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Quattrone A, Calomino C, Sarica A, Caligiuri ME, Bianco MG, Vescio B, Arcuri PP, Buonocore J, De Maria M, Vaccaro MG, Quattrone A. Neuroimaging correlates of postural instability in Parkinson's disease. J Neurol 2024; 271:1910-1920. [PMID: 38108896 DOI: 10.1007/s00415-023-12136-9] [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: 06/21/2023] [Revised: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Postural instability (PI) is a common disabling symptom in Parkinson's disease (PD), but little is known on its pathophysiological basis. OBJECTIVE In this study, we aimed to identify the brain structures associated with PI in PD patients, using different MRI approaches. METHODS We consecutively enrolled 142 PD patients and 45 control subjects. PI was assessed using the MDS-UPDRS-III pull-test item (PT). A whole-brain regression analysis identified brain areas where grey matter (GM) volume correlated with the PT score in PD patients. Voxel-based morphometry (VBM) and Tract-Based Spatial Statistics (TBSS) were also used to compare unsteady (PT ≥ 1) and steady (PT = 0) PD patients. Associations between GM volume in regions of interest (ROI) and several clinical features were then investigated using LASSO regression analysis. RESULTS PI was present in 44.4% of PD patients. The whole-brain approach identified the bilateral inferior frontal gyrus (IFG) and superior temporal gyrus (STG) as the only regions associated with the presence of postural instability. VBM analysis showed reduced GM volume in fronto-temporal areas (superior, middle, medial and inferior frontal gyrus, and STG) in unsteady compared with steady PD patients, and the GM volume of these regions was selectively associated with the PT score and not with any other motor or non-motor symptom. CONCLUSIONS This study demonstrates a significant atrophy of fronto-temporal regions in unsteady PD patients, suggesting that these brain areas may play a role in the pathophysiological mechanisms underlying postural instability in PD. This result paves the way for further studies on postural instability in Parkinsonism.
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Camilla Calomino
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Alessia Sarica
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Giovanna Bianco
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | | | - Pier Paolo Arcuri
- Institute of Radiology, Azienda Ospedaliero-Universitaria Dulbecco, Catanzaro, Italy
| | - Jolanda Buonocore
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Marida De Maria
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, University "Magna Graecia", Viale Europa, Germanetox, 88100, Catanzaro, Italy.
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Park M, Lee YG. Association of Family History and Polygenic Risk Score With Longitudinal Prognosis in Parkinson Disease. Neurol Genet 2024; 10:e200115. [PMID: 38169864 PMCID: PMC10759146 DOI: 10.1212/nxg.0000000000200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/02/2023] [Indexed: 01/05/2024]
Abstract
Background and Objectives Evidence suggests that either family history or polygenic risk score (PRS) is associated with developing Parkinson disease (PD). However, little is known about the longitudinal prognosis of PD according to family history and higher PRS. Methods From the Parkinson's Progression Markers Initiative database, 395 patients with PD who followed up for more than 2 years were grouped into those with family history within first-degree, second-degree, and third-degree relatives (N = 127 [32.2%]) vs those without (N = 268 [67.8%]). The PRS of 386 patients was computed using whole-genome sequencing data. Longitudinal assessment of motor, cognition, and imaging based on dopaminergic degeneration was conducted during the regular follow-up period. Effects of family history, PRS, or both on longitudinal changes of cognition, motor severity, and nigrostriatal degeneration were tested using a linear mixed model. The risk of freezing of gait (FOG) according to family history was assessed using the Kaplan-Meier analysis and Cox regression models. Results During a median follow-up of 9.1 years, PD with positive family history showed a slower decline of caudate dopamine transporter uptake (β estimate of family history × time = 0.02, 95% CI = 0.002-0.036, p = 0.027). Family history of PD and higher PRS were independently associated with a slower decline of Montreal Cognitive Assessment (β estimate of family history × time = 0.12, 95% CI = 0.02-0.22, p = 0.017; β estimate of PRS × time = 0.09, 95% CI = 0.03-0.16, p = 0.006). In those 364 patients without FOG at baseline, PD with positive family history had a lower risk of FOG (hazard ratio of family history = 0.57, 95% CI = 0.38-0.84, p = 0.005). Discussion Having a family history of PD predicts slower progression of cognitive decline and caudate dopaminergic degeneration, and less FOG compared with those without a family history independent of PRS. Taken together, information on family history could be used as a proxy for the clinical heterogeneity of PD. Trial Registration Information The study was registered at clinicaltrials.gov (NCT01141023), and the enrollment began June 1, 2010.
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Affiliation(s)
- Mincheol Park
- From the Department of Neurology (M.P.), Gwangmyeong Hospital, Chung-Ang University College of Medicine; and Department of Neurology (Y.L.), Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young-Gun Lee
- From the Department of Neurology (M.P.), Gwangmyeong Hospital, Chung-Ang University College of Medicine; and Department of Neurology (Y.L.), Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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3
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Gong NJ, Clifford GD, Esper CD, Factor SA, McKay JL, Kwon H. Classifying Tremor Dominant and Postural Instability and Gait Difficulty Subtypes of Parkinson's Disease from Full-Body Kinematics. SENSORS (BASEL, SWITZERLAND) 2023; 23:8330. [PMID: 37837160 PMCID: PMC10575216 DOI: 10.3390/s23198330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
Characterizing motor subtypes of Parkinson's disease (PD) is an important aspect of clinical care that is useful for prognosis and medical management. Although all PD cases involve the loss of dopaminergic neurons in the brain, individual cases may present with different combinations of motor signs, which may indicate differences in underlying pathology and potential response to treatment. However, the conventional method for distinguishing PD motor subtypes involves resource-intensive physical examination by a movement disorders specialist. Moreover, the standardized rating scales for PD rely on subjective observation, which requires specialized training and unavoidable inter-rater variability. In this work, we propose a system that uses machine learning models to automatically and objectively identify some PD motor subtypes, specifically Tremor-Dominant (TD) and Postural Instability and Gait Difficulty (PIGD), from 3D kinematic data recorded during walking tasks for patients with PD (MDS-UPDRS-III Score, 34.7 ± 10.5, average disease duration 7.5 ± 4.5 years). This study demonstrates a machine learning model utilizing kinematic data that identifies PD motor subtypes with a 79.6% F1 score (N = 55 patients with parkinsonism). This significantly outperformed a comparison model using classification based on gait features (19.8% F1 score). Variants of our model trained to individual patients achieved a 95.4% F1 score. This analysis revealed that both temporal, spectral, and statistical features from lower body movements are helpful in distinguishing motor subtypes. Automatically assessing PD motor subtypes simply from walking may reduce the time and resources required from specialists, thereby improving patient care for PD treatments. Furthermore, this system can provide objective assessments to track the changes in PD motor subtypes over time to implement and modify appropriate treatment plans for individual patients as needed.
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Affiliation(s)
- N. Jabin Gong
- School of Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30322, USA
| | - Christine D. Esper
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - J. Lucas McKay
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
| | - Hyeokhyen Kwon
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
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Jansen JAF, Capato TTC, Darweesh SKL, Barbosa ER, Donders R, Bloem BR, Nonnekes J. Exploring the levodopa-paradox of freezing of gait in dopaminergic medication-naïve Parkinson's disease populations. NPJ Parkinsons Dis 2023; 9:130. [PMID: 37689706 PMCID: PMC10492797 DOI: 10.1038/s41531-023-00575-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
The relationship between dopaminergic treatment and freezing of gait (FOG) in Parkinson's disease (PD) is complex: levodopa is the most effective symptomatic treatment for FOG, but long-term pulsatile levodopa treatment has also been linked to an increase in the occurrence of FOG. This concept, however, continues to be debated. Here, we compared the occurrence of FOG between a levodopa-naive PD cohort and a levodopa-treated cohort. Forty-nine treatment-naive patients and 150 levodopa-treated patients were included. The time since first motor symptoms was at least 5 years. Disease severity was assessed using the MDS-UPDRS part III. Occurrence of FOG was assessed subjectively (new freezing-of-gait-questionnaire) and objectively (rapid turns test and Timed Up-and-Go test). The presence of FOG was compared between the levodopa-treated and levodopa-naive groups using a chi-square test of homogeneity. We also performed a binomial Firth logistic regression with disease duration, disease severity, country of inclusion, location of measurement, and executive function as covariates. Subjective FOG was more common in the levodopa-treated cohort (n = 41, 27%) compared to the levodopa-naive cohort (n = 2, 4%, p < 0.001). The association between FOG and levodopa treatment remained after adjustment for covariates (OR = 6.04, 95%Cl [1.60, 33.44], p = 0.006). Objectively verified FOG was more common in the levodopa-treated cohort (n = 21, 14%) compared to the levodopa-naive cohort (n = 1, 2%, p = 0.02). We found an association between long-term pulsatile levodopa treatment and an increased occurrence of FOG. Future studies should further explore the role of nonphysiological stimulation of dopamine receptors in generating FOG, as a basis for possible prevention studies.
