods. RESULTS During standing and walking, both PD groups showed increased trunk inclination and decreased lordosis angle with respect to HCO, as well as a decreased range in variation of kyphosis angle, pelvic obliquity, and shoulder-pelvis angles. Only PD-FOG participants showed reduced range of lordosis angle and spinal length compared to HCO. PD-FOG individuals were also not able to straighten their spine during walking compared to standing. Stride length and velocity were decreased in both patient groups compared to HCO, while swing duration was reduced only in the PD-FOG group. In individuals with FoG, trunk inclination and lordosis angle showed moderate but significant positive correlations with all gait alterations. SIGNIFICANCE Spine alterations impacted gait performance in individuals with PD suffering from FoG. Excessive trunk inclination and poor mastering of the lordosis spinal region may create an unfavourable postural precondition for forward walking. Physical therapy should target combined spinal and stepping alterations in these individuals.
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Affiliation(s)
- C Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
| | - V Farinelli
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milano, Italy
| | - F Camuncoli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - A Favata
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - G Pezzoli
- Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
| | - C A Frigo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - I U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini-CTO, Milano, Italy
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Milane T, Hansen C, Correno MB, Chardon M, Barbieri FA, Bianchini E, Vuillerme N. Comparison of sleep characteristics between Parkinson's disease with and without freezing of gait: A systematic review. Sleep Med 2024; 114:24-41. [PMID: 38150950 DOI: 10.1016/j.sleep.2023.11.021] [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: 05/25/2023] [Revised: 08/03/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Among the motor complaints, freezing of gait (FOG) is a common and disabling phenomenon that episodically hinders patients' ability to produce efficient steps. Concurrently, sleep disorders are prevalent in PD and significantly impact the quality of life of affected individuals. Numerous studies have suggested a bidirectional relationship between FOG and sleep disorders. Therefore, our objective was to systematically review the literature and compare sleep outcomes in PD patients with FOG (PD + FOG) and those without FOG (PD-FOG). By conducting a comprehensive search of the PubMed and Web of Science databases, we identified 20 eligible studies for inclusion in our analysis. Our review revealed that compared to PD-FOG, PD + FOG patients exhibited more severe symptoms of rapid eye movement sleep behavior disorder in nine studies, increased daytime sleepiness in eight studies, decreased sleep quality in four studies, and more frequent and severe sleep disturbances in four studies. These findings indicate that PD + FOG patients generally experience worse sleep quality, higher levels of daytime sleepiness, and more disruptive sleep disturbances compared to those without FOG (PD-FOG). The association between sleep disturbances and FOG highlights the importance of evaluating and monitoring these symptoms in PD patients and open the possibility for future studies to assess the impact of managing sleep disturbances on the severity and occurrence of FOG, and vice versa.
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Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Mathias Baptiste Correno
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Matthias Chardon
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Fabio A Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189, Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000, Grenoble, France; Institut Universitaire de France, 75005, Paris, France.
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10
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Zhang W, Sun H, Huang D, Zhang Z, Li J, Wu C, Sun Y, Gong M, Wang Z, Sun C, Cui G, Guo Y, Chan P. Detection and prediction of freezing of gait with wearable sensors in Parkinson's disease. Neurol Sci 2024; 45:431-453. [PMID: 37843692 DOI: 10.1007/s10072-023-07017-y] [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: 02/11/2023] [Accepted: 08/06/2023] [Indexed: 10/17/2023]
Abstract
Freezing of gait (FoG) is one of the most distressing symptoms of Parkinson's Disease (PD), commonly occurring in patients at middle and late stages of the disease. Automatic and accurate FoG detection and prediction have emerged as a promising tool for long-term monitoring of PD and implementation of gait assistance systems. This paper reviews the recent development of FoG detection and prediction using wearable sensors, with attention on identifying knowledge gaps that need to be filled in future research. This review searched the PubMed and Web of Science databases to collect studies that detect or predict FoG with wearable sensors. After screening, 89 of 270 articles were included. The data description, extracted features, detection/prediction methods, and classification performance were extracted from the articles. As the number of papers of this area is increasing, the performance has been steadily improved. However, small datasets and inconsistent evaluation processes still hinder the application of FoG detection and prediction with wearable sensors in clinical practice.
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Affiliation(s)
- Wei Zhang
- Department of Neurology, Suining County People's Hospital, Xuzhou, 221200, Jiangsu, China
- Department of Neurology, Neurobiology and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Hong Sun
- Department of Neurology, Neurobiology and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
- Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, 100053, China
- National Clinical Research Center of Geriatric Disorders, Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, 100053, China
| | - Debin Huang
- Department of Automation Science and Electrical Engineering, Beihang University, Beijing, 100191, China
| | - Zixuan Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Jinyu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Chan Wu
- Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100029, China
| | - Yingying Sun
- Department of Neurology, Suining County People's Hospital, Xuzhou, 221200, Jiangsu, China
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Mengyi Gong
- Department of Neurology, Suining County People's Hospital, Xuzhou, 221200, Jiangsu, China
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Zhi Wang
- Department of Neurology, Suining County People's Hospital, Xuzhou, 221200, Jiangsu, China
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Chao Sun
- Department of Neurology, Suining County People's Hospital, Xuzhou, 221200, Jiangsu, China
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, China.
| | - Yuzhu Guo
- Department of Automation Science and Electrical Engineering, Beihang University, Beijing, 100191, China.
| | - Piu Chan
- Department of Neurology, Neurobiology and Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
- Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, 100053, China.
- National Clinical Research Center of Geriatric Disorders, Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, 100053, China.
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11
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Yin N, Wang H, Wang Z, Feng K, Xu G, Yin S. A study of brain networks associated with Freezing of gait in Parkinson's disease using transfer entropy analysis. Brain Res 2023; 1821:148610. [PMID: 37783260 DOI: 10.1016/j.brainres.2023.148610] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a common neurodegenerative disease in the elderly. Freezing of Gait (FOG) is one of the common motor symptoms of PD, but the potential mechanism remains unclear. This study aimed to investigate the changes of brain functional network topology in PD patients with FOG. METHODS The resting electroencephalogram (EEG) were acquired from15 PD patients with FOG (PD-FOG), 13 PD patients without FOG (PD-nFOG), and 16 healthy control (HC). Cognitive and motor functions were assessed using subjective scales. The whole-brain functional networks were constructed based on transfer entropy. Transfer entropy was used to analyse the information flow and causality in the network and the network connectivity was analyzed by graph theory. The characteristics of PD-FOG and PD-nFOG were compared by receiver operator characteristic (ROC) curve analysis. RESULTS The θ bands brain network of PD-FOG, PD-nFOG and HC group was significantly different (P < 0.05). The average characteristic path length of the θ bands brain network was positively correlated with FOG Questionnaire (FOGQ). PD-FOG and PD-nFOG get high classification accuracy according to this feature. The information inflow in the frontal and occipital lobes and information outflow in the temporal lobe of PD-FOG patients in the θ bands increased significantly. CONCLUSIONS The whole-brain functional network characteristics of PD-FOG in the θ bands can serve as potential biomarkers for early diagnosis of PD-FOG. Abnormal information flow of the frontal, occipital, and temporal lobes in the θ bands may be an important factor leading to FOG.
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Affiliation(s)
- Ning Yin
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, China; School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Haili Wang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, China; School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Zhaoya Wang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, China; School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
| | - Guizhi Xu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, China; School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300130, China.
| | - Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China.
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Li D, Hallack A, Gwilym S, Li D, Hu MT, Cantley J. Investigating gait-responsive somatosensory cueing from a wearable device to improve walking in Parkinson's disease. Biomed Eng Online 2023; 22:108. [PMID: 37974260 PMCID: PMC10652624 DOI: 10.1186/s12938-023-01167-y] [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: 06/16/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
Freezing-of-gait (FOG) and impaired walking are common features of Parkinson's disease (PD). Provision of external stimuli (cueing) can improve gait, however, many cueing methods are simplistic, increase task loading or have limited utility in a real-world setting. Closed-loop (automated) somatosensory cueing systems have the potential to deliver personalised, discrete cues at the appropriate time, without requiring user input. Further development of cue delivery methods and FOG-detection are required to achieve this. In this feasibility study, we aimed to test if FOG-initiated vibration cues applied to the lower-leg via wearable devices can improve gait in PD, and to develop real-time FOG-detection algorithms. 17 participants with Parkinson's disease and daily FOG were recruited. During 1 h study sessions, participants undertook 4 complex walking circuits, each with a different intervention: continuous rhythmic vibration cueing (CC), responsive cueing (RC; cues initiated by the research team in response to FOG), device worn with no cueing (NC), or no device (ND). Study sessions were grouped into 3 stages/blocks (A-C), separated by a gap of several weeks, enabling improvements to circuit design and the cueing device to be implemented. Video and onboard inertial measurement unit (IMU) data were analyzed for FOG events and gait metrics. RC significantly improved circuit completion times demonstrating improved overall performance across a range of walking activities. Step frequency was significantly enhanced by RC during stages B and C. During stage C, > 10 FOG events were recorded in 45% of participants without cueing (NC), which was significantly reduced by RC. A machine learning framework achieved 83% sensitivity and 80% specificity for FOG detection using IMU data. Together, these data support the feasibility of closed-loop cueing approaches coupling real-time FOG detection with responsive somatosensory lower-leg cueing to improve gait in PD.
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Affiliation(s)
- Dongli Li
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Andre Hallack
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Sophie Gwilym
- Oxfordshire Neurophysiotherapy, The Bosworth Clinic, Quarry Court, Bell Lane, Cassington, OX29 4DS, UK
| | - Dongcheng Li
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, 75082, USA
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Division of Neurology, University of Oxford, Oxford, Oxfordshire, UK
| | - James Cantley
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK.
- Division of Systems Medicine, Ninewells Hospital & Medical School, University of Dundee, James Arrott Drive, Dundee, DD1 9SY, UK.
