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Churchill L, Chen YC, Lewis SJG, Matar E. Understanding REM Sleep Behavior Disorder through Functional MRI: A Systematic Review. Mov Disord 2024. [PMID: 38934216 DOI: 10.1002/mds.29898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Neuroimaging studies in rapid eye movement sleep behavior disorder (RBD) can inform fundamental questions about the pathogenesis of Parkinson's disease (PD). Across modalities, functional magnetic resonance imaging (fMRI) may be better suited to identify changes between neural networks in the earliest stages of Lewy body diseases when structural changes may be subtle or absent. This review synthesizes the findings from all fMRI studies of RBD to gain further insight into the pathophysiology and progression of Lewy body diseases. A total of 32 studies were identified using a systematic review conducted according to PRISMA guidelines between January 2000 to February 2024 for original fMRI studies in patients with either isolated RBD (iRBD) or RBD secondary to PD. Common functional alterations were detectable in iRBD patients compared with healthy controls across brainstem nuclei, basal ganglia, frontal and occipital lobes, and whole brain network measures. Patients with established PD and RBD demonstrated decreased functional connectivity across the whole brain and brainstem nuclei, but increased functional connectivity in the cerebellum and frontal lobe compared with those PD patients without RBD. Finally, longitudinal changes in resting state functional connectivity were found to track with disease progression. Currently, fMRI studies in RBD have demonstrated early signatures of neurodegeneration across both motor and non-motor pathways. Although more work is needed, such findings have the potential to inform our understanding of disease, help to distinguish between prodromal PD and prodromal dementia with Lewy bodies, and support the development of fMRI-based outcome measures of phenoconversion and progression in future disease modifying trials. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lachlan Churchill
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Yu-Chi Chen
- Brain Dynamic Centre, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Simon J G Lewis
- Macquarie Medical School and Macquarie University Centre for Parkinson's Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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2
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The Executive-Function-Related Cognitive-Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson's Disease. Healthcare (Basel) 2023; 11:healthcare11040567. [PMID: 36833101 PMCID: PMC9956339 DOI: 10.3390/healthcare11040567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
To safely walk in a community environment requires dual cognitive-walking ambulation ability for people with Parkinson's disease (PD). A past study showed inconsistent results on cognitive-walking performance for PD patients, possibly due to the various cognitive tasks used and task priority assignment. This study designed cognitive-walking tests that used executive-related cognitive tasks to evaluate patients with early-stage Parkinson's disease who did not have obvious cognitive deficits. The effect of assigning task prioritization was also evaluated. Sixteen individuals with PD (PD group) and 16 individuals without PD (control group) underwent single cognitive tests, single walking tests, dual walking tests, and prioritizing task tests. Three types of cognitive, spatial memory, Stroops, and calculation tasks were employed. The cognitive performance was evaluated by response time, accuracy, and speed-accuracy trade off composite score. The walking performance was evaluated by the temporal spatial gait characteristics and variation in gait. The results showed that the walking performance of the PD group was significantly worse than the control group in both single and dual walking conditions. The group difference in cognitive performance was shown in composite score under the dual calculation walking task but not under the single task. While assigning priority to walking, no group difference in walking was observed but the response accuracy rate of PD groups declined. This study concluded that the dual task walking test could sharpen the cognitive deficits for early-stage PD patients. The task priority assignment might not be recommended while testing gait deficits since it decreased the ability to discriminate group differences.
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3
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Fathipour-Azar Z, Azad A, Akbarfahimi M, Behzadipour S, Taghizadeh G. Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases. Ann N Y Acad Sci 2022; 1511:244-261. [PMID: 35194819 DOI: 10.1111/nyas.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.
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Affiliation(s)
- Zeinab Fathipour-Azar
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malahat Akbarfahimi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Djavad Mowafaghian Research Center for Intelligent Neuro-rehabilitation Technologies, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Mandal M, Khan A. Attention switching deficit in patients of Parkinson's disease who experience freezing of gait. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 30:389-400. [PMID: 34284654 DOI: 10.1080/23279095.2021.1951268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Attention switching is involved in postural adjustments for gait. A deficit in attention switching was expected among patients having Parkinson's disease and experiencing freezing. There was a deficit in attention switching abilities among the patients of Parkinson's disease, having episodes of freezing of gait. The task accuracy and reaction time of the freezing group was significantly reduced compared to the non-freezing group having Parkinson's disease and healthy control group on total AST task performance, congruent and incongruent trials. The non-freezing group with Parkinson's disease was also slower than the healthy control group, but its accuracy was not affected. The results suggest that patients with freezing of gait experienced a stronger deficit in attention-switching than the non-freezing group of Parkinson's disease. This attention switching deficit among freezers may imply inappropriate allocation of attention for postural responses required for stepping and resulting in freezing. Also, the non-freezing group may have prioritized accuracy over time as a compensatory strategy that may be slowing their gait but prevents freezing.