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Affiliation(s)
- Jamie A F Jansen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Tamine T C Capato
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Egberto R Barbosa
- University of São Paulo, Department of Neurology, Movement Disorders Center, São Paulo, Brazil
| | - Rogier Donders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands.
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Flores-Leon M, Outeiro TF. More than meets the eye in Parkinson's disease and other synucleinopathies: from proteinopathy to lipidopathy. Acta Neuropathol 2023; 146:369-385. [PMID: 37421475 PMCID: PMC10412683 DOI: 10.1007/s00401-023-02601-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
The accumulation of proteinaceous inclusions in the brain is a common feature among neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease (PD), and dementia with Lewy bodies (DLB). The main neuropathological hallmark of PD and DLB are inclusions, known as Lewy bodies (LBs), enriched not only in α-synuclein (aSyn), but also in lipid species, organelles, membranes, and even nucleic acids. Furthermore, several genetic risk factors for PD are mutations in genes involved in lipid metabolism, such as GBA1, VSP35, or PINK1. Thus, it is not surprising that mechanisms that have been implicated in PD, such as inflammation, altered intracellular and vesicular trafficking, mitochondrial dysfunction, and alterations in the protein degradation systems, may be also directly or indirectly connected through lipid homeostasis. In this review, we highlight and discuss the recent evidence that suggests lipid biology as important drivers of PD, and which require renovated attention by neuropathologists. Particularly, we address the implication of lipids in aSyn accumulation and in the spreading of aSyn pathology, in mitochondrial dysfunction, and in ER stress. Together, this suggests we should broaden the view of PD not only as a proteinopathy but also as a lipidopathy.
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Affiliation(s)
- Manuel Flores-Leon
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073, Göttingen, Germany
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de México, Mexico
| | - Tiago Fleming Outeiro
- Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, 37073, Göttingen, Germany.
- Max Planck Institute for Multidisciplinary Science, Göttingen, Germany.
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
- Scientific Employee with an Honorary Contract at Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Göttingen, Germany.
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Virmani T, Patra M, Glover A, Pillai L. Objective quantification of responses to the clinical pull-test in people with Parkinson's disease. Gait Posture 2023; 103:106-112. [PMID: 37156162 PMCID: PMC10524570 DOI: 10.1016/j.gaitpost.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Postural instability can occur in the later-stages of Parkinson's disease (PD). The clinical pull-test is scored on a 0-4 scale on the Unified Parkinson's disease rating scale (UPDRS), with postural instability scored 2 or higher. This ordinal scale does not adequately track progression in early-PD or predict development of postural instability. RESEARCH QUESTION To develop a test that quantifiably measured the backward stepping response on the pull-test in early-PD. METHODS Participants (35 controls and 79 PD participants) were prospectively enrolled in this study. Participants stepped backwards with each shoulder pull at four strengths on an instrumented gait mat. Four spatiotemporal parameters (reaction-time, step-back-time, step-back-distance, step-back-velocity) were quantified using Protokinetics Movement Analysis Software. Spatiotemporal pull-test parameters were compared to standard PD measures using linear regression and correlation coefficients. Repeated measures analysis was used to determine group differences in pull-test parameters. In a subset of participants repeated testing was performed and Bland-Altman plots were used to determine reproducibility of the pull-test parameters. RESULT Step-back-distance and step-back-velocity were inversely related to motor UPDRS and freezing of gait questionnaire scores. PD participants had shorter step-back-distance than controls adjusted for age and sex. Repeat assessments in 16 participants, on average 0.7 years apart, showed good agreement on most of the quantified parameters. SIGNIFICANCE The backward stepping response in PD participants was quantifiable, reproducible, and related to disease severity and could be used to quantify progression towards postural instability in early-PD.
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Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock 72205 , AR, USA.
| | - Mousumi Patra
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock 72205 , AR, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock 72205 , AR, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock 72205 , AR, USA
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Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Pongmala C, Roytman S, van Emde Boas M, Dickinson O, Kanel P, Bohnen NI. Composite measures of motor performance and self-efficacy are better determinants of postural instability and gait difficulties than individual clinical measures in Parkinson's disease. Parkinsonism Relat Disord 2023; 107:105251. [PMID: 36566525 PMCID: PMC10028594 DOI: 10.1016/j.parkreldis.2022.105251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postural instability and gait difficulties (PIGD) are a significant cause of disability and loss of quality of life (QoL) in Parkinson's Disease. Most research on clinical predictors of PIGD measures have focused on individual clinical often motor performance variables, However, PIGD motor features often result in fear of falling (FoF) lowering a patient's mobility self-efficacy. The purpose of this study was to assess composite measures of motor and self-efficacy determinants PIGD motor features in PD and compare these to analysis of individual clinical metrics. METHODS 75 PD participants underwent detailed motor and non-motor test batteries. Principal component analysis (PCA) was used to identify clusters of covarying correlates of slow walking, imbalance, falls, freezing of gait, FoG and compare these to traditional univariate analyses. RESULTS A single PCA-derived composite measure of motor performance and self-efficacy of mobility was the most robust determinant of all PIGD motor features except for falls. In contrast, analysis of the individual clinical variables showed more limited and diverging findings, including evidence of better cognitive performance but more severe motor parkinsonian ratings in the fall group. CONCLUSION There are robust associations between composite measures of motor performance and self-efficacy of mobility and all PIGD motor features except for falls. Univariate analysis of individual clinical measures showed limited correlates of PIGD motor features. Patient's own perception of motor performance, FoF, and QoL deserve more attention as PIGD therapeutic targets in PD.
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Affiliation(s)
- Chatkaew Pongmala
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Miriam van Emde Boas
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Olivia Dickinson
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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The effect of galvanic vestibular stimulation on postural balance in Parkinson's disease: A systematic review and meta-analysis. J Neurol Sci 2022; 442:120414. [PMID: 36116217 DOI: 10.1016/j.jns.2022.120414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
Abstract
People with Parkinson's disease (PD) develop postural imbalance and falls. Galvanic Vestibular Stimulation (GVS) may potentially improve postural balance in humans and hence reduce falls in PD. This systematic review and meta-analysis investigate the effects of GVS on postural balance in PD. Six separate databases and research registers were searched for cross-over design trials that evaluated the effects of GVS on postural balance in PD. We used standardized mean difference (Hedges' g) as a measure of effect size in all studies. We screened 223 studies, evaluated 14, of which five qualified for the meta-analysis. Among n = 40 patients in five studies (range n = 5 to 13), using a fixed effects model we found an effect size estimate of g = 0.43 (p < 0.001, 95% CI [0.29,0.57]). However, the test for residual heterogeneity was significant (p < 0.001), thus we used a random effects model and found a pooled effect size estimate of 0.62 (p > 0.05, 95% CI [- 0.17, 1.41], I2 = 96.21%). Egger's test was not significant and thus trim and funnel plot indicated no bias. To reduce heterogeneity, we performed sensitivity analysis and by removing one outlier study (n = 7 patients), we found an effect size estimate of 0.16 (p < 0.05, 95% CI [0.01, 0.31], I2 = 0%). Our meta-analysis found GVS has a favourable effect on postural balance in PD patients, but due to limited literature and inconsistent methodologies, this favourable effect must be interpreted with caution.