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13
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Falaki A, Cuadra C, Lewis MM, Prado-Rico JM, Huang X, Latash ML. Multi-muscle synergies in preparation for gait initiation in Parkinson's disease. Clin Neurophysiol 2023; 154:12-24. [PMID: 37524005 DOI: 10.1016/j.clinph.2023.06.022] [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: 03/16/2023] [Revised: 05/20/2023] [Accepted: 06/25/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE We investigated changes in indices of muscle synergies prior to gait initiation and the effects of gaze shift in patients with Parkinson's disease (PD). A long-term objective of the study is to develop a method for quantitative assessment of gait-initiation problems in PD. METHODS PD patients without clinical signs of postural instability and two control groups (age-matched and young) performed a gait initiation task in a self-paced manner, with and without a quick prior gaze shift produced by turning the head. Muscle groups with parallel scaling of activation levels (muscle modes) were identified as factors in the muscle activation space. Synergy index stabilizing center of pressure trajectory in the anterior-posterior and medio-lateral directions (indices of stability) was quantified in the muscle mode space. A drop in the synergy index in preparation to gait initiation (anticipatory synergy adjustment, ASA) was quantified. RESULTS Compared to the control groups, PD patients showed significantly smaller synergy indices and ASA for both directions of the center of pressure shift. Both PD and age-matched controls, but not younger controls, showed detrimental effects of the prior gaze shift on the ASA indices. CONCLUSIONS PD patients without clinically significant posture or gait disorders show impaired stability of the center of pressure and its diminished adjustment during gait initiation. SIGNIFICANCE The indices of stability and ASA may be useful to monitor pre-clinical gait disorders, and lower ASA may be relevant to emergence of freezing of gait in PD.
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Affiliation(s)
- Ali Falaki
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
| | - Cristian Cuadra
- Department of Physical Therapy, Emory University, Atlanta, GA, USA; Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538 Santiago, Chile
| | - Mechelle M Lewis
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Janina M Prado-Rico
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Radiology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Neurosurgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA.
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14
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Ciocca M, Seemungal BM, Tai YF. Spinal Cord Stimulation for Gait Disorders in Parkinson's Disease and Atypical Parkinsonism: A Systematic Review of Preclinical and Clinical Data. Neuromodulation 2023; 26:1339-1361. [PMID: 37452800 DOI: 10.1016/j.neurom.2023.06.003] [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: 02/25/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Falls in extrapyramidal disorders, particularly Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP), are key milestones affecting patients' quality of life, incurring increased morbidity/mortality and high healthcare costs. Unfortunately, gait and balance in parkinsonisms respond poorly to currently available treatments. A serendipitous observation of improved gait and balance in patients with PD receiving spinal cord stimulation (SCS) for back pain kindled an interest in using SCS to treat gait disorders in parkinsonisms. OBJECTIVES We reviewed preclinical and clinical studies of SCS to treat gait dysfunction in parkinsonisms, covering its putative mechanisms and efficacies. MATERIALS AND METHODS Preclinical studies in animal models of PD and clinical studies in patients with PD, PSP, and MSA who received SCS for gait disorders were included. The main outcome assessed was clinical improvement in gait, together with outcome measures used and possible mechanism of actions. RESULTS We identified 500 references, and 45 met the selection criteria and have been included in this study for analysis. Despite positive results in animal models, the outcomes in human studies are inconsistent. CONCLUSIONS The lack of blind and statistically powered studies, the heterogeneity in patient selection and study outcomes, and the poor understanding of the underlying mechanisms of action of SCS are some of the limiting factors in the field. Addressing these limitations will allow us to draw more reliable conclusions on the effects of SCS on gait and balance in extrapyramidal disorders.
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Affiliation(s)
- Matteo Ciocca
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Yen F Tai
- Department of Brain Sciences, Imperial College London, London, UK.
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15
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Beigi OM, Nóbrega LR, Houghten S, Alves Pereira A, de Oliveira Andrade A. Freezing of gait in Parkinson's disease: Classification using computational intelligence. Biosystems 2023; 232:105006. [PMID: 37634658 DOI: 10.1016/j.biosystems.2023.105006] [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: 03/31/2023] [Revised: 08/20/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease represented by the progressive loss of dopamine producing neurons, with motor and non-motor symptoms that may be hard to distinguish from other disorders. Affecting millions of people across the world, its symptoms include bradykinesia, tremors, depression, rigidity, postural instability, cognitive decline, and falls. Furthermore, changes in gait can be used as a primary diagnosis factor. A dataset is described that records data on healthy individuals and on PD patients, including those who experience freezing of gait, in both the ON and OFF-medication states. The dataset is comprised of data for four separate tasks: voluntary stop, timed up and go, simple motor task, and dual motor and cognitive task. Seven different classifiers are applied to two problems relating to this data. The first problem is to distinguish PD patients from healthy individuals, both overall and per task. The second problem is to determine the effectiveness of medication. A thorough analysis on the classifiers and their results is performed. Overall, multilayer perceptron and decision tree provide the most consistent results.
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Affiliation(s)
- Omid Mohamad Beigi
- Computer Science Department, Brock University, St. Catharines, Ontario, Canada
| | - Lígia Reis Nóbrega
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Sheridan Houghten
- Computer Science Department, Brock University, St. Catharines, Ontario, Canada.
| | - Adriano Alves Pereira
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
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16
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Tedeschi R. Automated mechanical peripheral stimulation for gait rehabilitation in Parkinson's disease: A comprehensive review. Clin Park Relat Disord 2023; 9:100219. [PMID: 37780489 PMCID: PMC10539662 DOI: 10.1016/j.prdoa.2023.100219] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
Background Automated Mechanical Peripheral Stimulation (AMPS) has emerged as a potential rehabilitative intervention for gait abnormalities in Parkinson's disease (PD). However, the long-term effects and combined therapy with physical exercise remain unclear. This review aimed to explore the effects of automated mechanical peripheral stimulation (AMPS) on gait and motor performance in individuals with Parkinson's disease (PD). Methods A research was conducted in relevant databases to identify studies investigating the effects of AMPS on gait and motor outcomes in PD patients. Inclusion criteria were set based on Population, Concept, and Context (PCC) criteria. Data extraction and analysis were performed to synthesize the findings. Results Ten studies met the inclusion criteria and were included in the review. The studies collectively demonstrated positive effects of AMPS on gait parameters, such as walking velocity, stride length, and walking stability. Some studies also reported improvements in functional performance and muscle activation during walking. Conclusions The findings suggest that AMPS holds promise as a potential intervention to improve gait and motor performance in individuals with PD. However, the evidence is limited, and further well-designed randomized controlled trials are needed to establish the long-term efficacy and optimal protocols for AMPS in PD rehabilitation.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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17
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Potvin-Desrochers A, Martinez-Moreno A, Clouette J, Parent-L'Ecuyer F, Lajeunesse H, Paquette C. Upregulation of the parietal cortex improves freezing of gait in Parkinson's disease. J Neurol Sci 2023; 452:120770. [PMID: 37633012 DOI: 10.1016/j.jns.2023.120770] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The posterior parietal cortex (PPC) is a key brain area for visuospatial processing and locomotion. It has been repetitively shown to be involved in the neural correlates of freezing of gait (FOG), a common symptom of Parkinson's disease (PD). However, current neuroimaging modalities do not allow to precisely determine the role of the PPC during real FOG episodes. OBJECTIVES The purpose of this study was to modulate the PPC cortical excitability using repetitive transcranial magnetic stimulation (rTMS) to determine whether the PPC contributes to FOG or compensates for dysfunctional neural networks to reduce FOG. METHODS Fourteen participants with PD who experience freezing took part in a proof of principle study consisting of three experimental sessions targeting the PPC with inhibitory, excitatory, and sham rTMS. Objective FOG outcomes and cortical excitability measurements were acquired before and after each stimulation protocol. RESULTS Increasing PPC excitability resulted in significantly fewer freezing episodes and percent time frozen during a FOG-provoking task. This reduction in FOG most likely emerged from the trend in PPC inhibiting the lower leg motor cortex excitability. CONCLUSION Our results suggest that the recruitment of the PPC is linked to less FOG, providing support for the beneficial role of the PPC upregulation in preventing FOG. This could potentially be linked to a reduction of the cortical input burden on the basal ganglia prior to FOG. Excitatory rTMS interventions targeting the PPC may have the potential to reduce FOG.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; McGill University, Integrated Program in Neuroscience, McGill University, Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Alejandra Martinez-Moreno
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Julien Clouette
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Frédérike Parent-L'Ecuyer
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Henri Lajeunesse
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Caroline Paquette
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; McGill University, Integrated Program in Neuroscience, McGill University, Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada.
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18
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Gan C, Ji M, Sun H, Cao X, Shi J, Wang L, Zhang H, Yuan Y, Zhang K. Dynamic functional connectivity reveals hyper-connected pattern and abnormal variability in freezing of gait of Parkinson's disease. Neurobiol Dis 2023; 185:106265. [PMID: 37597816 DOI: 10.1016/j.nbd.2023.106265] [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: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is an intractable and paroxysmal gait disorder that seriously affects the quality of life of Parkinson's disease (PD) patients. Emerging studies have reported abnormal brain activity of distributed networks in FOG patients, whereas ignoring the intrinsic dynamic fluctuations of functional connectivity. The purpose of this study was to examine the dynamic functional network connectivity (dFNC) of PD-FOG. METHODS In total, 52 PD patients with FOG (PD-FOG), 73 without FOG (PD-NFOG) and 38 healthy controls (HCs) received resting state functional magnetic resonance imaging (rs-fMRI). Sliding window method, k-means clustering and graph theory analysis were employed to retrieve dynamic characteristics of PD-FOG. Partial correlation analysis was conducted to verify whether the dFNC was related to freezing gait severity. RESULTS Seven brain networks were identified and configured into seven states. Compared to PD-NFOG, significant spatial pattern was identified for state 2 in freezers, showing increased functional coupling between default mode network (DMN) and basal ganglia network (BG), as a concrete manifestation of increased precuneus-caudate coupling. The mean dwell time and fractional window of state 2 had a positive correlation with FOG severity. Furthermore, PD-FOG group exhibited lower variance in nodal efficiency of independent components (IC) 7 (left precuneus). CONCLUSIONS Our study suggested that aberrant coupling of precuneus-caudate and disrupted variability of precuneus efficiency might be associated to the neural mechanisms of FOG.
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Affiliation(s)
- Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jiaxin Shi
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Mancini M, Hasegawa N, Peterson DS, Horak FB, Nutt JG. Digital measures of freezing of gait across the spectrum of normal, non-freezers, possible freezers and definite freezers. J Neurol 2023; 270:4309-4317. [PMID: 37208526 DOI: 10.1007/s00415-023-11773-4] [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: 01/29/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
Over the course of the disease, freezing of gait (FoG) will gradually impact over 80% of people with Parkinson's disease (PD). Clinical decision-making and research design are often based on classification of patients as 'freezers' or 'non-freezers'. We derived an objective measure of FoG severity from inertial sensors on the legs to examine the continuum of FoG from absent to possible and severe in people with PD and in healthy controls. One hundred and forty-seven people with PD (Off-medication) and 83 healthy control subjects turned 360° in-place for 1 minute while wearing three wearable sensors used to calculate a novel Freezing Index. People with PD were classified as: 'definite freezers', new FoG questionnaire (NFOGQ) score > 0 and clinically observed FoG; 'non-freezers', NFOGQ = 0 and no clinically observed FoG; and 'possible freezers', either NFOGQ > 0 but no FoG observed or NFOGQ = 0 but FoG observed. Linear mixed models were used to investigate differences in participant characteristics among groups. The Freezing Index significantly increased from healthy controls to non-freezers to possible freezers and to definite freezers and showed, in average, excellent test-retest reliability (ICC = 0.89). Unlike the Freezing Index, sway, gait and turning impairments were similar across non-freezers, possible and definite freezers. The Freezing Index was significantly related to NFOG-Q, disease duration, severity, balance confidence, and the SCOPA-Cog (p < 0.01). An increase in the Freezing Index, objectively assessed with wearable sensors during a turning- in-place test, may help identify prodromal FoG in people with PD prior to clinically-observable or patient-perceived freezing. Future work should follow objective measures of FoG longitudinally.