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Affiliation(s)
- Moulika Mandal
- Psychophysiology Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, India
| | - Azizuddin Khan
- Psychophysiology Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, India
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Sousa NMF, Macedo RC, Brucki SMD. Cross-sectional associations between cognition and mobility in Parkinson's disease. Dement Neuropsychol 2021; 15:105-111. [PMID: 33907603 PMCID: PMC8049584 DOI: 10.1590/1980-57642021dn15-010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cross-sectional studies show an association of decline in mental flexibility and
inhibitory control with reduced gait speed and falls, as well as divided
attention deficit and difficulty in initiating gait.
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Affiliation(s)
- Nariana Mattos Figueiredo Sousa
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil.,Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
| | - Roberta Correa Macedo
- Neurorehabilitation Program, Rede SARAH de Hospitais de Reabilitação - Salvador, BA, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo - São Paulo, SP, Brazil
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6
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Ruitenberg MFL, van Wouwe NC, Wylie SA, Abrahamse EL. The role of dopamine in action control: Insights from medication effects in Parkinson's disease. Neurosci Biobehav Rev 2021; 127:158-170. [PMID: 33905788 DOI: 10.1016/j.neubiorev.2021.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/26/2021] [Accepted: 04/18/2021] [Indexed: 01/14/2023]
Abstract
Parkinson's disease (PD) is a neurological disorder associated primarily with overt motor symptoms. Several studies show that PD is additionally accompanied by impairments in covert cognitive processes underlying goal-directed motor functioning (e.g., action planning, conflict adaptation, inhibition), and that dopaminergic medication may modulate these action control components. In this review we aim to leverage findings from studies in this domain to elucidate the role of dopamine (DA) in action control. A qualitative review of studies that investigated the effects of medication status (on vs. off) on action control in PD suggests a component-specific role for DA in action control, although the expression of medication effects depends on characteristics of both the patients and experimental tasks used to measure action control. We discuss these results in the light of findings from other research lines examining the role of DA in action control (e.g., animal research, pharmacology), and recommend that future studies use multi-method, within-subject approaches to model DA effects on action control across different components as well as underlying striatal pathways (ventral vs. dorsal).
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Affiliation(s)
- M F L Ruitenberg
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden, the Netherlands; Department of Experimental Psychology, Ghent University, Ghent, Belgium.
| | - N C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - S A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - E L Abrahamse
- Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
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Chen L, Bedard P, Hallett M, Horovitz SG. Dynamics of Top-Down Control and Motor Networks in Parkinson's Disease. Mov Disord 2021; 36:916-926. [PMID: 33404161 DOI: 10.1002/mds.28461] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Motor symptoms in Parkinson's disease (PD) patients might be related to high-level task-control deficits. We aimed at investigating the dynamics between sensorimotor network and top-down control networks (frontal-parietal, cingulo-opercular, and cerebellar) in PD and at determining the effects of levodopa on the dynamics of these networks. METHODS We investigated dynamic functional connectivity (dFC), during resting state functional magnetic resonance imaging, between sensorimotor network and top-down control networks in 36 PD patients (OFF medication, PD-OFF) and 36 healthy volunteers. We further assessed the effect of medication on dFC in18 PD patients who were also scanned ON medication. RESULTS The dFC analyses identified three discrete states: State I (35.68%) characterized by connections between the cerebellum and sensorimotor network, State II (34.17%) with connections between the sensorimotor and frontal-parietal network, and State III (30.15%) with connection between the sensorimotor and cingulo-opercular network. PD patients have significantly fewer occurrences and overall spent less time (shorter dwell time) in State II compared to healthy controls. After levodopa intake, dwell time improved toward normal. The change in dwell time before and after taking levodopa was negatively related to the respective changes in Unified Parkinson's Disease Rating Scale, Part III. PD-OFF showed significantly decreased connectivity between sensorimotor and control networks and increased connectivity within control networks. These changes were partially improved after levodopa intake. CONCLUSIONS Dopamine depletion in PD is associated with abnormalities in temporal and spatial properties between cognitive control and sensorimotor network, possibly contributing to clinical deficits. Levodopa partially restores the network function toward the values observed in healthy volunteers. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Li Chen
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Patrick Bedard
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Maslivec A, Fielding A, Wilson M, Norris M, Young W. 'Recoupling' the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson's. J Neuroeng Rehabil 2020; 17:146. [PMID: 33129334 PMCID: PMC7603666 DOI: 10.1186/s12984-020-00776-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods Thirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n = 17, FoG-F) or voluntarily stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: (i) explicit verbal instruction, and (ii) implicit movement analogies. Results At Baseline, weight-shift amplitudes were smaller during: (i) unsuccessful, compared to successful step initiations (FoG-F group), and (ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.
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Affiliation(s)
- Amy Maslivec
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna Fielding
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mark Wilson
- School of Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Meriel Norris
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - William Young
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK. .,School of Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, UK.
