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Carlson SJ, Chiu YF, Landers MR, Fritz NE, Mishra VR, Longhurst JK. Dual-Task Performance and Brain Morphologic Characteristics in Parkinson's Disease. NEURODEGENER DIS 2024:1-11. [PMID: 39084207 DOI: 10.1159/000540393] [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: 02/12/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Parkinson's disease (PD) reduces an individual's capacity for automaticity which limits their ability to perform two tasks simultaneously, negatively impacting daily function. Understanding the neural correlates of dual tasks (DTs) may pave the way for targeted therapies. To better understand automaticity in PD, we aimed to explore whether individuals with differing DT performances possessed differences in brain morphologic characteristics. METHODS Data were obtained from 34 individuals with PD and 47 healthy older adults including (1) demographics (age, sex), (2) disease severity (Movement Disorder Society - Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr, levodopa equivalent daily dose [LEDD]), (3) cognition (Montreal Cognitive Assessment), (4) LEDD, (5) single-task and DT performance during a DT-timed-up-and-go test utilizing a serial subtraction task, and (6) cortical thicknesses and subcortical volumes obtained from volumetric MRI. Participants were categorized as low or high DT performers if their combined DT effect was greater than the previously determined mean value for healthy older adults (μ = -74.2). Nonparametric testing using Quade's ANCOVA was conducted to compare cortical thicknesses and brain volumes between the highDT and lowDT groups while controlling for covariates: age, sex, MDS-UPDRS part III, LEDD, and intracranial volume. Secondarily, similar comparisons were made between the healthy older adult group and the highDT and lowDT groups. Lastly, a hierarchical linear regression model was conducted regressing combined DT effect on covariates (block one) and cortical thicknesses (block 2) in stepwise fashion. RESULTS The highDT group had thicker cortices than the lowDT group in the right primary somatosensory cortex (p = 0.001), bilateral primary motor cortices (p ≤ 0.001, left; p = 0.002, right), bilateral supplementary motor areas (p = 0.001, left; p < 0.001, right), and mean of the bilateral hemispheres (p = 0.001, left; p < 0.001, right). Of note, left primary cortex thickness (p = 0.002), left prefrontal cortex thickness (p < 0.001), and right supplementary motor area thickness (p = 0.003) differed when adding a healthy comparison group. Additionally, the regression analysis found that the left paracentral lobule thickness explained 20.8% of the variability in combined DT effect (p = 0.011) beyond the influence of covariates. CONCLUSIONS These results suggest regions underlying DT performance, specifically, a convergence of neural control relying on sensorimotor integration, motor planning, and motor activation to achieve higher levels of DT performance for individuals with PD.
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Affiliation(s)
- Sarah J Carlson
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, Missouri, USA,
| | - Yi-Fang Chiu
- Department of Speech, Language, and Hearing Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, USA
| | - Nora E Fritz
- Departments of Health Care Sciences and Neurology, Wayne State University, Detroit, Michigan, USA
| | - Virendra R Mishra
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, Missouri, USA
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Çetin B, Kılınç M, Çakmaklı GY. The effects of exergames on upper extremity performance, trunk mobility, gait, balance, and cognition in Parkinson's disease: a randomized controlled study. Acta Neurol Belg 2024; 124:853-863. [PMID: 38182919 DOI: 10.1007/s13760-023-02451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND In recent years, game-based exercises have been included more in the rehabilitation programs of Parkinson's disease (PD) patients and positive effects have been observed. AIM This study aims to investigate the effects of innovative games particularly designed for neurological patients on upper extremity performance, trunk mobility and cognition in patients with PD. METHOD Twenty-three patients were enrolled in this randomized controlled study and randomly allocated into two groups: Exergames Program (EP) and Conventional Exercise Program (CP). Both groups received supervised physiotherapy sessions for 3 days a week and 8 weeks in total (24 sessions). Each session lasted 1 h. Evaluations were applied before and after the treatment: 9-Hole Peg Test (9-HPT), Minnesota Manual Dexterity Test (MMDT), Trunk Impairment Scale (TIS), Montreal Cognitive Assessment (MoCA), Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Timed Up and Go (TUG), Functional Reach Test (FRT), and Parkinson Disease Questionnaire (PDQ-39). RESULTS Twenty patients were included in the analysis because of the dropouts. Our findings showed that both groups improved significantly in 9-HPT dominant side, MMDT, TIS, MDS-UPDRS, TUG, FRT, and PDQ-39 (p < 0.05). MoCA scores of EP group improved significantly (p < 0.05) while CP group's did not (p > 0.05). It was found that EP group had better improvements in 9-HPT dominant side, MMDT turning test, and MoCA than CP group when the differences in the changes within the groups were compared (p < 0.05). CONCLUSION Game-based training can be a useful rehabilitation tool to improve upper extremities performance, trunk mobility, cognition, functional mobility, balance, and quality of life and may have superiority over conventional exercises in improving cognition and upper extremity functions. CLINICAL TRIAL NUMBER NCT05235880. Release Date: April 1, 2022.