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Affiliation(s)
- Martina Mancini
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Road, OP-32, Portland, OR, 97239, USA.
| | - Naoya Hasegawa
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Road, OP-32, Portland, OR, 97239, USA
- Department of Rehabilitation Science, Hokkaido University, Sapporo, Japan
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Fay B Horak
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Road, OP-32, Portland, OR, 97239, USA
| | - John G Nutt
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Road, OP-32, Portland, OR, 97239, USA
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20
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Mezzarobba S, Cosentino C, Putzolu M, Panuccio F, Fabbrini G, Valente D, Costi S, Galeoto G, Pelosin E. Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study. Neurol Sci 2023; 44:3133-3140. [PMID: 37072581 PMCID: PMC10112304 DOI: 10.1007/s10072-023-06800-1] [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: 07/08/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Freezing of gait (FOG) in Parkinson's disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD. OBJECTIVE The aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It). METHODS The translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach's alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y). To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Falls Efficacy Scale-International (FES-I), the 6-min Walking Test (6MWT), the Mini Balance Evaluation System Test (Mini-BESTest) and the Short Physical Performance Battery (SPPB) were investigated. RESULTS The Italian N-FOGQ had high internal consistency (Cronbach's α = 0.859). Validity analysis showed significant correlations between NFOG-Q-IT total score and M-H&Y scores (r = 0.281 p < 0.001), MDS-UPDRS (r = 0.359 p < 0.001), FES-I (r = 0.230 p = 0.002), Mini BESTest (r = -0.256 p = 0.001) and 6MWT (r = -0.166 p = 0.026). No significant correlations were found with SPPB, MOCA and MMSE. CONCLUSION The NFOG-It is a valuable and reliable tool for assessing FOG symptoms, duration and frequency in PD subjects. Results provide the validity of NFOG-Q-It by reproducing and enlarging previous psychometric data.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Francescaroberta Panuccio
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Università Di Modena E Reggio Emilia, 41100, Modena, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy.
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
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21
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Goh L, Canning CG, Song J, Clemson L, Allen NE. The effect of rehabilitation interventions on freezing of gait in people with Parkinson's disease is unclear: a systematic review and meta-analyses. Disabil Rehabil 2023; 45:3199-3218. [PMID: 36106644 DOI: 10.1080/09638288.2022.2120099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/19/2021] [Revised: 08/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To summarize the effects of rehabilitation interventions to reduce freezing of gait (FOG) in people with Parkinson's disease. METHODS A systematic review with meta-analyses of randomized trials of rehabilitation interventions that reported a FOG outcome was conducted. Quality of included studies and certainty of FOG outcome were assessed using the PEDro scale and GRADE framework. RESULTS Sixty-five studies were eligible, with 62 trialing physical therapy/exercise, and five trialing cognitive and/or behavioral therapies. All meta-analyses produced very low-certainty evidence. Physical therapy/exercise had a small effect on reducing FOG post-intervention compared to control (Hedges' g= -0.26, 95% CI= -0.38 to -0.14, 95% prediction interval (PI)= -0.38 to -0.14). We are uncertain of the effects on FOG post-intervention when comparing: exercise with cueing to without cueing (Hedges' g= -0.58, 95% CI= -0.86 to -0.29, 95% PI= -1.23 to 0.08); action observation training plus movement strategy practice to practice alone (Hedges' g= -0.56, 95% CI= -1.16 to 0.05); and dance to multimodal exercises (Hedges' g= -0.64, 95% CI= -1.53 to 0.25). CONCLUSIONS We are uncertain if physical therapy/exercise, cognitive or behavioral therapies, are effective at reducing FOG.Implications for rehabilitationFOG leads to impaired mobility and falls, but the effect of rehabilitation interventions (including physical therapy/exercise and cognitive/behavioral therapies) on FOG is small and uncertain.Until more robust evidence is generated, clinicians should assess FOG using both self-report and physical measures, as well as other related impairments such as cognition, anxiety, and fear of falling.Interventions for FOG should be personalized based on the individual's triggers and form part of a broader exercise program addressing gait, balance, and falls prevention.Interventions should continue over the long term and be closely monitored and adjusted as individual circumstances change.
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Affiliation(s)
- Lina Goh
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jooeun Song
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lindy Clemson
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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22
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Jin C, Qi S, Yang L, Teng Y, Li C, Yao Y, Ruan X, Wei X. Abnormal functional connectivity density involvement in freezing of gait and its application for subtyping Parkinson's disease. Brain Imaging Behav 2023; 17:375-385. [PMID: 37243751 DOI: 10.1007/s11682-023-00765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/29/2023]
Abstract
The pathophysiological mechanisms at work in Parkinson's disease (PD) patients with freezing of gait (FOG) remain poorly understood. Functional connectivity density (FCD) could provide an unbiased way to analyse connectivity across the brain. In this study, a total of 23 PD patients with FOG (PD FOG + patients), 26 PD patients without FOG (PD FOG- patients), and 22 healthy controls (HCs) were recruited, and their resting-state functional magnetic resonance imaging (rs-fMRI) images were collected. FCD mapping was first performed to identify differences between groups. Pearson correlation analysis was used to explore relationships between FCD values and the severity of FOG. Then, a machine learning model was employed to classify each pair of groups. PD FOG + patients showed significantly increased short-range FCD in the precuneus, cingulate gyrus, and fusiform gyrus and decreased long-range FCD in the frontal gyrus, temporal gyrus, and cingulate gyrus. Short-range FCD values in the middle temporal gyrus and inferior temporal gyrus were positively correlated with FOG questionnaire (FOGQ) scores, and long-range FCD values in the middle frontal gyrus were negatively correlated with FOGQ scores. Using FCD in abnormal regions as input, a support vector machine (SVM) classifier can achieve classification with good performance. The mean accuracy values were 0.895 (PD FOG + vs. HC), 0.966 (PD FOG- vs. HC), and 0.897 (PD FOG + vs. PD FOG-). This study demonstrates that PD FOG + patients showed altered short- and long-range FCD in several brain regions involved in action planning and control, motion processing, emotion, cognition, and object recognition.
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Affiliation(s)
- Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Lei Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yueyang Teng
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Chen Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yudong Yao
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, Hoboken, USA
| | - Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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23
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An EJ, Sim WS, Kim SM, Kim JY. Suitability of visual cues for freezing of gait in patients with idiopathic Parkinson's disease: a case-control pilot study. J Neuroeng Rehabil 2023; 20:91. [PMID: 37464390 PMCID: PMC10354967 DOI: 10.1186/s12984-023-01214-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most debilitating symptoms in patients with idiopathic Parkinson's disease (IPD). Visual cues can relieve FOG symptoms. However, there is no consensus on patient characteristics that can benefit from visual cues. Therefore, we examined the differences in IPD patient characteristics according to the effectiveness of visual cueing. METHODS Through gait experiments, we investigated the number of FOG occurrences, average FOG period per episode, proportion of FOG duration in the total gait cycles, and FOG-free period gait spatiotemporal parameters in ten participants diagnosed with FOG due to IPD. Subsequently, the differences between their clinical characteristics and striatal dopamine active transporter availability from six subregions of the striatum were compared by dividing them into two groups based on the three reduction rates: occurrence numbers, mean durations per episode, and proportion of FOG duration in the total gait cycles improved by visual cueing using laser shoes. The relationships among these three reduction rates and other FOG-related parameters were also investigated using Spearman correlation analyses. RESULTS According to the three FOG-related reduction rates, the group assignments were the same, which was also related to the baseline self-reported FOG severity score (New Freezing of Gait Questionnaire): the more severe the FOG, the poorer the response to the visual cueing. By visual cueing, the better response group demonstrated the characteristics of lower new FOG questionnaire total scores, higher dopamine active transporter availability of the anterior and posterior putamen, and shorter mean duration of FOG per episode in the absence of cueing. These results were replicated using Spearman correlation analyses. CONCLUSIONS For FOG symptoms following IPD, gait assistance by visual cueing may be more effective when the total NFOGQ score is lower and the DAT of putamen is higher. Through this study, we demonstrated clinical and striatal dopaminergic conditions to select patients who may be more likely to benefit from visual cueing with laser shoes, and these findings lead to the need for early diagnosis of FOG in patients with IPD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05080413. Registered on September 14, 2021.
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Affiliation(s)
- Eui Jin An
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Woo-Sob Sim
- Department of Prosthetics and Orthotics Center, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Seung Min Kim
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jun Yup Kim
- Department of Physical Medicine and Rehabilitation, Hanyang University Medical Center, Seoul, Republic of Korea.
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.
- Mailing address:, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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24
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Suharto AP, Sensusiati AD, Hamdan M, Bastiana DS. Structural magnetic resonance imaging in Parkinson disease with freezing of gait: A systematic review of literature. J Neurosci Rural Pract 2023; 14:399-405. [PMID: 37692820 PMCID: PMC10483193 DOI: 10.25259/jnrp_107_2023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This review aims to the existing structural neuroimaging literature in Parkinson disease presenting with freezing of gait. The summary of this article provides an opportunity for a better understanding of the structural findings of freezing of gait in Parkinson disease based on MRI. Methods This systematic review of literature follows the procedures as described by the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Initial searches yielded 545 documents. After exclusions, 11 articles were included into our study. Current findings of structural MRI on freezing of gait in Parkinson disease are associated with structural damage between sensorimotor-related cortical grey matter structures and thalamus, but not cerebellum and smaller systems, as well as extensive injuries on white matter connecting between those structures. Conclusion Current findings of structural MRI on freezing of gait in Parkinson disease are associated with structural damage between sensorimotor-related cortical grey matter structures and thalamus, but not cerebellum and smaller systems, as well as extensive injuries on white matter connecting between those structures.