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Okubadejo NU, Okunoye O, Ojo OO, Arabambi B, Akinyemi RO, Osaigbovo GO, Abubakar SA, Iwuozo EU, Wahab KW, Agabi OP, Agulanna U, Imarhiagbe FA, Abiodun OV, Achoru CO, Adebowale AA, Adeniji O, Akpekpe JE, Ali MW, Ani-Osheku I, Arigbodi O, Balarabe SA, Bello AH, Ekenze OS, Erameh CO, Farombi TH, Fawale MB, Komolafe MA, Nwani PO, Nwazor EO, Nyandaiti Y, Obehighe EE, Obiabo YO, Odeniyi OA, Odiase FE, Ojini FI, Onwuegbuzie GA, Osemwegie N, Oshinaike OO, Otubogun FM, Oyakhire SI, Taiwo FT, Williams UE, Ozomma S, Zubair Y, Hernandez D, Bandres-Ciga S, Blauwendraat C, Singleton A, Houlden H, Hardy J, Rizig M. APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease. NPJ Parkinsons Dis 2022; 8:155. [PMID: 36371506 PMCID: PMC9653490 DOI: 10.1038/s41531-022-00411-x] [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: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD.
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Affiliation(s)
- Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria.
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria.
| | - Olaitan Okunoye
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
| | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Babawale Arabambi
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Sani A Abubakar
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Emmanuel U Iwuozo
- Neurology Unit, Benue State University & Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Kolawole W Wahab
- Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Osigwe P Agabi
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Uchechi Agulanna
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Frank A Imarhiagbe
- University of Benin & University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | | | - Akintunde A Adebowale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | | | | | - Ifeyinwa Ani-Osheku
- Asokoro District Hospital, Asokoro, Abuja, Federal Capital Territory, Nigeria
| | - Ohwotemu Arigbodi
- Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - Salisu A Balarabe
- Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University & Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Oluchi S Ekenze
- Neurology Unit, Department of Medicine, Faculty of Medical Sciences, University of Nigeria & University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | | | - Temitope H Farombi
- Chief Tony Anenih Geriatrics Center, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Michael B Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Paul O Nwani
- Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ernest O Nwazor
- Department of Medicine, Madonna University College of Medical Sciences, Elele, Rivers State & Federal Medical Center, Owerri, Imo State, Nigeria
| | - Yakub Nyandaiti
- University of Maiduguri & University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | | | - Yahaya O Obiabo
- Department of Internal Medicine, Delta State University & Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Francis E Odiase
- University of Benin & University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Francis I Ojini
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Gerald A Onwuegbuzie
- University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Abuja, Federal Capital Territory, Nigeria
| | - Nosakhare Osemwegie
- University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Olajumoke O Oshinaike
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | | | - Shyngle I Oyakhire
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Funlola T Taiwo
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Uduak E Williams
- Department of Internal Medicine, University of Calabar/University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria
| | - Simon Ozomma
- Department of Internal Medicine, University of Calabar/University of Calabar Teaching Hospital, Calabar, Cross Rivers State, Nigeria
| | - Yusuf Zubair
- Department of Internal Medicine, National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Dena Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Sara Bandres-Ciga
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Cornelis Blauwendraat
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- Center For Alzheimer's and Related Dementias, NIA, NIH, Bethesda, MD, USA
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
- Neurogenetics Laboratory, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - John Hardy
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
| | - Mie Rizig
- Department of Molecular Neuroscience, University College London Institute of Neurology, Queen Square, London, UK
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11
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Lv L, Zhang H, Tan X, Long Z, Qin L, Bai R, Xiao Q, Wu Z, Hu S, Tan C, Liao H, Yan W, Tang B, Ren F, Wang C. Associated factors and abnormal dorsal raphe nucleus connectivity patterns of freezing of gait in Parkinson's disease. J Neurol 2022; 269:6452-6466. [PMID: 35933494 DOI: 10.1007/s00415-022-11294-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common, disabling symptom of Parkinson's disease (PD), and its exact pathophysiological mechanism is still poorly understood. The control of gait is a complex process that may be influenced by emotions modulated by serotonergic networks. Therefore, this study aimed to determine factors associated with FOG in PD patients and to evaluate the importance of the dorsal raphe nucleus (DRN; central node in the serotoninergic system) in FOG pathophysiology. METHODS We combined cross-sectional survey data from 453 PD patients. According to the Freezing of Gait Questionnaire (FOGQ), patients were divided into two groups: the "PD with frozen gait (PD-FOG)" and "PD without frozen gait (PD-nFOG)" groups. Demographic characteristics, clinical features, and motor and nonmotor symptoms (NMS) assessments of PD patients were recorded. Univariate statistical analysis was performed between the two groups, and then regression analysis was performed on related factors. We also acquired resting-state functional MRI (rs-fMRI) data from 20 PD-FOG, 21 PD-nFOG, and 22 healthy controls (HCs) who were randomly chosen. We defined seeds in the DRN to evaluate functional connectivity (FC) patterns. RESULTS The overall frequency of FOG was 11.9% patients in the PD-FOG group were older, had a longer disease duration, had a higher levodopa equivalent daily dose, had more severe motor symptoms and worse quality of life, had a higher proportion of dyskinesia, wearing-off and postural instability/gait difficulty (PIGD) clinical phenotype, and experienced more depression and impaired sleep function than those in the PD-nFOG group. Logistic regression analysis showed that H&Ystage ≥ 3, UPDRS-III scores, PIGD clinical phenotype and excessive daytime sleepiness were associated with FOG. In addition, there was significantly lower FC between the DRN and some cortical structures, including the supplementary motor area (SMA), left superior frontal gyrus (SFG), and left median cingulated cortex (MCC) in PD-FOG patients than HCs and PD-nFOG patients. CONCLUSIONS These results demonstrate that the severity of PD and PIGD clinical phenotype are associated factors for freezing and that DRN dysfunction may play a key role in PD-related NMS and FOG. An abnormal cortical and brainstem networks may contribute to the mechanisms underlying FOG.
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Affiliation(s)
- Lingling Lv
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Xuling Tan
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhe Long
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Rongrong Bai
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qile Xiao
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ziwei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shenglan Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Haiyan Liao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weiqian Yan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Beisha Tang
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Ren
- Department of Geriatric Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
- Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China.
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China.
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12
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Wang F, Pan Y, Zhang M, Hu K. Predicting the onset of freezing of gait in Parkinson's disease. BMC Neurol 2022; 22:213. [PMID: 35672669 PMCID: PMC9172010 DOI: 10.1186/s12883-022-02713-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Freezing of gait is a debilitating symptom of Parkinson's disease associated with high risks of falls and poor quality of life. While productive therapy for FoG is still underway, early prediction of FoG could help high-risk PD patients to take preventive measures. In this study, we predicted the onset of FoG in de novo PD patients using a battery of risk factors from patients enrolled in PPMI cohort. METHODS Baseline characteristics were compared between subjects who developed FoG (68 patients, 37.2%, pre-FoG group) during the five-year follow up and subjects who did not (115 patients, 62.8%, non-FoG group). A multivariate logistic regression model was built based on backward stepwise selection of factors that were associated with FoG onset in the univariate analysis. ROC curves were used to assess sensitivity and specificity of the predictive model. RESULTS At baseline, age, PIGD score, cognitive functions, autonomic functions, sleep behavior, fatigue and striatal DAT uptake were significantly different in the pre-FoG group relative to the non-FoG group. However, there was no difference in genetic characteristics between the two patient sets. Univariate analysis showed several motor and non-motor factors that correlated with FoG, including PIGD score, MDS-UPDRS part II score, SDMT score, HVLT Immediate/Total Recall, MOCA, Epworth Sleepiness Scale, fatigue, SCOPA-AUT gastrointestinal score, SCOPA-AUT urinary score and CSF biomarker Abeta42. Multivariate logistic analysis stressed that high PIGD score, fatigue, worse SDMT performance and low levels of Abeta42 were independent risk factors for FoG onset in PD patients. CONCLUSIONS Combining motor and non-motor features including PIGD score, poor cognitive functions and CSF Abeta can identify PD patients with high risk of FoG onset.
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Affiliation(s)
- Fengting Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025 China
| | - Yixin Pan
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Kejia Hu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
- Laboratory of Digital Medicine, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, 214023 China
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13
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Prange S, Klinger H, Laurencin C, Danaila T, Thobois S. Depression in Patients with Parkinson's Disease: Current Understanding of its Neurobiology and Implications for Treatment. Drugs Aging 2022; 39:417-439. [PMID: 35705848 PMCID: PMC9200562 DOI: 10.1007/s40266-022-00942-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/11/2022]
Abstract
Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson’s disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.