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Affiliation(s)
- Barış Çetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gül Yalçın Çakmaklı
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kazemi D, Chadeganipour AS, Dehghani M, Ghorbali F. Associations of dual-task walking costs with cognition in Parkinson's disease. Gait Posture 2024; 110:48-52. [PMID: 38484647 DOI: 10.1016/j.gaitpost.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Gait and cognition are closely associated in Parkinson's disease (PD), with specific cognitive domains being associated with different motor symptoms. By identifying gait parameters affected by cognition, clinicians can develop targeted interventions that address cognitive impairment, improve gait, and reduce the risk of injury in PD patients. RESEARCH QUESTION What gait parameters are affected by cognition in PD patients during dual-task walking, and how are these parameters related to cognitive function as measured by the Montreal Cognitive Assessment (MoCA)? METHODS 36 patients with available gait data and cognitive assessments were enrolled. Gait data of usual and dual-task walking sessions were recorded using lightweight wireless wearable sensors attached to trunk, lower, and upper extremities. Dual-task costs were calculated from usual and dual-task measures. Statistical analysis included non-parametric tests, Wilcoxon signed-rank test, Spearman's correlation, and stepwise linear regression models. RESULTS Walking speed, cadence, asymmetry in arm swing (ASA), between arms' amplitude symmetry (BAS), average stride time, and jerk of the acceleration movement of the legs were found to be affected during the dual-task walking session (P<0.05). Spearman's correlation showed significant correlations between MoCA scores and ASA (ρ=-0.469, P=0.036) and BAS (ρ=-0.448, P=0.036) costs. Stepwise linear regression models found that MoCA scores were significant predictors of BAS and ASA costs (P<0.05). SIGNIFICANCE This study found a significant association between global cognitive ability and several gait parameters costs under cognitive load caused by dual-task walking in PD patients. The study identified the gait parameters that were affected by cognitive load and found that MoCA scores were significant predictors of those gait parameters. Identifying gait parameters affected by cognition can lead to more targeted interventions for improving gait and reducing injury risk in PD patients.
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Affiliation(s)
- Danial Kazemi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mina Dehghani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Ghorbali
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Pereira-Pedro KP, de Oliveira IM, Mollinedo Cardalda I, Cancela-Carral JM. Effects of a forced cycling program with cognitive stimulation on symptomatology, physical condition, and cognition in people diagnosed with Parkinson disease. Medicine (Baltimore) 2022; 101:e31920. [PMID: 36482603 PMCID: PMC9726402 DOI: 10.1097/md.0000000000031920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Parkinson disease may present difficulties in performing dual tasks. The use of dual tasks during training can improve different abilities. Therefore, the objective of this study is creating a protocol, based on standard protocol items recommendations for interventional trials compliant, for a clinical trial study conduct, review, reporting, and interpretation. This protocol will provide the framework and a guide to a randomized double-blind study, that will be conducted to assess the influence of a cycling exercise program combined with a cognitive task, on cognitive and physical Parkinson disease aspects. METHODS Designed a protocol for a double-blind randomized study, where participants will perform a dual tasks intervention with cycling and a cognitive task. The revised version of the unified Parkinson disease rating scale, the Parkinson disease questionnaire, the timed up and go Test, the 30 seconds chair sit to stand test, the Stroop and the trail making test will be used to measure outcomes. DISCUSSION Research in Parkinson disease suggests that an improvement of motor and cognitive functions of Parkinson disease patients can be achieved by modifying different motor and cognitive pathways. The results of the present study will yield findings on both the physical and cognitive response to an intervention that combines a cognitive task with a motor task in Parkinson disease patients and will be essential tool for a better conducting of the clinical trial study.