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Affiliation(s)
- Ade Pambayu Suharto
- Department Neurology, Faculty of Medicine, Airlangga University - Dr Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Anggraini Dwi Sensusiati
- Department Radiology, Faculty of Medicine, Airlangga University - Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Hamdan
- Department Neurology, Faculty of Medicine, Airlangga University - Dr Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Dewi Setyaning Bastiana
- Department Neurology, Faculty of Medicine, Airlangga University - Dr Soetomo General Hospital, Surabaya, East Java, Indonesia
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25
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Heimler B, Koren O, Inzelberg R, Rosenblum U, Hassin-Baer S, Zeilig G, Bartsch RP, Plotnik M. Heart-rate variability as a new marker for freezing predisposition in Parkinson's disease. Parkinsonism Relat Disord 2023:105476. [PMID: 37321936 DOI: 10.1016/j.parkreldis.2023.105476] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Freezing of gait (FoG) is a debilitating symptom of advanced Parkinson's disease (PD) characterized by a sudden, episodic stepping arrest despite the intention to continue walking. The etiology of FoG is still unknown, but accumulating evidence unraveled physiological signatures of the autonomic nervous system (ANS) around FoG episodes. Here we aim to investigate for the first time whether detecting a predisposition for upcoming FoG events from ANS activity measured at rest is possible. METHODS We recorded heart-rate for 1-min while standing in 28 persons with PD with FoG (PD + FoG), while OFF, and in 21 elderly controls (EC). Then, PD + FoG participants performed walking trials containing FoG-triggering events (e.g., turns). During these trials, n = 15 did experience FoG (PD + FoG+), while n = 13 did not (PD + FoG-). Most PD participants (n = 20: 10 PD + FoG+ and 10 PD + FoG-) repeated the experiment 2-3 weeks later, while ON, and none experienced FoG. We then analyzed heart-rate variability (HRV), i.e., the fluctuations in time intervals between adjacent heartbeats, mainly generated by brain-heart interactions. RESULTS During OFF, HRV was significantly lower in PD + FoG + participants, reflecting imbalanced sympathetic/parasympathetic activity and disrupted self-regulatory capacity. PD + FoG- and EC participants showed comparable (higher) HRV. During ON, HRV did not differ among groups. HRV values did not correlate with age, PD duration, levodopa consumption, nor motor -symptoms severity scores. CONCLUSIONS Overall, these results document for the first time a relation between HRV at rest and FoG presence/absence during gait trials, expanding previous evidence regarding the involvement of ANS in FoG.
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Affiliation(s)
- Benedetta Heimler
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.
| | - Or Koren
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Rivka Inzelberg
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Rosenblum
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Hassin-Baer
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Movement Disorders Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Ronny P Bartsch
- Department of Physics, Bar-Ilan University, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Zhou W, He J, Zhang C, Pan Y, Sang T, Qiu X. Fiber-specific white matter alterations in Parkinson's disease patients with freezing of gait. Brain Res 2023:148440. [PMID: 37271491 DOI: 10.1016/j.brainres.2023.148440] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Freezing of gait (FOG) is a gait disorder that usually occurs in advanced stages of Parkinson's disease (PD). Understanding the underlying mechanism of FOG is important for treatment and prevention. Previous studies have investigated white matter (WM) structure to explore the pathology of FOG. However, the pathology is still unclear, possibly due to the methodological limitation in identifying specific fiber tracts. This study aimed to investigate tract-specific WM structural changes in FOG patients and their relationships with clinical characteristics. We enrolled 19 PD patients with FOG (PD-FOG), 19 without FOG (PD-woFOG) and 21 controls. Fixel-based analysis is a novel framework to avoid the effect of crossing fibers, which provides the metrics to assess WM morphology. By combining a method for segmenting fibers, we identified abnormalities in the specific fiber tracts. Compared to PD-woFOG, PD-FOG showed significant increased fiber-bundle cross-section (FC) in the corpus callosum (CC), fornix (FX), inferior longitudinal fasciculus (ILF), striato-premotor (ST_PREM), superior thalamic radiation (STR), thalamo-premotor (T_PREM), increased fiber density and cross-section (FDC) in the STR, and decreased fiber density (FD) in the CC and ILF. Additionally, the ILF was correlated with motor, cognition and memory, the CC was correlated with anxiety, and the T_PREM was also correlated with cognition. In conclusion, in addition to impairments of WM found in PD-FOG, we found enhancements in WM, which may imply compensatory mechanisms. Furthermore, multiple fiber tracts were correlated with clinical characteristics, especially the ILF, validating the involvement of transmission circuits of multiple distinct information in mechanisms of FOG.
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Affiliation(s)
- Wenyang Zhou
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China
| | - Jianzhong He
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China
| | - Chengzhe Zhang
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China
| | - Yiang Pan
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China
| | - Tian Sang
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China
| | - Xiang Qiu
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China; Department of Automation, Zhejiang University of Technology, Hangzhou 310023, People's Republic of China.
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Virmani T, Pillai L, Glover A, Landes RD. Levodopa responsive gait dynamics in OFF- and ONOFF-state freezing of gait in Parkinson's disease. Clin Park Relat Disord 2023; 9:100202. [PMID: 37288072 PMCID: PMC10241963 DOI: 10.1016/j.prdoa.2023.100202] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Background In people with Parkinson's disease (PwPD), Freezing of Gait (FOG) episodes can be levodopa responsive (OFF-FOG) or levodopa unresponsive (ONOFF-FOG). Steady-state gait abnormalities, outside of the freezing episodes themselves also exist and the response to levodopa in these different groups has not been previously documented. Objectives To define the levodopa responsiveness in steady-state gait in OFF-FOG and ONOFF-FOG individuals. Methods Steady-state gait was collected in both the effective levodopa OFF-state (doses withheld > 8 h) and ON-state (1 h after levodopa dosing) in 32 PwPD; 10 with OFF-FOG and 22 with ONOFF-FOG. Levodopa response was compared between the two groups in the mean and variability (CV) of 8 spatiotemporal gait parameters. Results Both OFF-FOG and ONOFF-FOG participants showed improvement in mean stride-length and stride-velocity with levodopa. Improvement was seen in the OFF-FOG but not the ONOFF-FOG groups in mean stride-width and CV Integrated pressure with levodopa. Discussion In this study we show that steady-state gait deficits improve with levodopa in PwPD with OFF-FOG and ONOFF-FOG, even though episodes of FOG did not resolve in the ONOFF-FOG group. Lowering levodopa in people with ONOFF-FOG, or levodopa-unresponsive freezing of gait, should be undertake with caution and objective gait titration at different levodopa doses may be beneficial. Further work is needed to elucidate the pathophysiologic mechanisms of these differences.
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Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Reid D. Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Ruan X, Huang X, Li Y, Kuang Z, Li M, Wei X. Dysfunction of human brain network hierarchy in Parkinson's disease patients with freezing of gait. Parkinsonism Relat Disord 2023; 112:105446. [PMID: 37245278 DOI: 10.1016/j.parkreldis.2023.105446] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Hierarchy has been identified as a principle underlying the organization of human brain networks. In Parkinson's disease with freezing of gait (PD-FOG), it remains unclear whether and how the network hierarchy is disrupted. Additionally, the associations between changes in the brain network hierarchy of PD patients with FOG and clinical scales remain unclear. The aim of this study was to explore alterations in the network hierarchy of PD-FOG and their clinical relevance. METHODS In this study, the brain network hierarchy of each group was described through a connectome gradient analysis among 31 PD-FOG, 50 PD patients without FOG (PD-NFOG), and 38 healthy controls (HC). Changes in the network hierarchy were assessed by comparing different gradient values of each network between the PD-FOG, PD-NFOG and HC groups. We further examined the relationship between dynamically changing network gradient values and clinical scales. RESULTS For the second gradient, Salience/ventral attention network-A (SalVentAttnA) network gradient of PD-FOG group was significantly lower than that of PD-NFOG, while both PD subgroups had a Default mode network-C gradient that was significantly lower than that of the HC group. In the third gradient, somatomotor network-A gradient of PD-FOG patients was significantly lower than the PD-NFOG group. Moreover, reduced SalVentAttnA network gradient values were associated with more severe gaits, fall risk, and frozen gait in PD-FOG patients. CONCLUSIONS The brain network hierarchy in PD-FOG is disturbed, this dysfunction is related to the severity of frozen gait. This study provides novel evidence for the neural mechanisms of FOG.
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Affiliation(s)
- Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiaofei Huang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuting Li
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Zhanyu Kuang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
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Dijkstra BW, Gilat M, D'Cruz N, Zoetewei D, Nieuwboer A. Neural underpinnings of freezing-related dynamic balance control in people with Parkinson's disease. Parkinsonism Relat Disord 2023; 112:105444. [PMID: 37257264 DOI: 10.1016/j.parkreldis.2023.105444] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/08/2023] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION People with Parkinson's disease (PD) with freezing of gait (FOG; freezers) show impaired dynamic balance and experience falls more frequently compared to those without (non-freezers). Here, we explore the neural underpinnings of these freezing-related balance problems. METHODS 12 freezers, 16 non-freezers and 14 controls performed a dynamic balance task in the lab. The next day, the same task was investigated in the MRI-scanner through motor imagery (MI). A visual imagery (VI) control task was also performed. Imagery engagement was determined by comparing the performance times between the dynamic balance task, and its MI- and VI-variants. Balance-related brain activations in regions of interest were contrasted between groups based on an MI > rest versus VI > rest contrast. RESULTS Freezers and non-freezers were matched for age, cognition and disease severity. Similar performance times between the balance control task and the MI-conditions revealed excellent imagery engagement. Compared to non-freezers, freezers showed decreased activation in regions of interest located in the left mesencephalic locomotor region (MLR; p = 0.006), right anterior cerebellum (p = 0.017) and cerebellar vermis (p < 0.001). Intriguingly, non-freezers showed higher activations in the cerebellar vermis than controls (p = 0.010). CONCLUSION Overall, we showed that decreased activation in the left MLR, and cerebellar regions in freezers relative to non-freezers could explain why dynamic balance is more affected in freezers. As non-freezers displayed increased cerebellar vermis activation compared to controls, it is possible that freezers show an inability to recruit sufficient compensatory cerebellar activity for effective dynamic balance control.
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Affiliation(s)
- Bauke W Dijkstra
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium.