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Affiliation(s)
- Stéphane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France
| | - Chloé Laurencin
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Teodor Danaila
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France.,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, NS-PARK/FCRIN Network, 59 Boulevard Pinel, 69500, Bron, France. .,Physiopathology of the Basal Ganglia Team, Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Univ Lyon, Université Claude Bernard Lyon 1, Oullins, France.
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14
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Cerebrospinal fluid biomarkers in Parkinson's disease with freezing of gait: an exploratory analysis. NPJ Parkinsons Dis 2021; 7:105. [PMID: 34845234 PMCID: PMC8629994 DOI: 10.1038/s41531-021-00247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 10/27/2021] [Indexed: 01/06/2023] Open
Abstract
We explore the association between three Alzheimer’s disease-related and ten inflammation-related CSF markers and freezing of gait (FOG) in patients with Parkinson’s disease (PD). The study population includes PD patients with FOG (PD-FOG, N = 12), without FOG (PD-NoFOG, N = 19), and healthy controls (HC, N = 12). Age and PD duration are not significantly different between groups. After adjusting for covariates and multiple comparisons, the anti-inflammatory marker, fractalkine, is significantly decreased in the PD groups compared to HC (P = 0.002), and further decreased in PD-FOG compared to PD-NoFOG (P = 0.007). The Alzheimer’s disease-related protein, Aβ42, is increased in PD-FOG compared to PD-NoFOG and HC (P = 0.001). Group differences obtained in individual biomarker analyses are confirmed with multivariate discriminant partial least squares regression (P < 0.001). High levels of Aβ42 in PD-FOG patients supports an increase over time from early to advanced state. Low levels of fractalkine might suggest anti-inflammatory effect. These findings warrant replication.
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15
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Urso D, Leta V, Batzu L, Yousaf T, Farrell C, van Wamelen DJ, Ray Chaudhuri K. Disentangling the PIGD classification for the prediction of cognitive impairment in de novo Parkinson's disease. J Neurol 2021; 269:1566-1573. [PMID: 34338858 PMCID: PMC8857169 DOI: 10.1007/s00415-021-10730-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Background Postural Instability and Gait difficulties (PIGD) subtype has been associated with worse cognitive performance in Parkinson’s disease (PD). Objective To investigate whether PIGD subtype classification or PIGD-related clinical features predict the development of cognitive decline in de novo PD patients. Methods Data from 422 PD patients with de novo PD were obtained from the PPMI database. At follow-up (up to 6 years), patients were categorized as having cognitive impairment or not. Multivariate Cox survival analysis was carried out including motor subtype and individual MDS-UPDRS items defining PIGD phenotype as predictors. Previously validated clinical predictors of cognitive impairment were included in the model as covariates. Occurrence of cognitive impairment at follow-up was used as the time-to-event and Kaplan–Meier curve was generated. Results At baseline, 76 patients were classified as PIGD, 299 tremor-dominant and 47 as indeterminate. Development of cognitive impairment was not associated with PIGD subtype (p = 0.252). When individual MDS-UPDRS items were interrogated in the model, postural instability proved to be an independent predictor of cognitive impairment (HR = 2.045; 95%CI: 1.068–3.918; p = 0.031), while gait difficulties were not associated with cognitive decline (p = 0.870). Conclusions Our findings suggest that postural instability, as assessed by MDS-UPDRS III, may serve as a possible indicator of the risk of developing cognitive impairment in de novo PD patients rather than the PIGD phenotype.
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Affiliation(s)
- Daniele Urso
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK. .,Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Valentina Leta
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Tayyabah Yousaf
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chloe Farrell
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel J van Wamelen
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
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16
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Prevalence of freezing of gait in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2021; 268:4138-4150. [PMID: 34236501 DOI: 10.1007/s00415-021-10685-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is considered one of the most disturbing and least understood symptoms in Parkinson's disease (PD). The reported prevalence rates of FOG in PD vary widely, ranging from 5 to 85.9%. OBJECTIVE We conducted a systematic review and meta-analysis to provide a reliable estimate of the average point prevalence of FOG in PD, and we further investigated the study characteristics that might have influenced the estimate. METHODS We searched different databases to identify studies that report the prevalence of FOG in PD or include relevant raw data for further calculation. The last inclusion date was February 20, 2020. The modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used for the quality assessment, and articles that met the predefined criteria were included in the quantitative analysis. RESULTS Sixty-six studies were selected from 3392 references. A weighted prevalence of 50.6% in 9072 PD patients experienced FOG based on the special questionnaires (the FOG-Q and NFOG-Q), which was about twice as high as that assessed by the specific items of the clinical rating scales (UPDRS item2.14 and MDS-UPDRS item3.11) (23.2%) or simple clinical questions (25.4%). The weighted prevalence was 37.9% for early stage (≤ 5 years) and 64.6% for advanced stage (≥ 9 years). Moreover, a higher prevalence was calculated from the population-based studies than that in multicenter and single-center studies (47.3% vs. 33.5% and 37.1%, respectively). CONCLUSION The result from this systematic review confirms that FOG is very common in PD and its prevalence is usually underestimated in hospital settings. Importantly, a more accurate assessment of FOG in future clinical researches would involve the use of special FOG scale rather than a single item on a scale or a general clinical inquiry.
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Pedersen CC, Lange J, Førland MGG, Macleod AD, Alves G, Maple-Grødem J. A systematic review of associations between common SNCA variants and clinical heterogeneity in Parkinson's disease. NPJ PARKINSONS DISEASE 2021; 7:54. [PMID: 34210990 PMCID: PMC8249472 DOI: 10.1038/s41531-021-00196-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/02/2021] [Indexed: 11/09/2022]
Abstract
There is great heterogeneity in both the clinical presentation and rate of disease progression among patients with Parkinson’s disease (PD). This can pose prognostic difficulties in a clinical setting, and a greater understanding of the risk factors that contribute to modify disease course is of clear importance for optimizing patient care and clinical trial design. Genetic variants in SNCA are an established risk factor for PD and are candidates to modify disease presentation and progression. This systematic review aimed to summarize all available primary research reporting the association of SNCA polymorphisms with features of PD. We systematically searched PubMed and Web of Science, from inception to 1 June 2020, for studies evaluating the association of common SNCA variants with age at onset (AAO) or any clinical feature attributed to PD in patients with idiopathic PD. Fifty-eight studies were included in the review that investigated the association between SNCA polymorphisms and a broad range of outcomes, including motor and cognitive impairment, sleep disorders, mental health, hyposmia, or AAO. The most reproducible findings were with the REP1 polymorphism or rs356219 and an earlier AAO, but no clear associations were identified with an SNCA polymorphism and any individual clinical outcome. The results of this comprehensive summary suggest that, while there is evidence that genetic variance in the SNCA region may have a small impact on clinical outcomes in PD, the mechanisms underlying the association of SNCA polymorphisms with PD risk may not be a major factor driving clinical heterogeneity in PD.
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Affiliation(s)
- Camilla Christina Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Johannes Lange
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | | | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Guido Alves
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jodi Maple-Grødem
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway. .,Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway.