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9
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Sousa NMF, Macedo RC. Relationship between cognitive performance and mobility in patients with Parkinson's disease: A cross-sectional study. Dement Neuropsychol 2019; 13:403-409. [PMID: 31844493 PMCID: PMC6907702 DOI: 10.1590/1980-57642018dn13-040006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gait disorders may be associated with cognitive impairment, and slow speed
predicts cognitive impairment and dementia. Objective: To investigate the
relationships between cognitive function and gait performance in patients with
Parkinson’s disease (PD) who attended a hospital neurorehabilitation program.
Methods: Descriptive and inferential statistics (Pearson’s correlation) were
used for data analysis. The cognitive functions were evaluated through Digit
Span, Mental Control, Trail Making Test, Phonemic Verbal Fluency Task, and
Addenbrooke’s Cognitive Examination III. The motor function was assessed through
10-meter walk test, Mini BESTest and Timed Up and Go Test. Results: A total of
65 patients were included in this study. Of these, 66.15% were males, mean age
was 61.14 (8.39) years, mean educational was 12 (8) years, disease progression
time was 5.45 (4.37) years. 64.61% were in stages I and II of the Hoehn and Yahr
stage. The correlation analyses showed that balance skills are significantly
correlated with the ability to switch attention between two tasks and
visuospatial function. The function mobility showed a significant correlation
with cognitive tests. Conclusion: Data suggest the importance of the aspects of
switch attention and mental flexibility in gait, evidencing the greater
difficulty for double tasks.
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Affiliation(s)
| | - Roberta Correa Macedo
- Rede SARAH de Hospitais de Reabilitação Ringgold standard institution - Reabilitação Neurológica, Salvador, BA, Brazil
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Bharti K, Suppa A, Tommasin S, Zampogna A, Pietracupa S, Berardelli A, Pantano P. Neuroimaging advances in Parkinson's disease with freezing of gait: A systematic review. Neuroimage Clin 2019; 24:102059. [PMID: 31795038 PMCID: PMC6864177 DOI: 10.1016/j.nicl.2019.102059] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
Freezing of gait (FOG) is a paroxysmal gait disorder that often occurs at advanced stages of Parkinson's disease (PD). FOG consists of abrupt walking interruption and severe difficulty in locomotion with an increased risk of falling. Pathophysiological mechanisms underpinning FOG in PD are still unclear. However, advanced MRI and nuclear medicine studies have gained relevant insights into the pathophysiology of FOG in PD. Neuroimaging studies have demonstrated structural and functional abnormalities in a number of cortical and subcortical brain regions in PD patients with FOG. In this paper, we systematically review existing neuroimaging literature on the structural and functional brain changes described in PD patients with FOG, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We evaluate previous studies using various MRI techniques to estimate grey matter loss and white matter degeneration. Moreover, we review functional brain changes by examining functional MRI and nuclear medicine imaging studies. The current review provides up-to-date knowledge in this field and summarizes the possible mechanisms responsible for FOG in PD.
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Affiliation(s)
- Komal Bharti
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
| | | | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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Mi TM, Garg S, Ba F, Liu AP, Wu T, Gao LL, Dan XJ, Chan P, McKeown MJ. High-frequency rTMS over the supplementary motor area improves freezing of gait in Parkinson's disease: a randomized controlled trial. Parkinsonism Relat Disord 2019; 68:85-90. [PMID: 31689588 DOI: 10.1016/j.parkreldis.2019.10.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) contributes to falls in Parkinson's disease (PD), but robust, effective treatments remain elusive. There is evidence indicating that the supplementary motor area (SMA) plays an important role in the pathogenesis of FOG and may therefore be a potential neuromodulation target. The present study explored the clinical efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the SMA on FOG in PD patients. METHODS A group of 30 PD patients with FOG were enrolled in a randomized, double-blind, sham-controlled trial. Patients were randomly allocated 2:1 to receive ten sessions of either real (N = 20) or sham (N = 10) 10 Hz rTMS over SMA. The patients were assessed at baseline (T0), after the 5th (T1) and 10th (T2) sessions, and then 2 weeks (T3) and 4 weeks (T4) after the last session. The primary clinical outcome was the Freezing of Gait Questionnaire score (FOGQ), with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor scores (MDS-UPDRS III) and Timed Up and Go test as secondary clinical outcomes. All the assessments were carried out at the "ON" state. RESULTS With a four week's follow-up, there were significant interaction effects in the FOGQ (effect of group*time, p = 0.04), MDS-UPDRS III (p = 0.02) and several gait variables (total duration, p < 0.01; cadence, p = 0.04; turn duration, p = 0.01; and turn to sit duration, p = 0.02). Post-hoc analyses revealed a significantly decreased FOGQ score at T2 and T4, and significant improvements of MDS-UPDRS III and gait variables at T1, T2, T3 and T4 in the rTMS group. No significant improvements were found in the sham group. CONCLUSION High-frequency rTMS over SMA may ultimately serve as an add-on therapy for alleviating FOG in PD patients.