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
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Korkusuz S, Seçkinoğulları B, Özcan A, Demircan EN, Çakmaklı GY, Armutlu K, Yavuz F, Elibol B. Effects of freezing of gait on balance in patients with Parkinson's disease. Neurol Res 2023; 45:407-414. [PMID: 36413435 DOI: 10.1080/01616412.2022.2149510] [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: 07/07/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the effects of freezing of gait (FOG) on static and dynamic balance. METHODS Twenty patients with Parkinson's disease with and without FOG [PD+FOG (68,6±6,39 years) and PD-FOG group (70,6±4,57 years)] and 10 healthy individuals (68,4±4,92 years) with similar demographic characteristics were included in the study. Balance was compared between the three groups. Balance was evaluated with clinical tests Limits of stability (LoS) and body sway were measured using the E-LINK FP3 Force Plate and the Korebalance Balance Evaluation System, which measure the balance in static and dynamic conditions. Center of pressure (COP) change and average sway velocity were evaluated with the Zebris RehaWalk system. RESULTS Total and subscale scores of the Unified Parkinson's Disease Rating Scale were significantly higher in the PD+FOG group (p<0.05). The balance test results for both groups were similar (p>0.05). The PD+FOG group performed worse on the computerized static balance tests, the COP analysis, and the dynamic balance total score than the other two groups (p<0.05). The PD+FOG group had significantly greater sustained weight deviation than the healthy controls (p<0.05). Patients with Parkinson's disease had a lower LoS in the posterior direction than healthy controls (p<0.05). DISCUSSION FOG affects the dynamic balance more negatively than the static balance. In addition, FOG reduces LoS in the posterior direction and increases body sway in the anterior-posterior direction, which can lead to falls.
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Affiliation(s)
- Süleyman Korkusuz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Büşra Seçkinoğulları
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşenur Özcan
- Department of Physical Therapy and Rehabilitation, Çankırı Karatekin University, Çankırı, Turkey
| | - Emine Nur Demircan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gül Yalçın Çakmaklı
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
| | - Kadriye Armutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ferdi Yavuz
- Faculty of Health Sciences, European University of Lefke, Lefke, Cyprus
| | - Bülent Elibol
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
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Cockx H, Nonnekes J, Bloem B, van Wezel R, Cameron I, Wang Y. Dealing with the heterogeneous presentations of freezing of gait: how reliable are the freezing index and heart rate for freezing detection? J Neuroeng Rehabil 2023; 20:53. [PMID: 37106388 PMCID: PMC10134593 DOI: 10.1186/s12984-023-01175-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is an unpredictable gait arrest that hampers the lives of 40% of people with Parkinson's disease. Because the symptom is heterogeneous in phenotypical presentation (it can present as trembling/shuffling, or akinesia) and manifests during various circumstances (it can be triggered by e.g. turning, passing doors, and dual-tasking), it is particularly difficult to detect with motion sensors. The freezing index (FI) is one of the most frequently used accelerometer-based methods for FOG detection. However, it might not adequately distinguish FOG from voluntary stops, certainly for the akinetic type of FOG. Interestingly, a previous study showed that heart rate signals could distinguish FOG from stopping and turning movements. This study aimed to investigate for which phenotypes and evoking circumstances the FI and heart rate might provide reliable signals for FOG detection. METHODS Sixteen people with Parkinson's disease and daily freezing completed a gait trajectory designed to provoke FOG including turns, narrow passages, starting, and stopping, with and without a cognitive or motor dual-task. We compared the FI and heart rate of 378 FOG events to baseline levels, and to stopping and normal gait events (i.e. turns and narrow passages without FOG) using mixed-effects models. We specifically evaluated the influence of different types of FOG (trembling vs akinesia) and triggering situations (turning vs narrow passages; no dual-task vs cognitive dual-task vs motor dual-task) on both outcome measures. RESULTS The FI increased significantly during trembling and akinetic FOG, but increased similarly during stopping and was therefore not significantly different from FOG. In contrast, heart rate change during FOG was for all types and during all triggering situations statistically different from stopping, but not from normal gait events. CONCLUSION When the power in the locomotion band (0.5-3 Hz) decreases, the FI increases and is unable to specify whether a stop is voluntary or involuntary (i.e. trembling or akinetic FOG). In contrast, the heart rate can reveal whether there is the intention to move, thus distinguishing FOG from stopping. We suggest that the combination of a motion sensor and a heart rate monitor may be promising for future FOG detection.
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Affiliation(s)
- Helena Cockx
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands.
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Bastiaan Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Ian Cameron
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- OnePlanet Research Center, Nijmegen, The Netherlands
| | - Ying Wang
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525AJ, Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- ZGT Academy, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Cosentino C, Putzolu M, Mezzarobba S, Cecchella M, Innocenti T, Bonassi G, Botta A, Lagravinese G, Avanzino L, Pelosin E. One cue does not fit all: a systematic review with meta-analysis of the effectiveness of cueing on freezing of gait in Parkinson's disease. Neurosci Biobehav Rev 2023; 150:105189. [PMID: 37086934 DOI: 10.1016/j.neubiorev.2023.105189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
The difficulty in assessing FOG and the variety of existing cues, hamper to determine which cueing modality should be applied and which FOG-related aspect should be targeted to reach personalized treatments for FOG. This systematic review aimed to highlight: i) whether cues could reduce FOG and improve FOG-related gait parameters, ii) which cues are the most effective, iii) whether medication state (ON-OFF) affects cues-related results. Thirty-three repeated measure design studies assessing cueing effectiveness were included and subdivided according to gait tasks (gait initiation, walking, turning) and to the medication state. Main results reveal that: preparatory phase of gait initiation benefit from visual and auditory cues; spatio-temporal parameters (e.g., step and stride length) and are improved by visual cues during walking; turning time and step time variability are reduced by applying auditory and visual cues. Some findings on the potential benefits of cueing on FOG and FOG gait-related parameters were found. Questions remain about which are the best behavioral strategies according to FOG features and PD clinical characteristics.
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Affiliation(s)
- Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | - Martina Putzolu
- Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Margherita Cecchella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; GIMBE Foundation, Bologna, Italy
| | - Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | | | - Giovanna Lagravinese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Avanzino
- Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
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Monaghan AS, Gordon E, Graham L, Hughes E, Peterson DS, Morris R. Cognition and freezing of gait in Parkinson's disease: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 147:105068. [PMID: 36738813 DOI: 10.1016/j.neubiorev.2023.105068] [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: 09/19/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
Freezing of gait (FOG) is a common and disabling symptom in people with Parkinson's Disease (PwPD). Although cognition is thought to be worse in PwPD who freeze, a comprehensive analysis of this relationship will inform future research and clinical care. This systematic review and meta-analysis compared cognition between PwPD who do and do not exhibit FOG across a range of cognitive domains and assessed the impact of disease severity and medication status on this relationship. 145 papers (n = 9010 participants) were included in the analysis, with 144 and 138 articles meeting the criteria to assess moderating effects of disease severity and medication status, respectively. PwPD who freeze exhibited worse cognition than PwPD without FOG across global cognition, executive function/attention, language, memory, and visuospatial domains. Greater disease severity and "ON" levodopa medication status moderated the FOG status-cognition relationship in global cognitive performance but not in other cognitive domains. This meta-analysis confirmed that cognition is worse in PwPD with FOG and highlights the importance of disease severity and medication status in this relationship.
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Affiliation(s)
- A S Monaghan
- College of Health Solutions, Arizona State University, 5th St., Phoenix, AZ 85282, USA
| | - E Gordon
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - L Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - E Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - D S Peterson
- College of Health Solutions, Arizona State University, 5th St., Phoenix, AZ 85282, USA; Phoenix VA Health Care Center, 650 E Indian School Rd, Phoenix, AZ, USA.
| | - R Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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McKay JL, Nye J, Goldstein FC, Sommerfeld B, Smith Y, Weinshenker D, Factor SA. Levodopa responsive freezing of gait is associated with reduced norepinephrine transporter binding in Parkinson's disease. Neurobiol Dis 2023; 179:106048. [PMID: 36813207 DOI: 10.1016/j.nbd.2023.106048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a major cause of falling in Parkinson's disease (PD) and can be responsive or unresponsive to levodopa. Pathophysiology is poorly understood. OBJECTIVE To examine the link between noradrenergic systems, the development of FOG in PD and its responsiveness to levodopa. METHODS We examined norepinephrine transporter (NET) binding via brain positron emission tomography (PET) to evaluate changes in NET density associated with FOG using the high affinity selective NET antagonist radioligand [11C]MeNER (2S,3S)(2-[α-(2-methoxyphenoxy)benzyl]morpholine) in 52 parkinsonian patients. We used a rigorous levodopa challenge paradigm to characterize PD patients as non-freezing (NO-FOG, N = 16), levodopa responsive freezing (OFF-FOG, N = 10), and levodopa-unresponsive freezing (ONOFF-FOG, N = 21), and also included a non-PD FOG group, primary progressive freezing of gait (PP-FOG, N = 5). RESULTS Linear mixed models identified significant reductions in whole brain NET binding in the OFF-FOG group compared to the NO-FOG group (-16.8%, P = 0.021) and regionally in the frontal lobe, left and right thalamus, temporal lobe, and locus coeruleus, with the strongest effect in right thalamus (P = 0.038). Additional regions examined in a post hoc secondary analysis including the left and right amygdalae confirmed the contrast between OFF-FOG and NO-FOG (P = 0.003). A linear regression analysis identified an association between reduced NET binding in the right thalamus and more severe New FOG Questionnaire (N-FOG-Q) score only in the OFF-FOG group (P = 0.022). CONCLUSION This is the first study to examine brain noradrenergic innervation using NET-PET in PD patients with and without FOG. Based on the normal regional distribution of noradrenergic innervation and pathological studies in the thalamus of PD patients, the implications of our findings suggest that noradrenergic limbic pathways may play a key role in OFF-FOG in PD. This finding could have implications for clinical subtyping of FOG as well as development of therapies.
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Affiliation(s)
- J Lucas McKay
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA; Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, GA 30332, USA
| | - Jonathan Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Felicia C Goldstein
- Neuropsychology Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA
| | - Barbara Sommerfeld
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA
| | - Yoland Smith
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA; Emory National Primate Center, Emory University, Atlanta, GA 30329, USA
| | - David Weinshenker
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Stewart A Factor
- Jean & Paul Amos Parkinson's Disease & Movement Disorders Program, Department of Neurology, Emory University, Atlanta, GA 30329, USA.