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18
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Davis AA, Inman CE, Wargel ZM, Dube U, Freeberg BM, Galluppi A, Haines JN, Dhavale DD, Miller R, Choudhury FA, Sullivan PM, Cruchaga C, Perlmutter JS, Ulrich JD, Benitez BA, Kotzbauer PT, Holtzman DM. APOE genotype regulates pathology and disease progression in synucleinopathy. Sci Transl Med 2021; 12:12/529/eaay3069. [PMID: 32024799 DOI: 10.1126/scitranslmed.aay3069] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
Apolipoprotein E (APOE) ε4 genotype is associated with increased risk of dementia in Parkinson's disease (PD), but the mechanism is not clear, because patients often have a mixture of α-synuclein (αSyn), amyloid-β (Aβ), and tau pathologies. APOE ε4 exacerbates brain Aβ pathology, as well as tau pathology, but it is not clear whether APOE genotype independently regulates αSyn pathology. In this study, we generated A53T αSyn transgenic mice (A53T) on Apoe knockout (A53T/EKO) or human APOE knockin backgrounds (A53T/E2, E3, and E4). At 12 months of age, A53T/E4 mice accumulated higher amounts of brainstem detergent-insoluble phosphorylated αSyn compared to A53T/EKO and A53T/E3; detergent-insoluble αSyn in A53T/E2 mice was undetectable. By immunohistochemistry, A53T/E4 mice displayed a higher burden of phosphorylated αSyn and reactive gliosis compared to A53T/E2 mice. A53T/E2 mice exhibited increased survival and improved motor performance compared to other APOE genotypes. In a complementary model of αSyn spreading, striatal injection of αSyn preformed fibrils induced greater accumulation of αSyn pathology in the substantia nigra of A53T/E4 mice compared to A53T/E2 and A53T/EKO mice. In two separate cohorts of human patients with PD, APOE ε4/ε4 individuals showed the fastest rate of cognitive decline over time. Our results demonstrate that APOE genotype directly regulates αSyn pathology independent of its established effects on Aβ and tau, corroborate the finding that APOE ε4 exacerbates pathology, and suggest that APOE ε2 may protect against αSyn aggregation and neurodegeneration in synucleinopathies.
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Affiliation(s)
- Albert A Davis
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA. .,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Casey E Inman
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Zachary M Wargel
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Umber Dube
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Psychiatry, Washington University, St. Louis, MO 63110, USA
| | - Brittany M Freeberg
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Alexander Galluppi
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Jessica N Haines
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Dhruva D Dhavale
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Rebecca Miller
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Fahim A Choudhury
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Patrick M Sullivan
- Department of Medicine, Duke University Medical Center, Durham VAMC and Geriatric Research Clinical Center, Durham, NC 27705, USA
| | - Carlos Cruchaga
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Psychiatry, Washington University, St. Louis, MO 63110, USA
| | - Joel S Perlmutter
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA.,Departments of Neuroscience and Radiology, Programs in Physical and Occupational Therapy, Washington University, St. Louis, MO 63110, USA
| | - Jason D Ulrich
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Bruno A Benitez
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Psychiatry, Washington University, St. Louis, MO 63110, USA
| | - Paul T Kotzbauer
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA.,Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - David M Holtzman
- Hope Center for Neurologic Disease, Washington University, St. Louis, MO 63110, USA. .,Department of Neurology, Washington University, St. Louis, MO 63110, USA.,Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
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19
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Aktürk T, Güven H, Güven B, Çomoğlu S. Association of freezing of gait and clinical features in patients with Parkinson's disease. Acta Neurol Belg 2021; 121:153-159. [PMID: 31654392 DOI: 10.1007/s13760-019-01217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Freezing of gait (FOG) is a disabling symptom that affects the quality of life of patients with Parkinson's disease (PD) and its pathophysiology is not fully understood yet. The aim of the present study is to evaluate the relationship between FOG and other clinical characteristics in patients with PD. The clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson's Disease Rating Scale (UPDRS) scores, and total Freezing of Gait Questionnaire (FOG-Q) scores of the patients with PD were recorded. FOG-Q item 1.3 was used to evaluate patients with or without FOG. A total of 65 patients with PD (32 with FOG and 33 without FOG) were included to the study. Disease duration was longer, mHY stages were higher, bradykinesia and dyskinesia were more common in patients with FOG compared to patients without (p = 0.001, p = 0.036, p = 0.019 and p = 0.021; respectively). Patients with FOG had lower UPDRS part III tremor subscores (p = 0.020), although gait, postural balance subscores and part IV motor fluctuations scores were higher (p = 0.003, p = 0.023 and p < 0.001; respectively). A positive correlation was found between FOG-Q scores and mHY stages (p < 0.001), UPDRS part II and III total scores (p = 0.020 and p = 0.001) and part III bradykinesia, and gait and postural balance subscores (p = 0.003, p = 0.036 and p = 0.003, respectively), and part IV motor fluctuation scores (p = 0.006). The results of the present study point to an association between FOG and bradykinesia rather than tremor, prolonged disease duration and advanced disease stage reflecting its association with more severe and extensive neurodegenerative processes.
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20
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Saadat P, Faramarzi M, Salimkhani F, Khafri S. Psychiatric Symptoms in Patients and Caregivers with Parkinson's Disease. Oman Med J 2020; 35:e205. [PMID: 33274072 PMCID: PMC7703521 DOI: 10.5001/omj.2020.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives Psychiatric disorders in patients with Parkinson’s disease (PD) and their caregivers play an important role in patients’ treatment and follow-up. Our study aimed to examine the prevalence of psychiatric symptoms among patients with PD and their caregivers, demographic risk factors, and the influence of severity and manifestations of PD on psychiatric distress. Methods We included 125 patients with PD and 125 of their primary caregivers in this descriptive cross-sectional study. The severity of PD was evaluated according to the Hoehn and Yahr severity scale from the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale. PD patients and their caregivers completed the Symptom Checklist-25 to determine the presence of psychiatric distress. Also, demographic factors, including age, high level of education, occupation, residence, and cigarette smoking, were assessed in the PD patients and their caregivers. Results The prevalence of psychiatric distress was 47.2% for PD patients and 18.4% for caregivers. Female sex, city residency, and medical disease were risk factors for more psychiatric symptoms in PD patients. Also, the female sex, single status, living in a village, and having a medical disease were risk factors for greater psychiatric symptoms in caregivers. PD patients in more advanced stages of disease suffered significantly from psychiatric distress, somatization, anxiety, interpersonal sensitivity, obsessive-compulsive disorder, and phobia compared to the lower severity of disease. PD patients with manifestation of postural instability showed a higher score of somatization, phobia, and psychiatric distress as compared with tremor, hypokinesia, and rigidity. Conclusions Progression of PD influenced the psychiatric symptoms of both patients and their caregivers. A higher stage of PD is associated with higher scores of psychiatric distress, phobia, and somatization in the patients and their caregivers.
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Affiliation(s)
- Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farnaz Salimkhani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Department of Epidemiology and Biostatics, Babol University of Medical Sciences, Babol, Iran
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21
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Apolipoprotein E ε4 genotype and risk of freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2020; 81:173-178. [DOI: 10.1016/j.parkreldis.2020.10.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
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22
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Brown KA, Spencer KA. The Relationship Between Speech Characteristics and Motor Subtypes of Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2145-2154. [PMID: 32997516 DOI: 10.1044/2020_ajslp-20-00058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this study was to examine whether acoustic dysarthria characteristics align with overall motor profile in individuals with Parkinson's disease (PD). Potential speech differences between tremor-dominant and non-tremor-dominant subtypes are theoretically motivated but empirically inconclusive. Method Twenty-seven individuals with dysarthria from PD provided a contextual speech sample. Participants were grouped into non-tremor-dominant (n = 12) and tremor-dominant (n = 15) motor subtypes according to the Unified Parkinson Disease Rating Scale. Dependent speech variables included fundamental frequency range, average pause duration, cepstral peak prominence, stuttering dysfluencies, and maze dysfluencies. Results There were no significant differences between the speech of the tremor-dominant and non-tremor-dominant groups. High within-group variability existed across parameters and motor subtypes. Conclusion Speech characteristics across the areas of phonation, prosody, and fluency did not differ appreciably between PD motor subtypes.
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Affiliation(s)
- Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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23
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Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
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24
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The impact of freezing of gait on functional dependency in Parkinson’s disease with regard to motor phenotype. Neurol Sci 2020; 41:2883-2892. [DOI: 10.1007/s10072-020-04404-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/08/2020] [Indexed: 01/04/2023]
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25
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Reekes TH, Higginson CI, Ledbetter CR, Sathivadivel N, Zweig RM, Disbrow EA. Sex specific cognitive differences in Parkinson disease. NPJ PARKINSONS DISEASE 2020; 6:7. [PMID: 32284961 PMCID: PMC7142103 DOI: 10.1038/s41531-020-0109-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/24/2020] [Indexed: 12/22/2022]
Abstract
Parkinson disease (PD) is a progressive neurodegenerative disorder that is 1.5 times more common in males than in females. While motor progression tends to be more aggressive in males, little is known about sex difference in cognitive progression. We tested the hypothesis that there are sex differences in cognitive dysfunction in non-demented PD. We evaluated 84 participants (38 females) with PD and 59 controls (27 females) for demographic variables and cognitive function, including attention, working memory, executive function, and processing speed. Multivariate ANOVA revealed no significant differences between groups for demographic variables, including age, years of education, global cogntition, daytime sleepiness, predicted premorbid IQ, UPDRS score, PD phenotype, or disease duration. For cognitive variables, we found poorer performance in males versus females with PD for measures of executive function and processing speed, but no difference between male and female controls. Specifically, PD males showed greater deficits in Verbal Fluency (category fluency, category switching, and category switching accuracy), Color Word Interference (inhibition), and speed of processing (SDMT). There were no differences in measures of working memory or attention across sex and inconsistent findings for switching. Our data indicate that males with PD have significantly greater executive and processing speed impairments compared to females despite no differences in demographic variables or other measures of disease severity. Our findings are consistent with the steeper slope of disease progression reported in males with PD.