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Affiliation(s)
- Tao-Mian Mi
- National Clinical Research Center for Geriatric Disorders, Beijing, China; Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China; Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
| | - Saurabh Garg
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ai-Ping Liu
- University of Science and Technology of China, Hefei, Anhui, China.
| | - Tao Wu
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Lin-Lin Gao
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiao-Juan Dan
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
| | - Piu Chan
- National Clinical Research Center for Geriatric Disorders, Beijing, China; Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China; Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, China; Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Beijing, China.
| | - Martin J McKeown
- Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada; Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
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12
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Heremans E, Broeder S, Nieuwboer A, Bekkers EM, Ginis P, Janssens L, Nackaerts E. When motor control gets out of hand: Speeding up triggers freezing in the upper limb in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:163-168. [PMID: 30987896 DOI: 10.1016/j.parkreldis.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/10/2018] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) can suffer from sudden movement arrests during upper limb tasks. The current study investigated a test to assess freezing of the upper limbs (FOUL) at two speed conditions to improve the sensitivity of FOUL detection. METHODS Forty-nine patients with PD and 10 age-matched controls (HC) performed a freezing-provoking writing task, requiring up- and down-stroke writing at varying sizes in-between visual target zones indicating funnel-shapes on a touch-sensitive tablet. They performed five trials at their preferred speed, referred to as the Normal Funnel Task (NFT) and five trials at maximum speed, referred to as the Fast Funnel Task (FFT), in a random order. RESULTS Based on a combination of kinematic criteria and video analysis, 183 FOUL episodes were detected in 24 participants (23 PD, 1 HC). The number of patients with FOUL, number of FOUL episodes and percentage time frozen were significantly higher during FFT than NFT. Most FOUL episodes occurred during writing at small (51.6%) and decreasing size (36.3%). Additionally, FOUL outcomes significantly correlated with the Montreal Cognitive Assessment and New Freezing of Gait Questionnaire. CONCLUSION As FOUL is more prevalent under higher task demands, these data offer support for the "threshold model", previously proposed to provide insight in freezing of gait (FOG) and underscoring the presupposed link between FOG and FOUL. As well, this study may provide a novel paradigm to assess FOUL in both laboratory and clinical settings.
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Affiliation(s)
- Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Sanne Broeder
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Esther Mj Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Luc Janssens
- Electrical Engineering (ESAT), Group T Leuven Campus, KU Leuven, Belgium
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium.
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13
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Harrington DL, Shen Q, Theilmann RJ, Castillo GN, Litvan I, Filoteo JV, Huang M, Lee RR. Altered Functional Interactions of Inhibition Regions in Cognitively Normal Parkinson's Disease. Front Aging Neurosci 2018; 10:331. [PMID: 30405399 PMCID: PMC6206214 DOI: 10.3389/fnagi.2018.00331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022] Open
Abstract
Deficient inhibitory control in Parkinson's disease (PD) is often observed in situations requiring inhibition of impulsive or prepotent behaviors. Although activation of the right-hemisphere frontal-basal ganglia response inhibition network is partly altered in PD, disturbances in interactions of these regions are poorly understood, especially in patients without cognitive impairment. The present study investigated context-dependent connectivity of response inhibition regions in PD patients with normal cognition and control participants who underwent fMRI while performing a stop signal task. PD participants were tested off antiparkinsonian medication. To determine if functional disturbances depended on underlying brain structure, aberrant connectivity was correlated with brain volume and white-matter tissue diffusivity. We found no group differences in response inhibition proficiency. Yet the PD group showed functional reorganization in the long-range connectivity of inhibition regions, despite preserved within network connectivity. Successful inhibition in PD differed from the controls by strengthened connectivity of cortical regions, namely the right dorsolateral prefrontal cortex, pre-supplementary motor area and right caudal inferior frontal gyrus, largely with ventral and dorsal attention regions, but also the substantia nigra and default mode network regions. Successful inhibition in controls was distinguished by strengthened connectivity of the right rostral inferior frontal gyrus and subcortical inhibition nodes (right caudate, substantia nigra, and subthalamic nucleus). In both groups, the strength of context-dependent connectivity correlated with various indices of response inhibition performance. Mechanisms that may underlie aberrantly stronger context-specific connectivity include reduced coherence within reorganized systems, compensatory mechanisms, and/or the reorganization of intrinsic networks. In PD, but not controls, abnormally strengthened connectivity was linked to individual differences in underlying brain volumes and tissue diffusivity, despite no group differences in structural variables. The pattern of structural-functional associations suggested that subtle decreases in tissue diffusivity of underlying tracts and posterior cortical volumes may undermine the enhancement of normal cortical-striatal connectivity or cause strengthening in cortical-cortical connectivity. These novel findings demonstrate that functionally reorganized interactions of inhibition regions predates the development of inhibition deficits and clinically significant cognitive impairment in PD. We speculate that altered interactions of inhibition regions with attention-related networks and the dopaminergic system may presage future decline in inhibitory control.