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Tosserams A, Bloem BR, Ehgoetz Martens KA, Helmich RC, Kessels RPC, Shine JM, Taylor NL, Wainstein G, Lewis SJG, Nonnekes J. Modulating arousal to overcome gait impairments in Parkinson's disease: how the noradrenergic system may act as a double-edged sword. Transl Neurodegener 2023; 12:15. [PMID: 36967402 PMCID: PMC10040128 DOI: 10.1186/s40035-023-00347-z] [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: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
In stressful or anxiety-provoking situations, most people with Parkinson's disease (PD) experience a general worsening of motor symptoms, including their gait impairments. However, a proportion of patients actually report benefits from experiencing-or even purposely inducing-stressful or high-arousal situations. Using data from a large-scale international survey study among 4324 people with PD and gait impairments within the online Fox Insight (USA) and ParkinsonNEXT (NL) cohorts, we demonstrate that individuals with PD deploy an array of mental state alteration strategies to cope with their gait impairment. Crucially, these strategies differ along an axis of arousal-some act to heighten, whereas others diminish, overall sympathetic tone. Together, our observations suggest that arousal may act as a double-edged sword for gait control in PD. We propose a theoretical, neurobiological framework to explain why heightened arousal can have detrimental effects on the occurrence and severity of gait impairments in some individuals, while alleviating them in others. Specifically, we postulate that this seemingly contradictory phenomenon is explained by the inherent features of the ascending arousal system: namely, that arousal is related to task performance by an inverted u-shaped curve (the so-called Yerkes and Dodson relationship). We propose that the noradrenergic locus coeruleus plays an important role in modulating PD symptom severity and expression, by regulating arousal and by mediating network-level functional integration across the brain. The ability of the locus coeruleus to facilitate dynamic 'cross-talk' between distinct, otherwise largely segregated brain regions may facilitate the necessary cerebral compensation for gait impairments in PD. In the presence of suboptimal arousal, compensatory networks may be too segregated to allow for adequate compensation. Conversely, with supraoptimal arousal, increased cross-talk between competing inputs of these complementary networks may emerge and become dysfunctional. Because the locus coeruleus degenerates with disease progression, finetuning of this delicate balance becomes increasingly difficult, heightening the need for mental strategies to self-modulate arousal and facilitate shifting from a sub- or supraoptimal state of arousal to improve gait performance. Recognition of this underlying mechanism emphasises the importance of PD-specific rehabilitation strategies to alleviate gait disability.
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Affiliation(s)
- Anouk Tosserams
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Rick C Helmich
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - James M Shine
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Camperdown, NSW, Australia
| | - Natasha L Taylor
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Gabriel Wainstein
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
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Onder H, Oguz KK, Has AC, Elibol B. Comparative analysis of freezing of gait in distinct Parkinsonism types by diffusion tensor imaging method and cognitive profiles. J Neural Transm (Vienna) 2023; 130:521-535. [PMID: 36881182 DOI: 10.1007/s00702-023-02608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Freezing of gait (FOG) is an episodic gait pattern that is common in advanced Parkinson's disease (PD) and other atypical parkinsonism syndromes. Recently, disturbances in the pedunculopontine nucleus (PPN) and its connections have been suggested to play a critical role in the development of FOG. In this study, we aimed to demonstrate possible disturbances in PPN and its connections by performing the diffusion tensor imaging (DTI) technique. We included 18 patients of PD with FOG [PD-FOG], 13 patients of PD without FOG [PD-nFOG] and 12 healthy subjects as well as a group of patients with progressive supranuclear palsy (PSP), an atypical parkinsonism syndrome which is very often complicated with FOG [6 PSP-FOG, 5 PSP-nFOG]. To determine the specific cognitive parameters that can be related to FOG, deliberate neurophysiological evaluations of all the individuals were performed. The comparative analyses and correlation analyses were performed to reveal the neurophysiological and DTI correlates of FOG in either group. We have found disturbances in values reflecting microstructural integrity of the bilateral superior frontal gyrus (SFG), bilateral fastigial nucleus (FN), left pre-supplementary motor area (SMA) in the PD-FOG group relative to the PD-nFOG group. The analysis of the PSP group also demonstrated disturbance in left pre-SMA values in the PSP-FOG group likewise, while negative correlations were determined between right STN, left PPN values and FOG scores. In neurophysiological assessments, lower performances for visuospatial functions were demonstrated in FOG ( +) individuals for either patient group. The disturbances in the visuospatial abilities may be a critical step for the occurrence of FOG. Together with the results of DTI analyses, it might be suggested that impairment in the connectivity of disturbed frontal areas with disordered basal ganglia, maybe the key factor for the occurrence of FOG in the PD group, whereas left PPN which is a nondopaminergic nucleus may play a more prominent role in the process of FOG in PSP. Moreover, our results support the relationship between right STN, and FOG as mentioned before, as well as introduce the importance of FN as a new structure that may be involved in FOG pathogenesis.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Şehit Ömer Halisdemir Street. No: 20 Altındag, 06110, Ankara, Turkey.
| | - Kader Karli Oguz
- Department of Radiology, Hacettepe University Medical School, Ankara, Turkey
| | - Arzu Ceylan Has
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bulent Elibol
- Department of Neurology, Hacettepe University Medical School, Ankara, Turkey
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Yang N, Sang S, Peng T, Hu W, Wang J, Bai R, Lu H. Impact of GBA variants on longitudinal freezing of gait progression in early Parkinson's disease. J Neurol 2023; 270:2756-2764. [PMID: 36790548 DOI: 10.1007/s00415-023-11612-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common disabling gait disturbance among patients with Parkinson's disease (PD), but the influence of genetic variants on the incidence of FOG has been poorly studied to date. OBJECTIVES We aimed to evaluate the association of GBA variants with the risk of FOG development in a large early PD cohort. METHODS This study included 371 early PD patients from the Parkinson's Progression Markers Initiative (PPMI) who were divided into a GBA variant carrier group (GBA-PD group, n = 44) and an idiopathic PD group without GBA variants (iPD group, n = 327). They were followed up for up to 5 years to examine the progression of FOG. The cumulative incidence of FOG and risk factors for FOG were assessed using Kaplan‒Meier and Cox regression analyses. RESULTS At baseline, the GBA-PD group had lower CSF β-amyloid 1-42 (Aβ42) levels and more severe motor and nonmotor symptoms than the iPD group. During the 5-year follow-up, the GBA-PD group had a higher incidence of FOG than the iPD group, and the FOG progression rate was related to GBA variant severity. In the multivariable Cox model without CSF Aβ42, GBA variants were significant predictors of future FOG, and the association remained significant after adding CSF Aβ42 to the model. In the subgroup analyses, the effect of GBA variants was not observed in the "low-level" group. However, in the "high-level" group, GBA variants independently increased the risk of FOG, and this association was stronger than the association with CSF Aβ42. CONCLUSION GBA variants are novel genetic risk factors for future FOG development in early PD patients. This association seemed to be mediated by both Aβ-dependent pathways and Aβ-independent pathways.
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Affiliation(s)
- Nannan Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Shushan Sang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tao Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wentao Hu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jingtao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Rong Bai
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hong Lu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Razmkon A, Abdollahifard S, Taherifard E, Roshanshad A, Shahrivar K. Effect of deep brain stimulation on freezing of gait in patients with Parkinson's disease: a systematic review. Br J Neurosurg 2023; 37:3-11. [PMID: 35603983 DOI: 10.1080/02688697.2022.2077308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVES Freezing of gait (FOG) is a disabling gait disorder in patients with Parkinson's disease (PD), characterized by recurrent episodes of halting steps. Dopaminergic drugs are common treatments for PD and FOG; however, these drugs may worsen FOG. Deep brain stimulation (DBS) is another option used to treat selected patients. The device needs to be programmed at a specific frequency, amplitude, and pulse width to achieve optimum effects for each patient. This systematic review aimed to evaluate the efficacy of DBS for FOG and its correlation with programmed parameters and the location of the electrodes in the brain. MATERIALS AND METHODS Data for this systematic review were gathered from five online databases: Medline (via PubMed), Scopus, Embase, Web of Science, and Cochrane Library (including both Cochrane Reviews and Cochrane Trials) with a broad search strategy. We included those articles that reported clinical trials and a specific measurement for FOG. RESULTS This review included 13 studies of DBS that targeted the subthalamic nucleus (STN), substantia nigra (SNr), or pedunculopontine nucleus (PPN). Our analysis showed that low-frequency stimulation (LFS) was superior to high-frequency stimulation (HFS) for improving FOG. In the long term, the efficacy of both LFS and HFS decreased. The effect of amplitude was variable, and this parameter needed to be adjusted for each patient. Bilateral stimulation was better than unilateral stimulation. CONCLUSION DBS is a promising choice for the treatment of severe FOG in patients with PD. Bilateral, low-frequency stimulation combined with medical therapy is associated with better responses, especially in the first 2 years of treatment. However, individualizing the DBS parameters should be considered to optimize treatment response.
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Affiliation(s)
- Ali Razmkon
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Saeed Abdollahifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Unite de Recherche Clinique du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Erfan Taherifard
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Roshanshad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Master Public Health (MPH), School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyab Shahrivar
- Research Center for Neuromodulation and Pain, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Yogev-Seligmann G, Josman N, Bitterman N, Rosenblum S, Naaman S, Gilboa Y. The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study. Biomed Eng Online 2023; 22:2. [PMID: 36658571 PMCID: PMC9851591 DOI: 10.1186/s12938-023-01066-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND People with Parkinson's disease (PwP) may experience gait impairment and freezing of gait (FOG), a major cause of falls. External cueing, including visual (e.g., spaced lines on the floor) and auditory (e.g., rhythmic metronome beats) stimuli, are considered effective in alleviating mobility deficits and FOG. Currently, there is a need for a technology that delivers automatic, individually adjusted cues in the homes of PwP. The aims of this feasibility study were to describe the first step toward the development of a home-based technology that delivers external cues, test its effect on gait, and assess user experience. METHODS Iterative system development was performed by our multidisciplinary team. The system was designed to deliver visual and auditory cues: light stripes projected on the floor and metronome beats, separately. Initial testing was performed using the feedback of five healthy elderly individuals on the cues' clarity (clear visibility of the light stripes and the sound of metronome beats) and discomfort experienced. A pilot study was subsequently conducted in the homes of 15 PwP with daily FOG. We measured participants' walking under three conditions: baseline (with no cues), walking with light stripes, and walking to metronome beats. Outcome measures included step length and step time. User experience was also captured in semi-structured interviews. RESULTS Repeated-measures ANOVA of gait assessment in PwP revealed that light stripes significantly improved step length (p = 0.009) and step time (p = 0.019) of PwP. No significant changes were measured in the metronome condition. PwP reported that both cueing modalities improved their gait, confidence, and stability. Most PwP did not report any discomfort in either modality and expressed a desire to have such a technology in their homes. The metronome was preferred by the majority of participants. CONCLUSIONS This feasibility study demonstrated the usability and potential effect of a novel cueing technology on gait, and represents an important first step toward the development of a technology aimed to prevent FOG by delivering individually adjusted cues automatically. A further full-scale study is needed. Trial registration This study was registered in ClinicalTrials.gov at 1/2/2022 NCT05211687.