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Affiliation(s)
- Tyler Harrison Reekes
- 1Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA USA.,2LSU Health Shreveport Center for Brain Health, Shreveport, LA USA
| | | | - Christina Raye Ledbetter
- 2LSU Health Shreveport Center for Brain Health, Shreveport, LA USA.,4Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Niroshan Sathivadivel
- 2LSU Health Shreveport Center for Brain Health, Shreveport, LA USA.,5Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Richard Matthew Zweig
- 5Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Elizabeth Ann Disbrow
- 1Department of Pharmacology, Toxicology, and Neuroscience, Louisiana State University Health Sciences Center, Shreveport, LA USA.,2LSU Health Shreveport Center for Brain Health, Shreveport, LA USA.,5Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA USA
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26
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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27
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Bekkers EMJ, Mirelman A, Alcock L, Rochester L, Nieuwhof F, Bloem BR, Pelosin E, Avanzino L, Cereatti A, Della Croce U, Hausdorff JM, Nieuwboer A. Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality? Neurorehabil Neural Repair 2020; 34:440-449. [PMID: 32202203 DOI: 10.1177/1545968320912756] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background. People with Parkinson's disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG-. Objective. To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG-. Methods. A total of 77 FOG+ and 44 FOG- were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months' follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B). Results. Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG- had a greater reduction of falls after TT + VR compared with TT (P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group. Conclusions. Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG-, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms.
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Affiliation(s)
| | - Anat Mirelman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Alcock
- Newcastle University, Newcastle upon Tyne, UK
| | | | - Freek Nieuwhof
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elisa Pelosin
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Avanzino
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Cereatti
- University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush University Medical Center, Chicago, IL, USA
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28
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Tuning of Standing Postural Responses to Instability and Cost Function. Neuroscience 2020; 428:100-110. [PMID: 31917343 DOI: 10.1016/j.neuroscience.2019.12.043] [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: 08/27/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/20/2022]
Abstract
Whole-body movements are performed daily, and humans must constantly take into account the inherent instability of a standing posture. At times these movements may be performed in risky environments and when facing different costs of failure. The aim of the study was to test the hypothesis that in upright stance participants continuously estimate both probability of failure and cost of failure such that their postural responses will be based on these estimates. We designed a snowboard riding simulation experiment where participants were asked to control the position of a moving snowboard within a snow track in a risky environment. Cost functions were provided by modifying the penalty of riding in the area adjacent to the snow track. Uncertainty was modified by changing the gain of postural responses while participants were standing on a rocker board. We demonstrated that participants continually evaluated the environmental cost function and compensated for additional risk with feedback-based postural changes, even when probability of failure was negligible. Results showed also that the participants' estimates of the probability of failure accounted for their own inherent instability. Moreover, participants showed a tendency to overweight large probabilities of failure with more biomechanically constrained standing postures that results in suboptimal estimates of risky environments. Overall, our results suggest that participants tune their standing postural responses by empirically estimating the cost of failure and the uncertainty level in order to minimize the risk of falling when cost is high.
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Sharma R, Pillai L, Glover A, Virmani T. Objective impairment of tandem gait in Parkinson's disease patients increases with disease severity. Parkinsonism Relat Disord 2019; 68:33-39. [PMID: 31621615 DOI: 10.1016/j.parkreldis.2019.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/07/2019] [Accepted: 09/22/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tandem gait abnormalities have been reported to increase with advancing age, play a role in fall-prediction in Parkinson's disease, and distinguish it from atypical parkinsonism. Tandem gait has been scored based on the number of side steps off a straight line in these studies. Objective measurement of spatiotemporal tandem gait parameters in Parkinson's disease has not been previously reported. METHODS Subjects (74 Parkinson's disease and 28 controls) were enrolled after IRB approval. Those with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects tandem walked ("heel to toe") on a 20 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics). RESULTS Compared to controls, on tandem gait, Parkinson's subjects had increased step width, stride width and path width, with a slower stride velocity and an increased time spent in all phases of the gait cycle. Parkinson's subjects also applied greater pressure with each step and had greater step-to-step variability in tandem gait measures. While Hoehn & Yahr stage 1 subjects were not significantly different from controls, stage 2 and 2.5 + groups were different. Parkinson's subjects with freezing of gait also walked with a wider base compared to those without gait freezing. Tandem gait spatiotemporal parameters were not correlated with fall frequency. CONCLUSIONS Tandem gait is impaired in Parkinson's disease in a stage-dependent manner, with wider base and increased step-to-step variability, which could suggest involvement of cerebellar and mediolateral balance pathways.
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Affiliation(s)
- Rohan Sharma
- Department of Neurology, 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
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Lieberman A, Deep A, Olson MC, Smith Hussain V, Frames CW, McCauley M, Lockhart TE. Falls When Standing, Falls When Walking: Different Mechanisms, Different Outcomes in Parkinson Disease. Cureus 2019; 11:e5329. [PMID: 31598436 PMCID: PMC6777936 DOI: 10.7759/cureus.5329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
Our retrospective study of falls and resultant trauma in consecutive Parkinson disease (PD) patients seen in one year at the Muhammad Ali Parkinson Clinic found that multiple-fallers could be divided into patients who fell mainly when walking or those who fell mainly when standing. Patients who fell when walking were more likely to visit an emergency room or be admitted to a hospital. Of 455 consecutive patients who were evaluated over a one-year period, 51 were excluded because they had atypical Parkinson disorders, had multiple risk factors for falling, or were demented. Unified Parkinson Disease Rating Scales and Zeno Walkway results were compared among non-fallers, single-fallers, and multiple-fallers. Among multiple-fallers, comparisons were made between patients who fell mainly when standing and those who fell mainly when walking. Most patients (197, 49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once. Multiple-fallers differed significantly from single-fallers and non-fallers: they had PD significantly longer (p<0.001), were more severely affected (p<0.001), and took shorter steps (p<0.001). Of 65 multiple-fallers, 26 (40%) fell mainly when standing, 28 (43%) fell mainly when walking, and 11 (17%) fell equally often when standing or walking. Falls when walking resulted in more severe injuries. Patients who fell mainly when standing did not realize they could fall when standing; engaged in inappropriate weight shifting, bending, reaching, and multitasking; and failed to use their assistive devices. Such patients would benefit from being counseled about falling when standing. Patients who fell mainly when walking were aware they could fall, despite using an assisted device, and were more likely to have freezing of gait (FOG). They were more likely to sustain a severe injury, and were more likely to be admitted to an emergency room or hospital. Such patients would benefit from reducing, if possible, FOG.