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Affiliation(s)
- Deborah L. Harrington
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Qian Shen
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Rebecca J. Theilmann
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Gabriel N. Castillo
- Cognitive Neuroimaging Laboratory, Research Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - J. Vincent Filoteo
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Mingxiong Huang
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, United States
| | - Roland R. Lee
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, United States
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14
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Gallardo MJ, Cabello JP, Corrales MJ, Torres-Donaire J, Bravo JJ, Talavera MP, León A, Vaamonde-Gamo J. Freezing of gait in Parkinson’s disease: functional neuroimaging studies of the frontal lobe. Neurol Res 2018; 40:900-905. [DOI: 10.1080/01616412.2018.1484985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- María José Gallardo
- Neurology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Juan Pablo Cabello
- Neurology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Jose Javier Bravo
- Neurology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - María Prado Talavera
- Nuclear medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Alberto León
- Neurology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Julia Vaamonde-Gamo
- Neurology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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15
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Zhao D, Sun Q, Cheng S, He M, Chen X, Hou X. Extraction of Parkinson’s Disease-Related Features from Local Field Potentials for Adaptive Deep Brain Stimulation. NEUROPHYSIOLOGY+ 2018. [DOI: 10.1007/s11062-018-9717-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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16
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Ehgoetz Martens KA, Lukasik EL, Georgiades MJ, Gilat M, Hall JM, Walton CC, Lewis SJG. Predicting the onset of freezing of gait: A longitudinal study. Mov Disord 2017; 33:128-135. [PMID: 29150872 DOI: 10.1002/mds.27208] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/29/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Freezing of gait is a disabling symptom of Parkinson's disease that ultimately affects approximately 80% of patients, yet very little research has focused on predicting the onset of freezing of gait and tracking the longitudinal progression of symptoms prior to its onset. The objective of the current study was to examine longitudinal data spanning the transition period when patients with PD developed freezing of gait to identify symptoms that may precede freezing and create a prediction model that identifies those "at risk" for developing freezing of gait in the year to follow. METHODS Two hundred and twenty-one patients with PD were divided into 3 groups (88 nonfreezers, 41 transitional freezers, and 92 continuing freezers) based on their responses to the validated Freezing of Gait-Questionnaire item 3 at baseline and follow-up. Critical measures across motor, cognitive, mood, and sleep domains were assessed at 2 times approximately 1 year apart. RESULTS A logistic regression model that included age, disease duration, gait symptoms, motor phenotype, attentional set-shifting, and mood measures could predict with 70% and 90% accuracy those patients who would and would not develop, respectively, freezing of gait over the next year. Notably, the Freezing of Gait-Questionnaire total and the anxiety section of the Hospital Anxiety and Depression Scale were the strongest predictors and alone could significantly predict if one might develop freezing of gait in the next 15 months with 82% accuracy. CONCLUSIONS Our results suggest that it is possible to identify the majority of patients who will develop freezing of gait in the following year, potentially allowing targeted interventions to delay or possibly even prevent the onset of freezing. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Emily L Lukasik
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia.,School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
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17
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Georgiades MJ, Gilat M, Ehgoetz Martens KA, Walton CC, Bissett PG, Shine JM, Lewis SJ. Investigating motor initiation and inhibition deficits in patients with Parkinson’s disease and freezing of gait using a virtual reality paradigm. Neuroscience 2016; 337:153-162. [DOI: 10.1016/j.neuroscience.2016.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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18
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Hall JM, Shine JM, O'Callaghan C, Walton CC, Gilat M, Naismith SL, Lewis SJG. Freezing of Gait and its Associations in the Early and Advanced Clinical Motor Stages of Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSONS DISEASE 2016; 5:881-91. [PMID: 26444088 DOI: 10.3233/jpd-150581] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Freezing of gait is a common disabling symptom of Parkinson's disease (PD) with limited treatment options. The pathophysiological mechanisms of freezing behaviour are still contentious. OBJECTIVE To investigate the prevalence of freezing of gait and its associations with increasing disease severity to gain a better understanding of the underlying pathophysiology. METHODS This exploratory study included 389 idiopathic PD patients, divided into four groups; early and advanced PD with freezing of gait, and early and advanced PD without freezing of gait. Motor, cognitive and affective symptoms, REM sleep behaviour disorder and autonomic function were assessed. RESULTS Regardless of disease stage, patients with freezing of gait had more severe motor symptoms and a predominant non-tremor phenotype. In the early stages, freezers had a selective impairment in executive function and had more marked REM sleep behaviour disorder. Autonomic disturbances were not associated with freezing of gait across early or advanced disease stages. CONCLUSION These findings support the notion that impairments across the frontostriatal pathways are intricately linked to the pathophysiology underlying freezing of gait across all stages of PD. Features of REM sleep behaviour disorder suggest a contribution to freezing from brainstem pathology but this does not extend to more general autonomic dysfunction.