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Affiliation(s)
- Galit Yogev-Seligmann
- grid.18098.380000 0004 1937 0562Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, 3498838 Haifa, Israel
| | - Naomi Josman
- grid.18098.380000 0004 1937 0562Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, 3498838 Haifa, Israel
| | - Noemi Bitterman
- grid.6451.60000000121102151Technion, Israel Institute of Technology, Haifa, Israel
| | - Sara Rosenblum
- grid.18098.380000 0004 1937 0562Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, 3498838 Haifa, Israel
| | - Sitar Naaman
- grid.18098.380000 0004 1937 0562Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Yafit Gilboa
- grid.9619.70000 0004 1937 0538School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Mahmoud HM, Al-Turkistani ZI, Alayat MS, Abd El-Kafy EM, El Fiky AAR. Effect of dancing on freezing of gait in patients with Parkinson's disease: A systematic review and meta-analysis. NeuroRehabilitation 2023; 53:269-284. [PMID: 37927282 DOI: 10.3233/nre-230114] [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] [Indexed: 11/07/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is one of the major debilitating motor symptoms that affect Parkinson's disease (PD) patients' gait,OBJECTIVE:To investigate the effect of dancing on FOG, motor symptoms, and balance in patients with Parkinsonism. METHODS Eight databases were searched for full-text English randomized control trials (RCTs). The freezing of gait (FOG) was the primary outcome while the balance and Unified Parkinson Disease Rating Scale (UPDRS-3) were the secondary outcomes. Methodological quality was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Level of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. A random-effect model of meta-analysis was used to calculate the standardized mean difference (SMD) at a 95% confidence interval (CI), and the effect size. RESULTS A total of nine studies (263 patients) were included. Qualitative data related to participants, dancing type, measured outcomes, and follow-up were extracted. PEDro scale showed one fair-quality and eight high-quality studies. GRADE showed a low to very low level of evidence with moderate effect size on both UPDRS (SMD -70 [-1.04, -0.36]) and Balance (SMD 0.35 [0.08, 0.63]). CONCLUSION Dance is an effective modality on improving UPDRS and balance with small effect on FOG. Further high-quality studies with high-quality of evidence are recommended to increase the confidence to the effect estimate and support the finding results.
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Affiliation(s)
- Hayam Mahmoud Mahmoud
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Zenab Ibrahim Al-Turkistani
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamed Salaheldien Alayat
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ehab Mohamed Abd El-Kafy
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amir Abdel Raouf El Fiky
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Virmani T, Landes RD, Pillai L, Glover A, Larson-Prior L, Prior F, Factor SA. Gait Declines Differentially in, and Improves Prediction of, People with Parkinson's Disease Converting to a Freezing of Gait Phenotype. J Parkinsons Dis 2023; 13:961-973. [PMID: 37522218 PMCID: PMC10578275 DOI: 10.3233/jpd-230020] [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: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating, variably expressed motor symptom in people with Parkinson's disease (PwPD) with limited treatments. OBJECTIVE To determine if the rate of progression in spatiotemporal gait parameters in people converting from a noFOG to a FOG phenotype (FOGConv) was faster than non-convertors, and determine if gait parameters can help predict this conversion. METHODS PwPD were objectively monitored longitudinally, approximately every 6 months. Non-motor assessments were performed at the initial visit. Steady-state gait in the levodopa ON-state was collected using a gait mat (Protokinetics) at each visit. The rate of progression in 8 spatiotemporal gait parameters was calculated. FOG convertors (FOGConv) were classified if they did not have FOG at initial visit and developed FOG at a subsequent visit. RESULTS Thirty freezers (FOG) and 30 non-freezers were monitored an average of 3.5 years, with 10 non-freezers developing FOG (FOGConv). FOGConv and FOG had faster decline in mean stride-length, swing-phase-percent, and increase in mean total-double-support percent, coefficient of variability (CV) foot-strike-length and CV swing-phase-percent than the remaining non-freezers (noFOG). On univariate modeling, progression rates of mean stride-length, stride-velocity, swing-phase-percent, total-double-support-percent and of CV swing-phase-percent had high discriminative power (AUC > 0.83) for classification of the FOGConv and noFOG groups. CONCLUSION FOGConv had a faster temporal decline in objectively quantified gait than noFOG, and progression rates of spatiotemporal gait parameters were more predictive of FOG phenotype conversion than initial (static) parameters Objectively monitoring gait in disease prediction models may help define FOG prone groups for testing putative treatments.
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Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Linda Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Hwang YS, Jo S, Park KW, Lee SH, Lee S, Chung SJ. Association of Depression With Early Occurrence of Postural Instability in Parkinson's Disease. J Mov Disord 2023; 16:68-78. [PMID: 36537065 PMCID: PMC9978256 DOI: 10.14802/jmd.22091] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Depression in Parkinson's disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients. METHODS This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline. RESULTS Kaplan-Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32-4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively). CONCLUSION Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.
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Affiliation(s)
- Yun Su Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Won Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sangjin Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author: Sun Ju Chung, MD, PhD Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea / Tel: +82-2-3010-3440 / Fax: +82-2-474-4691 / E-mail:
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Qu Y, Li J, Chen Y, Li J, Qin Q, Wang D, Zhao J, Yang Q, Mao Z, Xiong Y, Min Z, Xue Z. Freezing of gait is a risk factor for cognitive decline in Parkinson's disease. J Neurol 2023; 270:466-476. [PMID: 36166069 PMCID: PMC9813160 DOI: 10.1007/s00415-022-11371-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUNDS Freezing of gait (FOG) and cognitive impairment are serious symptoms of Parkinson's disease (PD). Understanding the association between FOG and cognition may help formulate specific interventions for PD individuals. OBJECTIVES We aimed to investigate the associations of cognitive impairment in different domains with FOG status using multiple neuropsychological tests. METHODS Two cohorts including 691 and 104 participants were recruited from Parkinson's progression markers initiative (PPMI) and central China, respectively. All participants underwent FOG assessment and neuropsychological tests, and 595 individuals from PPMI and 51 from central China were enrolled for longitudinal observation. Cross-sectional and longitudinal associations between cognition and FOG status were evaluated using multivariable-adjusted models. RESULTS Worse cognitive performances were observed in patients with FOG compared to those without FOG in both cohorts (β = - 0.020, p < 0.001) using multivariate-adjusted models. Moreover, patients with progressive FOG during follow-up manifested more serious cognitive declines (HR = 1.40, 95% CI = 1.07-1.80). The FOG was mainly associated with the decline of executive, attention, and orientation. Furthermore, FOG was associated with higher levels of cognition-related biomarkers including T-tau, P-tau, and NfL in cerebrospinal fluid (p < 0.050). CONCLUSIONS FOG is a risk factor for cognitive decline in PD, which emphasizes the need for early detection and monitoring of cognitive changes and interventions on cognitive impairments in PD patients with FOG.
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Affiliation(s)
- Yi Qu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jiangting Li
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yupeng Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jingyi Li
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qixiong Qin
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Danlei Wang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jingwei Zhao
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qingmei Yang
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhijuan Mao
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongjie Xiong
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhe Min
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zheng Xue
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Togo H, Nakamura T, Wakasugi N, Takahashi Y, Hanakawa T. Interactions across emotional, cognitive and subcortical motor networks underlying freezing of gait. Neuroimage Clin 2023; 37:103342. [PMID: 36739790 PMCID: PMC9932566 DOI: 10.1016/j.nicl.2023.103342] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Freezing of gait (FOG) is a gait disorder affecting patients with Parkinson's disease (PD) and related disorders. The pathophysiology of FOG is unclear because of its phenomenological complexity involving motor, cognitive, and emotional aspects of behavior. Here we used resting-state functional MRI to retrieve functional connectivity (FC) correlated with the New FOG questionnaire (NFOGQ) reflecting severity of FOG in 67 patients with PD. NFOGQ scores were correlated with FCs in the extended basal ganglia network (BGN) involving the striatum and amygdala, and in the extra-cerebellum network (CBLN) involving the frontoparietal network (FPN). These FCs represented interactions across the emotional (amygdala), subcortical motor (BGN and CBLN), and cognitive networks (FPN). Using these FCs as features, we constructed statistical models that explained 40% of the inter-individual variances of FOG severity and that discriminated between PD patients with and without FOG. The amygdala, which connects to the subcortical motor (BGN and CBLN) and cognitive (FPN) networks, may have a pivotal role in interactions across the emotional, cognitive, and subcortical motor networks. Future refinement of the machine learning-based classifier using FCs may clarify the complex pathophysiology of FOG further and help diagnose and evaluate FOG in clinical settings.
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Affiliation(s)
- Hiroki Togo
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Tatsuhiro Nakamura
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Noritaka Wakasugi
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Takashi Hanakawa
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan.
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Abstract
The frontal lobe is crucial and contributes to controlling truncal motion, postural responses, and maintaining equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. For human walking, it is necessary to simultaneously achieve at least two tasks, such as maintaining a bipedal upright posture and locomotion. Particularly, postural control plays an extremely significant role in enabling the subject to maintain stable gait behaviors to adapt to the environment. To achieve these requirements, the frontal cortex (1) uses cognitive information from the parietal, temporal, and occipital cortices, (2) creates plans and programs of gait behaviors, and (3) acts on the brainstem and spinal cord, where the core posture-gait mechanisms exist. Moreover, the frontal cortex enables one to achieve a variety of gait patterns in response to environmental changes by switching gait patterns from automatic routine to intentionally controlled and learning the new paradigms of gait strategy via networks with the basal ganglia, cerebellum, and limbic structures. This chapter discusses the role of each area of the frontal cortex in behavioral control and attempts to explain how frontal lobe controls walking with special reference to postural control.
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Affiliation(s)
- Kaoru Takakusaki
- Department of Physiology, Division of Neuroscience, Asahikawa Medical University, Asahikawa, Japan.