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Affiliation(s)
- Abraham Lieberman
- Neurology, Muhammad Ali Parkinson Center, Barrow Neurological Institute, Phoenix, USA
| | - Aman Deep
- Neurology, University of Tennessee Health Science Center, Memphis, USA
| | - Markey C Olson
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Victoria Smith Hussain
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Christopher W Frames
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Margaret McCauley
- Neurology, Muhammad Ali Parkinson Center, Bob & Renee Parsons Fall Prevention Center, Barrow Neurological Institute, Phoenix, USA
| | - Thurmon E Lockhart
- Biomedical Engineering, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, USA
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Wichmann T. Changing views of the pathophysiology of Parkinsonism. Mov Disord 2019; 34:1130-1143. [PMID: 31216379 DOI: 10.1002/mds.27741] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Studies of the pathophysiology of parkinsonism (specifically akinesia and bradykinesia) have a long history and primarily model the consequences of dopamine loss in the basal ganglia on the function of the basal ganglia/thalamocortical circuit(s). Changes of firing rates of individual nodes within these circuits were originally considered central to parkinsonism. However, this view has now given way to the belief that changes in firing patterns within the basal ganglia and related nuclei are more important, including the emergence of burst discharges, greater synchrony of firing between neighboring neurons, oscillatory activity patterns, and the excessive coupling of oscillatory activities at different frequencies. Primarily focusing on studies obtained in nonhuman primates and human patients with Parkinson's disease, this review summarizes the current state of this field and highlights several emerging areas of research, including studies of the impact of the heterogeneity of external pallidal neurons on parkinsonism, the importance of extrastriatal dopamine loss, parkinsonism-associated synaptic and morphologic plasticity, and the potential role(s) of the cerebellum and brainstem in the motor dysfunction of Parkinson's disease. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Thomas Wichmann
- Department of Neurology/School of Medicine and Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
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Kim R, Lee J, Kim HJ, Kim A, Jang M, Jeon B, Kang UJ. CSF β-amyloid 42 and risk of freezing of gait in early Parkinson disease. Neurology 2018; 92:e40-e47. [PMID: 30504429 DOI: 10.1212/wnl.0000000000006692] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/06/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether CSF biomarkers can be used as a predictor of freezing of gait (FOG) in Parkinson disease (PD) and to investigate the predictive value of clinical, dopamine transporter (DAT) imaging, and CSF parameters both separately and in combination. METHODS This study using the PPMI data included 393 patients with newly diagnosed PD without FOG at baseline. We evaluated CSF for β-amyloid 1-42 (Aβ42), α-synuclein, total tau, phosphorylated tau181, and the calculated ratio of Aβ42 to total tau at baseline. Demographic and clinical data and DAT imaging results were also investigated. Cox proportional-hazards regression analyses were performed to identify the factors predictive of FOG. From these results, we constructed a predictive model for the development of FOG. RESULTS During a median follow-up of 4.0 years, only Aβ42 among the CSF biomarkers was associated with the development of FOG (hazard ratio 0.997, 95% confidence interval [CI] 0.996-0.999, p = 0.009). Postural instability gait difficulty (PIGD) score, caudate DAT uptake, and, to a lesser extent, male sex, Movement Disorders Society Unified Parkinson's Disease Rating Scale motor score, and Montreal Cognitive Assessment score were also predictive of FOG. The combined model integrating the PIGD score, caudate DAT uptake, and CSF Aβ42 achieved a better discriminative ability (area under the curve 0.755, 95% CI 0.700-0.810) than any factor alone. CONCLUSION We found CSF Aβ42 to be a predictor of FOG in patients with early PD. Furthermore, the development of FOG within 4 years after diagnosis of PD can be predicted with acceptable accuracy with our risk model.
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Affiliation(s)
- Ryul Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Joongyub Lee
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Han-Joon Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Aryun Kim
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Mihee Jang
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
| | - Beomseok Jeon
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY.
| | - Un Jung Kang
- From the Department of Neurology (R.K., H.-J.K., A.K., B.J.), Seoul National University Hospital, College of Medicine; Department of Neurology (R.K.), Aerospace Medical Center, Republic of Korea Air Force, Cheongju; Medical Research Collaborating Center (J.L.), Seoul National University Hospital; Department of Neurology (M.J.), Presbyterian Medical Center, Jeonju, Republic of Korea; and Department of Neurology (U.J.K.), Columbia University Medical Center, New York, NY
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Bekkers EMJ, Dijkstra BW, Heremans E, Verschueren SMP, Bloem BR, Nieuwboer A. Balancing between the two: Are freezing of gait and postural instability in Parkinson's disease connected? Neurosci Biobehav Rev 2018; 94:113-125. [PMID: 30125601 DOI: 10.1016/j.neubiorev.2018.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 01/11/2023]
Abstract
Postural instability and freezing of gait (FoG) are key features of Parkinson's disease (PD) closely related to falls. Growing evidence suggests that co-existing postural deficits could influence the occurrence and severity of FoG. To date, the exact nature of this interrelationship remains largely unknown. We analyzed the complex interaction between postural instability and gait disturbance by comparing the findings available in the posturographic literature between patients with and without FoG. Results showed that FoG and postural instability are intertwined, can influence each other behaviorally and may coincide neurologically. The most common FoG-related postural deficits included weight-shifting impairments, and inadequate scaling and timing of postural responses most apparent at forthcoming postural changes under time constraints. Most likely, a negative cycle of combined and more severe postural deficits in people with FoG will enhance postural stability breakdown. As such, the wide brain network deficiencies involved in FoG may also concurrently influence postural stability. Future work needs to examine whether training interventions targeting both symptoms will have extra clinical benefits on fall frequency.
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Affiliation(s)
- E M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium; Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - B W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - E Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - S M P Verschueren
- Research Group for Musculoskeletal Research, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - A Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
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34
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Disease progression in Parkinson subtypes: the PPMI dataset. Neurol Sci 2018; 39:1971-1976. [PMID: 30109466 DOI: 10.1007/s10072-018-3522-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/02/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Discrete patterns of progression have been suggested for patients with Parkinson disease and presenting tremor dominant (TD) or postural instability gait disorders (PIGD). However, longitudinal prospective assessments need to take into consideration the variability in clinical manifestations and the evidence that only 40% of initially classified PIGD remain in this subtype at subsequent visits. METHODS We analyzed clinical progression of PIGD compared to TD using longitudinal clinical data from the PPMI. Given the reported instability of such clinical classification, we only included patients who were reported as PIGD/TD at each visit during the 4-year observation. We used linear mixed-effects models to test differences in progression in these subgroups in 51 dependent variables. RESULTS There were 254 patients with yearly assessment. The number of PIGD was 36/254 vs 144/254 TD. PIGD had more severe motor disease at baseline but progressed faster than TD only in three non-motor items of the MDS-UPDRS: cognitive impairment, hallucinations, and psychosis plus features of DDS. Our analysis also showed in PIGD faster increase in the average time with dyskinesia. CONCLUSIONS PIGD are characterized by more severe disease manifestations at diagnosis and greater cognitive progression, more frequent hallucinations, psychosis as well as features of DDS than TD patients. We interpret these findings as expression of greater cortical and subcortical involvement in PIGD already at onset. Since PIGD/TD classification is very unstable at onset, our analysis based on stricter definition criteria provides important insight for clinical trial stratification and definition of related outcome measures.
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35
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Bekkers EMJ, Dockx K, Devan S, Van Rossom S, Verschueren SMP, Bloem BR, Nieuwboer A. The Impact of Dual-Tasking on Postural Stability in People With Parkinson’s Disease With and Without Freezing of Gait. Neurorehabil Neural Repair 2018; 32:166-174. [DOI: 10.1177/1545968318761121] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Esther M. J. Bekkers
- KU Leuven, Leuven, Belgium
- Radboud University Medical Center, Nijmegen, the Netherlands
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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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Rabel C, Le Goff F, Lefaucheur R, Ozel G, Fetter D, Rouillé A, Maltête D. Subjective Perceived Motor Improvement after Acute Levodopa Challenge in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:779-785. [PMID: 27662330 DOI: 10.3233/jpd-160906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies found a poor association between parkinsonian patient's reported subjective improvement after commencing dopaminergic treatment and improvements in objective measures of motor impairment by clinician. OBJECTIVE To compare PD patient's subjective perceived motor improvement after acute levodopa challenge test with objective motor improvement assessed by the clinician using the UPDRS part III. To analyze clinical characteristics, i.e. age, disease duration, cognitive performance or severity of axial features, that may have influenced patient's perception. METHODS Fifty-seven consecutive PD patients (23 women, 34 men; mean age, 63.4±7.7 years) (Hoehn and Yahr off score, 2.5±0.7; mean disease duration, 11.4±4.1 years) completed the acute levodopa challenge. The percentage of improvement in motor disability, i.e. objective motor improvement, was determined with respect to the off-drug condition. RESULTS Bland & Altman visual analysis reveals a high degree of correlation between objective and subjective perceived motor improvement. Both the axial sub-scores in the off- and on-state (respectively, P = 0.006 and P = 0.024) and the presence of peak-dose dyskinesia (P = 0.043) significantly influence the difference between objective and subjective perceived motor improvement. CONCLUSIONS This is the first study reporting on how PD patients assessed their motor improvement after acute levodopa challenge. These findings suggest a strong correlation between objective motor improvement assessed by the clinician using the UPDRS part III and subjective perceived motor improvement reported by the patient.