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Affiliation(s)
| | - Iris Machado de Oliveira
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, Healthy Fit Research Group, University of Vigo
- * Correspondence: Iris Machado de Oliveira, Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, Healthy Fit Research Group, University of Vigo, Campus Pontevedra, s/n, 36005, Pontevedra (Pontevedra), Spain (e-mail: )
| | - Irimia Mollinedo Cardalda
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, Healthy Fit Research Group, University of Vigo
| | - José M. Cancela-Carral
- Department of Special Didactics, Faculty of Education and Sports Sciences, HealthyFit Research Group, University of Vigo
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Effects of dual task training on dual task gait performance and cognitive function in individuals with Parkinson's disease: A meta-analysis and meta-regression. Arch Phys Med Rehabil 2022:S0003-9993(22)01727-0. [PMID: 36574531 DOI: 10.1016/j.apmr.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the effects of dual task (DT) training on DT gait performance and cognitive function in individuals with Parkinson's disease (PD) and to examine factors that might influence the effects of DT training. DATA SOURCES PubMed, Wiley Online Library, Cochrane Library, CINAHL, and Medline were searched for articles published from January 2006 to December 2021. STUDY SELECTION Randomized controlled trials comparing DT training with usual care or general exercise were included. DATA EXTRACTION The outcomes studied were DT gait parameters including speed, step and stride length, cadence, step and stride time variability, dual task cost on gait speed, and Trail Making Tests (TMT) presented as standardized mean differences. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of evidence. DATA SYNTHESIS Ten randomized controlled trials with 466 participants were included in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. Meta-analyses used a random-effects model for all analysis. The meta-analysis showed the DT training effects on DT gait speed (SMD=0.825, p=0.012), DT step and stride length (SMD=0.400, p=0.015), TMT-A (SMD=0.533, p=0.010) and TMT-B (SMD=0.516, p=0.012) compared to the control group. Only the effect on TMT-A was maintained at the follow-up assessment. The results of meta-regression showed that participants with slower initial single task gait speed improved more after DT training on DT step and stride length. CONCLUSIONS The DT training improved more in DT gait speed with moderate-quality evidence as compared with usual care or conventional physical training in individuals with PD. The beneficial effects of DT training on DT step and stride length, attention and executive function were also demonstrated in this meta-analysis. Furthermore, the improvement in the DT walking step and stride length was related to the participant's initial single task gait speed.
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Maranesi E, Casoni E, Baldoni R, Barboni I, Rinaldi N, Tramontana B, Amabili G, Benadduci M, Barbarossa F, Luzi R, Di Donna V, Scendoni P, Pelliccioni G, Lattanzio F, Riccardi GR, Bevilacqua R. The Effect of Non-Immersive Virtual Reality Exergames versus Traditional Physiotherapy in Parkinson's Disease Older Patients: Preliminary Results from a Randomized-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214818. [PMID: 36429537 PMCID: PMC9690935 DOI: 10.3390/ijerph192214818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 05/28/2023]
Abstract
(1) Background: Parkinson's disease (PD) is one of the most frequent causes of disability among older people. Recently, virtual reality and exergaming have been emerged as promising tools for gait and balance rehabilitation in PD patients. Our purpose is to evaluate an innovative treatment for older patients with PD, based on non-immersive virtual reality exergames, improving gait and balance and reducing falling risk. (2) Methods: Thirty PD patients were recruited and randomly divided into two groups, to receive a traditional rehabilitation (CG) or a technological rehabilitation (TG). (3) Results: A statistical improvement of balance at the end of treatments was observed in both groups (CG: 12.4 ± 0.7 vs. 13.5 ± 0.8, p = 0.017; TG: 13.8 ± 0.5 vs. 14.7 ± 0.4, p = 0.004), while the overall risk of falling was significantly reduced only in the TG (POMA Total: 24.6 ± 0.9 vs. 25.9 ± 0.7, p = 0.010). The results between groups shows that all POMA scores differ in a statistically significant manner in the TG, emphasizing improvement not only in balance but also in gait characteristics (9.7 ± 0.8 vs. 11.4 ± 0.2, p = 0.003). Moreover, TG also improves the psychological sphere, measured thorough MSC-(17.1 ± 0.4 vs. 16.5 ± 0.4, p = 0.034). Although an improvement in FES-I and Gait Speed can be observed, this increase does not turn out to be significant. (4) Conclusions: Results suggest how non-immersive virtual reality exergaming technology offers the opportunity to effectively train cognitive and physical domains at the same time.
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Affiliation(s)
| | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Ilaria Barboni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Barbara Tramontana
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | | | | | | | | | - Valentina Di Donna
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Pietro Scendoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
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Zawadka-Kunikowska M, Klawe JJ, Tafil-Klawe M, Bejtka M, Rzepiński Ł, Cieślicka M. Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912694. [PMID: 36231994 PMCID: PMC9566250 DOI: 10.3390/ijerph191912694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson's disease (PD) compared to age-matched healthy controls (HCs). METHODS The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT. RESULTS In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior-posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs. CONCLUSIONS Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Monika Bejtka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
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