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Borzì L, Sigcha L, Rodríguez-Martín D, Olmo G. Real-time detection of freezing of gait in Parkinson's disease using multi-head convolutional neural networks and a single inertial sensor. Artif Intell Med 2023; 135:102459. [PMID: 36628783 DOI: 10.1016/j.artmed.2022.102459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson's disease (PD), contributing to poor quality of life and increased risk of falls. Wearable sensors represent a valuable means for detecting FOG in the home environment. Moreover, real-time feedback has proven to help reduce the duration of FOG episodes. This work proposes a robust real-time FOG detection algorithm, which is easy to implement in stand-alone devices working in non-supervised conditions. METHOD Data from three different data sets were used in this study, with two employed as independent test sets. Acceleration recordings from 118 PD patients and 21 healthy elderly subjects were collected while they performed simulated daily living activities. A single inertial sensor was attached to the waist of each subject. More than 17 h of valid data and a total number of 1110 FOG episodes were analyzed in this study. The implemented algorithm consisted of a multi-head convolutional neural network, which exploited different spatial resolutions in the analysis of inertial data. The architecture and the model parameters were designed to provide optimal performance while reducing computational complexity and testing time. RESULTS The developed algorithm demonstrated good to excellent classification performance, with more than 50% (30%) of FOG episodes predicted on average 3.1 s (1.3 s) before the actual onset in the main (independent) data set. Around 50% of FOG was detected with an average delay of 0.8 s (1.1 s) in the main (independent) data set. Moreover, a specificity above 88% (93%) was obtained when testing the algorithm on the main (independent) test set, while 100% specificity was obtained on healthy elderly subjects. CONCLUSION The algorithm proved robust, with low computational complexity and processing time, thus paving the way to a real-time implementation in a stand-alone device that can be used in non-supervised environments.
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Affiliation(s)
- Luigi Borzì
- Department of Control and Computer Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy.
| | - Luis Sigcha
- Instrumentation and Applied Acoustics Research Group (I2A2), Universidad Politecnica de Madrid, Ctra. Valencia, Km 7, 28031 Madrid, Spain; ALGORITMI Research Center, School of Engineering, University of Minho, 4800-058 Guimaraes, Portugal.
| | - Daniel Rodríguez-Martín
- Sense4Care S.L., Cornellà de Llobregat, 08940 Barcelona, Spain; Technical Research Centre for Dependency Care and Autonomous Living (CETPD), Universitat Politecnica de Catalunya, 08800 Vilanova i la Geltrù, Spain.
| | - Gabriella Olmo
- Department of Control and Computer Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy.
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Wang L, Ji M, Sun H, Gan C, Zhang H, Cao X, Yuan Y, Zhang K. Reduced Short-Latency Afferent Inhibition in Parkinson's Disease Patients with L-dopa-Unresponsive Freezing of Gait. J Parkinsons Dis 2022; 12:2507-2518. [PMID: 36502341 DOI: 10.3233/jpd-223498] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Freezing of gait (FOG) in Parkinson's disease (PD), especially the "L-dopa-unresponsive" subtype, is associated with the dysfunction of non-dopaminergic circuits. OBJECTIVE We sought to determine whether cortical sensorimotor inhibition evaluated by short-latency afferent inhibition (SAI) related to cholinergic and gamma-aminobutyric acid (GABA)-ergic activities is impaired in PD patients with L-dopa-unresponsive FOG (ONOFF-FOG). METHODS SAI protocol was performed in 28 PD patients with ONOFF-FOG, 15 PD patients with "off" FOG (OFF-FOG), and 25 PD patients without FOG during medication "on" state. Additionally, 10 ONOFF-FOG patients underwent SAI testing during both "off" and "on" states. Twenty healthy controls participated in this study. Gait was measured objectively using a portable Inertial Measurement Unit system, and participants performed 5-meter Timed Up and Go single- and dual-task conditions. Spatiotemporal gait characteristics and their variability were determined. FOG manifestations and cognition were assessed with clinical scales. RESULTS Compared to controls, PD patients without FOG and with OFF-FOG, ONOFF-FOG PD patients showed significantly reduced SAI. Further, dopaminergic therapy had no remarkable effect on this SAI alterations in ONOFF-FOG. Meanwhile, OFF-FOG patients presented decreased SAI only relative to controls. PD patients with ONOFF-FOG exhibited decreased gait speed, stride length, and increased gait variability relative to PD patients without FOG and controls under both walking conditions. For ONOFF-FOG patients, significant associations were found between SAI and FOG severity, gait characteristics and variability. CONCLUSION Reduced SAI was associated with severe FOG manifestations, impaired gait characteristics and variability in PD patients with ONOFF-FOG, suggesting the impaired thalamocortical cholinergic-GABAergic SAI pathways underlying ONOFF-FOG.
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Affiliation(s)
- Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Phuenpathom W, Panyakaew P, Vateekul P, Surangsrirat D, Hiransuthikul A, Bhidayasiri R. Vibratory and plantar pressure stimulation: Steps to improve freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2022; 105:43-51. [PMID: 36347154 DOI: 10.1016/j.parkreldis.2022.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a devastating symptom that develops in patients with advanced Parkinson's disease (PD) and is often unresponsive to pharmacological treatment. Recent research suggests that FOG may result from dysfunctional plantar peripheral sensory systems. The impact of combined plantar pressure and vibratory stimulation over vibratory or pressure alone on FOG remains unexplored. METHODS PD patients with FOG were randomised into four groups and treated with combined vibratory and pressure stimulation, vibratory stimulation alone, pressure stimulation alone, or controls (no stimulation). Vibratory stimulation targeted both Achilles' tendons. Simultaneous bilateral pressure stimulation was applied to the first hallux, first metatarsal bone, and the sole. The primary outcome included normalized percent changes in percent FOG measured both pre- and immediately post-stimulation. Other outcomes including clinical rating scale, response to questionnaires, number and duration of freezing episodes, and spatiotemporal gait parameters at pre- and freezing episodes were also explored. RESULTS Sixty PD patients participated in the study. Patients who were treated with combined vibratory and pressure stimulation responded with significant decreases in normalized percent changes of percent FOG (62.75 ± 25.54%, p < 0.001) compared with those treated with vibration alone (11.38 ± 8.29%, p < 0.001), pressure alone (15.15 ± 16.18%, p < 0.001), or controls (8.59 ± 16.85%, p < 0.001). CONCLUSION Our study demonstrated the benefit of combined vibratory and pressure stimulation on FOG suggesting that this strategy might be developed as a novel treatment modality for PD patients with FOG.
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Affiliation(s)
- Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Doctor of Philosophy Programme in Medicine (Neurology), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Decho Surangsrirat
- Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Akarin Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
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Ruan X, Huang X, Li Y, Li E, Li M, Wei X. Diffusion Tensor Imaging Analysis Along the Perivascular Space Index in Primary Parkinson's Disease Patients With and Without Freezing of Gait. Neuroscience 2022; 506:51-57. [PMID: 36341724 DOI: 10.1016/j.neuroscience.2022.10.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Parkinson's disease (PD) is a common neurodegeneration disease associated with the abnormal deposition and spread of misfolded proteins (α-synuclein and Tau protein), which progressively damages the glymphatic system. This research intended to investigate the activity of the glymphatic system in PD individuals with freezing of gait (PD-FOG) and PD patients without it (PD-nFOG), as well as their relationship to the clinical neural scale. Diffusion tensor imaging (DTI) was performed in 28 PD-FOG individuals, 31 PD-nFOG individuals, and 34 healthy controls (HC). The DTI analysis along the perivascular space (DTI-ALPS) index was computed after post-processing of DTI images, representing brain glymphatic functions. The DTI-ALPS index was assessed for the association with the clinical variables. Compared to the HC group, the DTI-ALPS index of both PD-FOG and PD-nFOG patients was significantly decreased; however, no notable difference was found between the PD-FOG and PD-nFOG group. In addition, the DTI-ALPS index of PD-nFOG patients were positively correlated with disease duration, Unified Parkinson's Disease Rating-III Right (UPDRS-III R), UPDRS-III TOTAL, UPDRS-IV. Taken together, these findings highlighted the weakening of function of the glymphatic system in PD individuals, which is associated with motor symptoms and treatment complications. We speculate that treatment aimed at enhancing the flow and clearance of the glymphatic system may alleviate clinical symptoms of PD.
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Affiliation(s)
- Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiaofei Huang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuting Li
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - E Li
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China; Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Temiz G, Santin MDN, Olivier C, Collomb-Clerc A, Fernandez-Vidal S, Hainque E, Bardinet E, Lau B, François C, Karachi C, Welter ML. Freezing of gait depends on cortico-subthalamic network recruitment following STN-DBS in PD patients. Parkinsonism Relat Disord 2022; 104:49-57. [PMID: 36242900 DOI: 10.1016/j.parkreldis.2022.10.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Subthalamic deep-brain-stimulation (STN-DBS) is an effective means to treat Parkinson's disease (PD) symptoms. Its benefit on gait disorders is variable, with freezing of gait (FOG) worsening in about 30% of cases. Here, we investigate the clinical and anatomical features that could explain post-operative FOG. METHODS Gait and balance disorders were assessed in 19 patients, before and after STN-DBS using clinical scales and gait recordings. The location of active stimulation contacts were evaluated individually and the volumes of activated tissue (VAT) modelled for each hemisphere. We used a whole brain tractography template constructed from another PD cohort to assess the connectivity of each VAT within the 39 Brodmann cortical areas (BA) to search for correlations between postoperative PD disability and cortico-subthalamic connectivity. RESULTS STN-DBS induced a 100% improvement to a 166% worsening in gait disorders, with a mean FOG decrease of 36%. We found two large cortical clusters for VAT connectivity: one "prefrontal", mainly connected with BA 8,9,10,11 and 32, and one "sensorimotor", mainly connected with BA 1-2-3,4 and 6. After surgery, FOG severity positively correlated with the right prefrontal VAT connectivity, and negatively with the right sensorimotor VAT connectivity. The right prefrontal VAT connectivity also tended to be positively correlated with the UPDRS-III score, and negatively with step length. The MDRS score positively correlated with the right sensorimotor VAT connectivity. CONCLUSION Recruiting right sensorimotor and avoiding right prefrontal cortico-subthalamic fibres with STN-DBS could explain reduced post-operative FOG, since gait is a complex locomotor program that necessitates accurate cognitive control.
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Affiliation(s)
- Gizem Temiz
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Marie des Neiges Santin
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Claire Olivier
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; PANAM core Facility, Paris Brain Institute, Paris, France
| | - Antoine Collomb-Clerc
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Sara Fernandez-Vidal
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Elodie Hainque
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Eric Bardinet
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Brian Lau
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Chantal François
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France
| | - Carine Karachi
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; Neurosurgery Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, F-75013, Paris, France
| | - Marie-Laure Welter
- Inserm 1127, Sorbonne Université, UPMC Univ Paris 06, UMRS 1127, CNRS, UMR 7225, Institut Du Cerveau et de la Moelle Epinière, F-75013, Paris, France; PANAM core Facility, Paris Brain Institute, Paris, France; Neurophysiology Department, Rouen University Hospital, CHU Rouen, F-76000, Rouen, France.
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