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Affiliation(s)
- Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia.,School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia.,Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.,School of Psychology, Stanford University, California, USA
| | - Claire O'Callaghan
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia.,Neuroscience Research Australia and School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia.,Healthy Brain Ageing Program, Ageing Brain Centre, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Ageing Brain Centre, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
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Anxiety is associated with freezing of gait and attentional set-shifting in Parkinson's disease: A new perspective for early intervention. Gait Posture 2016; 49:431-436. [PMID: 27513741 DOI: 10.1016/j.gaitpost.2016.07.182] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 02/02/2023]
Abstract
Previous research has shown that anxiety in Parkinson's disease (PD) is associated with freezing of gait (FOG), and may even contribute to the underlying mechanism. However, limited research has investigated whether PD patients with FOG (PD+FOG) have higher anxiety levels when compared directly to non-freezing PD patients (PD-NF) and moreover, how anxiety might contribute to FOG. The current study evaluated whether: (i) PD+FOG have greater anxiety compared to PD-NF, and (ii) anxiety in PD is related to attentional set-shifting, in order to better understand how anxiety might be contributing to FOG. In addition, we explored whether anxiety levels differed between those PD patients with mild FOG (PD+MildFOG) compared to PD-NF. Four hundred and sixty-one patients with PD (231 PD-NF, 180 PD+FOG, 50 PD+MildFOG) were assessed using the Freezing of Gait Questionnaire item 3 (FOG-Q3), Hospital Anxiety and Depression Scale (HADS), Digit Span Test, Logical Memory Retention Test and Trail Making Tests. Compared to PD-NF, PD+FOG had significantly greater anxiety (p<0.001). PD+MildFOG, however, demonstrated similar levels of anxiety as the PD+FOG. In all patients, the severity of anxiety symptoms was significantly correlated to their degree of self-reported FOG on FOG-Q3 (p<0.001) and TMT B-A (p=0.039). Similar results were found for depression. In conclusion, these results confirm the key role played by anxiety in FOG and also suggest that anxiety might be a promising biomarker for FOG. Future research should consider whether treating anxiety with pharmacological and/or cognitive behavioural therapies at early stages of gait impairment in PD may alleviate troublesome FOG.
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20
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Tard C, Delval A, Duhamel A, Moreau C, Devos D, Dujardin K. Specific Attentional Disorders and Freezing of Gait in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:379-87. [PMID: 25882060 DOI: 10.3233/jpd-140498] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is thought to be associated with dysexecutive syndrome and attentional disorders. However, the role of specific attentional disorders in patients with freezing of gait is still unclear. OBJECTIVE Here, we sought to specifically determine which basic attentional modalities are impaired in patients with freezing of gait. METHODS Seventy-eight parkinsonian patients performed a computer-controlled reaction-time paradigm designed to measure the different attentional subcomponents, controlled for visuospatial processing and motor participation. RESULTS The freezer (n = 42) and non-freezer (n = 36) groups were matched for age, educational level, MMSE and Mattis Dementia Rating Scale. There were no intergroup differences in simple reaction times, whereas choice reaction times were higher in the freezer group than in the non-freezer group for divided attention (p = 0.023). CONCLUSIONS At equivalent levels of overall cognitive efficiency, freezer patients showed a greater slowdown than non-freezer patients with a specific impairment in divided attention.
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Affiliation(s)
- Céline Tard
- Inserm, U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, France.,Neurology and Movement Disorders Department, Lille University Hospital, Lille, France
| | - Arnaud Delval
- Inserm, U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, France
| | - Alain Duhamel
- Department of Medical Statistics, Lille University Hospital, Lille, France
| | - Caroline Moreau
- Inserm, U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, France.,Neurology and Movement Disorders Department, Lille University Hospital, Lille, France
| | - David Devos
- Inserm, U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, France
| | - Kathy Dujardin
- Inserm, U1171, Troubles cognitifs dégénératifs et vasculaires, Université de Lille, France.,Neurology and Movement Disorders Department, Lille University Hospital, Lille, France
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21
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Shine JM. Electrophysiological insights into freezing in Parkinson's disease. Clin Neurophysiol 2016; 127:2334-6. [PMID: 27178847 DOI: 10.1016/j.clinph.2016.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
Affiliation(s)
- James M Shine
- Department of Psychology, Stanford University, Stanford, CA, USA; Neuroscience Research Australia, The University of New South Wales, Sydney, NSW, Australia.
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22
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Cognitive Contributions to Freezing of Gait in Parkinson Disease: Implications for Physical Rehabilitation. Phys Ther 2016; 96:659-70. [PMID: 26381808 PMCID: PMC4858659 DOI: 10.2522/ptj.20140603] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/07/2015] [Indexed: 12/31/2022]
Abstract
People with Parkinson disease (PD) who show freezing of gait also have dysfunction in cognitive domains that interact with mobility. Specifically, freezing of gait is associated with executive dysfunction involving response inhibition, divided attention or switching attention, and visuospatial function. The neural control impairments leading to freezing of gait have recently been attributed to higher-level, executive and attentional cortical processes involved in coordinating posture and gait rather than to lower-level, sensorimotor impairments. To date, rehabilitation for freezing of gait primarily has focused on compensatory mobility training to overcome freezing events, such as sensory cueing and voluntary step planning. Recently, a few interventions have focused on restitutive, rather than compensatory, therapy. Given the documented impairments in executive function specific to patients with PD who freeze and increasing evidence of overlap between cognitive and motor function, incorporating cognitive challenges with mobility training may have important benefits for patients with freezing of gait. Thus, a novel theoretical framework is proposed for exercise interventions that jointly address both the specific cognitive and mobility challenges of people with PD who freeze.
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23
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Antisaccade errors reveal cognitive control deficits in Parkinson's disease with freezing of gait. J Neurol 2015; 262:2745-54. [PMID: 26464101 DOI: 10.1007/s00415-015-7910-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Freezing of gait is a poorly understood symptom of Parkinson's disease (PD) that is commonly accompanied by executive dysfunction. This study employed an antisaccade task to measure deficits in inhibitory control in patients with freezing, and to determine if these are associated with a specific pattern of grey matter loss using voxel-based morphometry. PD patients with (n = 15) and without (n = 11) freezing along with 10 age-matched controls were included. A simple prosaccade task was administered, followed by a second antisaccade task that required subjects to either look towards or away from a peripheral target. Behavioral results from the antisaccade task were entered as covariates in the voxel-based morphometry analysis. Patient and control groups performed equally well on the first task. However, patients with freezing were significantly worse on the second, which was driven by a specific impairment in suppressing their responses toward the target on the antisaccade trials. Impaired antisaccade performance was associated with grey matter loss across bilateral visual and fronto-parietal regions. These results suggest that patients with freezing have a significant deficit of inhibitory control that is associated with volume reductions in regions crucial for orchestrating both complex motor behaviors and cognitive control. These findings highlight the inter-relationship between freezing of gait and cognition and confirm that dysfunction along common neural pathways is likely to mediate the widespread cognitive dysfunction that emerges with this symptom.
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24
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Bissett PG, Logan GD, van Wouwe NC, Tolleson CM, Phibbs FT, Claassen DO, Wylie SA. Generalized motor inhibitory deficit in Parkinson's disease patients who freeze. J Neural Transm (Vienna) 2015; 122:1693-701. [PMID: 26354102 DOI: 10.1007/s00702-015-1454-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/01/2015] [Indexed: 11/25/2022]
Abstract
Freezing of gait is a disabling symptom of Parkinson's disease (PD) that involves failure to initiate and continue motor activity appropriately. PD disrupts fronto-basal ganglia circuitries that also implement the inhibition of responses, leading to the hypothesis that freezing of gait may involve fundamental changes in both initiation and inhibition of motor actions. We asked whether PD patients who show freezing of gait show selective deficits in their ability to inhibit upper and lower extremity reactions. We compared older healthy controls, older PD controls without freezing of gait, and older PD participants with freezing of gait, in stop-signal tasks that measured the initiation (go trials) and inhibition (stop trials) of both hand and foot responses. When only go trials were presented, all three groups showed similar initiation speeds across lower and upper extremity responses. When stop-signal trials were introduced, both PD groups slowed their reactions nearly twice as much as healthy controls. While this adjustment helped PD controls stop their actions as quickly as healthy controls, PD patients with freezing showed significantly delayed inhibitory control of both upper and lower extremities. When anticipating the need to stop their actions urgently, PD patients show greater adjustments (i.e., slowing) to reaction speed than healthy controls. Despite these proactive adjustments, PD patients who freeze show marked impairments in inhibiting both upper and lower extremity responses, suggesting that freezing may involve a fundamental disruption to the brain's inhibitory control system.
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Affiliation(s)
| | - Gordon D Logan
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | | | - Scott A Wylie
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
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25
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Szeto JYY, O’Callaghan C, Shine JM, Walton CC, Mowszowski L, Naismith SL, Halliday GM, Lewis SJG. The relationships between mild cognitive impairment and phenotype in Parkinson's disease. NPJ Parkinsons Dis 2015; 1:15015. [PMID: 28725684 PMCID: PMC5516553 DOI: 10.1038/npjparkd.2015.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 07/19/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The concept of differing clinical phenotypes within Parkinson's disease (PD) is well represented in the literature. However, there is no consensus as to whether any particular disease phenotype is associated with an increased risk of mild cognitive impairment (MCI) using the newly proposed Movement Disorders Society diagnostic criteria for this feature. AIMS To explore the expression of PD-MCI in relation to the heterogeneity of idiopathic PD. METHODS A cluster analysis incorporating a range of specific demographic, clinical and cognitive variables was performed on 209 patients in the early stages of PD (between Hoehn and Yahr stages I-III). Post hoc analyses exploring variables not included in the clustering solution were performed to interrogate the veracity of the subgroups generated. RESULTS This study identified four distinct PD cohorts: a younger disease-onset subgroup, a tremor dominant subgroup, a non-tremor dominant subgroup, and a subgroup with rapid disease progression. The present study identified a differential expression of PD-MCI across these subgroups, with the highest frequency observed in the non-tremor dominant cluster. The non-tremor dominant subgroup was also associated with a higher prevalence of freezing of gait, hallucinations, daytime somnolence, and rapid eye movement sleep behavior disorder compared with other subgroups. CONCLUSIONS This study confirms the existence of heterogeneity within the early clinical stages of PD and for the first time highlights the differential expression of PD-MCI using the newly defined diagnostic criteria for this feature. An improved understanding of PD-MCI and its clinical relationships may lead to an improved understanding of the pathophysiology underlying heterogeneity in PD.
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Affiliation(s)
- Jennifer YY Szeto
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Claire O’Callaghan
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
- Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia
| | - James M Shine
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Courtney C Walton
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Loren Mowszowski
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Glenda M Halliday
- Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia
| | - Simon JG Lewis
- Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
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26
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Trager MH, Velisar A, Koop MM, Shreve L, Quinn E, Bronte-Stewart H. Arrhythmokinesis is evident during unimanual not bimanual finger tapping in Parkinson's disease. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2015; 2:8. [PMID: 26788344 PMCID: PMC4711026 DOI: 10.1186/s40734-015-0019-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Arrhythmokinesis, the variability in repetitive movements, is a fundamental feature of Parkinson's disease (PD). We hypothesized that unimanual repetitive alternating finger tapping (AFT) would reveal more arrhythmokinesis compared to bimanual single finger alternating hand tapping (SFT), in PD. METHODS The variability of inter-strike interval (CVISI) and of amplitude (CVAMP) during AFT and SFT were measured on an engineered, MRI-compatible keyboard in sixteen PD subjects off medication and in twenty-four age-matched controls. RESULTS The CVISI and CVAMP of the more affected (MA) and less affected (LA) sides in PD subjects were greater during AFT than SFT (P < 0.05). However, there was no difference between AFT and SFT for controls. Both CVISI and CVAMP were greater in the MA and LA hands of PD subjects versus controls during AFT (P < 0.01). The CVISI and CVAMP of the MA, but not the LA hand, were greater in PDs versus controls during SFT (P < 0.05). Also, AFT, but not SFT, detected a difference between the MA and LA hands of PDs (P < 0.01). CONCLUSIONS Unimanual, repetitive alternating finger tapping brings out more arrhythmokinesis compared to bimanual, single finger tapping in PDs but not in controls. Arrhythmokinesis during unimanual, alternating finger tapping captured a significant difference between both the MA and LA hands of PD subjects and controls, whereas that during a bimanual, single finger tapping task only distinguished between the MA hand and controls. Arrhythmokinesis underlies freezing of gait and may also underlie the freezing behavior documented in fine motor control if studied using a unimanual alternating finger tapping task.
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Affiliation(s)
- Megan H Trager
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Mandy Miller Koop
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Lauren Shreve
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Emma Quinn
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive, Stanford, CA 94305 USA ; Department of Neurosurgery, Stanford University, Stanford, CA USA
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27
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Walton CC, Shine JM, Hall JM, O'Callaghan C, Mowszowski L, Gilat M, Szeto JYY, Naismith SL, Lewis SJG. The major impact of freezing of gait on quality of life in Parkinson's disease. J Neurol 2014; 262:108-15. [PMID: 25319020 DOI: 10.1007/s00415-014-7524-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/08/2014] [Accepted: 09/30/2014] [Indexed: 11/24/2022]
Abstract
Freezing of gait (FOG) is a disabling motor symptom experienced by a large proportion of patients with Parkinson's disease (PD). While it is known that FOG contributes to lower health-related quality of life (HRQoL), previous studies have not accounted for other important factors when measuring the specific impact of this symptom. The aim of this study was to examine FOG and HRQoL while controlling for other factors that are known to impact patient well-being, including cognition, motor severity, sleep disturbance and mood. Two hundred and three patients with idiopathic PD (86 with FOG) were included in the study. All patients were between Hoehn and Yahr stages I-III. A forced entry multiple regression model evaluating the relative contribution of all symptoms was conducted, controlling for time since diagnosis and current dopaminergic treatment. Entering all significantly correlated variables into the regression model accounted for the majority of variance exploring HRQoL. Self-reported sleep-wake disturbances, depressive and anxious symptoms and FOG were individually significant predictors. FOG accounted for the highest amount of unique variance. While sleep-wake disturbance and mood have a significant negative impact on HRQoL in PD, the emergence of FOG represents the most substantial predictor among patients in the earlier clinical stages of disease. This finding presumably reflects the disabling loss of independence and fear of injury associated with FOG and underlines the importance of efforts to reduce this common symptom.
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Affiliation(s)
- Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
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