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Affiliation(s)
- Constance Rabel
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Floriane Le Goff
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Romain Lefaucheur
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Gulden Ozel
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Damien Fetter
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - Audrey Rouillé
- Department of Neurology, Rouen University Hospital and University of Rouen, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital and University of Rouen, France.,INSERM U1073, Rouen, France
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Arie L, Herman T, Shema-Shiratzky S, Giladi N, Hausdorff JM. Do cognition and other non-motor symptoms decline similarly among patients with Parkinson's disease motor subtypes? Findings from a 5-year prospective study. J Neurol 2017; 264:2149-2157. [PMID: 28879438 DOI: 10.1007/s00415-017-8605-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
Among patients with Parkinson's disease (PD), a wide range of motor and non-motor symptoms (NMS) are evident. PD is often divided into tremor dominant (TD) and postural instability gait difficulty (PIGD) motor subtypes. We evaluated the effect of disease duration and aimed to characterize whether there are differences in the deterioration of cognitive function and other NMS between the PIGD and TD subtypes. Sixty-three subjects were re-evaluated at the follow-up visit about 5 years after baseline examination. Cognitive function and other NMS were assessed. At follow-up, the PIGD and TD groups were similar with respect to medications, comorbidities and disease-related symptoms. There was a significant time effect for all measures, indicating deterioration and worsening in both groups. However, cognitive scores, particularly those related to executive function, became significantly worse in the PIGD with a more moderate decrease in the TD group. For example, the computerized global cognitive score declined in the PIGD group from 94.21 ± 11.88 to 83.91 ± 13.76, p < 0.001. This decline was significantly larger (p = 0.03) than the decrease observed in the TD group (96.56 ± 10.29 to 92.21 ± 14.20, p = 0.047). A significant group × time interaction effect was found for the change in global cognitive score (p = 0.047), the executive function index (p = 0.002) and accuracy on a motor-cognitive catch game (p = 0.008). In contrast, several NMS including depression, health-related quality of life and fear of falling deteriorated in parallel in both subtypes, with no interaction effect. The present findings highlight the difference in the natural history of the disease between the two PD "motor" subtypes. While the PIGD group demonstrated a significant cognitive decline, especially in executive functions, a more favorable course was observed in the TD subtype. This behavior was not seen in regards to the other NMS.
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Affiliation(s)
- L Arie
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.
| | - S Shema-Shiratzky
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - N Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA
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Emamzadeh FN. Role of Apolipoproteins and α-Synuclein in Parkinson's Disease. J Mol Neurosci 2017; 62:344-355. [PMID: 28695482 PMCID: PMC5541107 DOI: 10.1007/s12031-017-0942-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is a progressive brain disorder that interferes with activities of normal life. The main pathological feature of this disease is the loss of more than 80% of dopamine-producing neurons in the substantia nigra (SN). Dopaminergic neuronal cell death occurs when intraneuronal, insoluble, aggregated proteins start to form Lewy bodies (LBs), the most important component of which is a protein called α-synuclein (α-syn). α-Syn structurally contains hexameric repeats of 11 amino acids, which are characteristic of apolipoproteins and thus α-syn can also be considered an apolipoprotein. Moreover, apolipoproteins seem to be involved in the incidence and development of PD. Some apolipoproteins such as ApoD have a neuroprotective role in the brain. In PD, apoD levels increase in glial cells surrounding dopaminergic cells. However, elevated levels of some other apolipoproteins such as ApaA1 and ApoE are reported as a vulnerability factor of PD. At present, when a clinical diagnosis of PD is made, based on symptoms such as shaking, stiff muscles and slow movement, serious damage has already been done to nerve cells of the SN. The diagnosis of PD in its earlier stages, before this irreversible damage, would be of enormous benefit for future treatment strategies designed to slow or halt the progression of PD. This review presents the roles of apolipoproteins and α-syn in PD and how some of them could potentially be used as biomarkers for PD.
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Affiliation(s)
- Fatemeh Nouri Emamzadeh
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, LA1 4AY, UK.
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40
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Factor SA, McDonald WM, Goldstein FC. The role of neurotransmitters in the development of Parkinson's disease-related psychosis. Eur J Neurol 2017; 24:1244-1254. [PMID: 28758318 DOI: 10.1111/ene.13376] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/27/2017] [Indexed: 01/29/2023]
Abstract
Psychotic symptoms are common, disabling non-motor features of Parkinson's disease (PD). Despite noted heterogeneity in clinical features, natural history and therapy response, current dogma posits that psychosis generally progresses in a stereotypic manner through a cascade of events that begins with minor hallucinations and evolves to severe hallucinations and delusions. Further, the occurrence of psychotic symptoms is believed to indicate a poor prognosis. Here we propose a classification scheme that outlines the pathogenesis of psychosis as it relates to dysfunction of several neurotransmitter systems. We hypothesize that several subtypes exist, and that PD psychosis is not consistently indicative of a progressive cascade and poor prognosis. The literature was reviewed from 1990 to 2017. An overview of the features of PD psychosis is followed by a review of data indicating the existence of neurotransmitter-related subtypes of psychosis. We found that ample evidence exists to demonstrate the presence of multiple subtypes of PD psychosis, which are traced to dysfunction of the following neurotransmitter systems: dopamine, serotonin and acetylcholine. Dysfunction of each of these systems is recognizable through their clinical features and correlates, and the varied long-term prognoses. Identifying which neurotransmitter system is dysfunctional may help to develop targeted therapies. PD psychosis has various subtypes that differ in clinical features, underlying pathology and pathophysiology, treatment response and prognosis. A novel classification scheme is presented that describes the clinical subtypes with different outcomes, which could lead to the development of targeted therapies. Future research should focus on testing the viability of this classification.
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Affiliation(s)
- S A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - W M McDonald
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - F C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
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Claassen DO, McDonell KE, Donahue M, Rawal S, Wylie SA, Neimat JS, Kang H, Hedera P, Zald D, Landman B, Dawant B, Rane S. Cortical asymmetry in Parkinson's disease: early susceptibility of the left hemisphere. Brain Behav 2016; 6:e00573. [PMID: 28031997 PMCID: PMC5167000 DOI: 10.1002/brb3.573] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Clinically, Parkinson's disease (PD) presents with asymmetric motor symptoms. The left nigrostriatal system appears more susceptible to early degeneration than the right, and a left-lateralized pattern of early neuropathological changes is also described in several neurodegenerative conditions, including Alzheimer's disease, frontotemporal dementia, and Huntington's disease. In this study, we evaluated hemispheric differences in estimated rates of atrophy in a large, well-characterized cohort of PD patients. METHODS Our cohort included 205 PD patients who underwent clinical assessments and T1-weighted brain MRI's. Patients were classified into Early (n = 109) and Late stage (n = 96) based on disease duration, defined as greater than or less than 10 years of motor symptoms. Cortical thickness was determined using FreeSurfer, and a bootstrapped linear regression model was used to estimate differences in rates of atrophy between Early and Late patients. RESULTS Our results show that patients classified as Early stage exhibit a greater estimated rate of cortical atrophy in left frontal regions, especially the left insula and olfactory sulcus. This pattern was replicated in left-handed patients, and was not influenced by the degree of motor symptom asymmetry (i.e., left-sided predominant motor symptoms). Patients classified as Late stage exhibited greater atrophy in the bilateral occipital, and right hemisphere-predominant cortical areas. CONCLUSIONS We show that cortical degeneration in PD differs between cerebral hemispheres, and findings suggest a pattern of early left, and late right hemisphere with posterior cortical atrophy. Further investigation is warranted to elucidate the underlying mechanisms of this asymmetry and pathologic implications.
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Affiliation(s)
| | | | - Manus Donahue
- Vanderbilt University Institute of Imaging Science Nashville TN USA
| | - Shiv Rawal
- Meharry Medical College Nashville TN USA
| | - Scott A Wylie
- Department of Neurology Vanderbilt University Nashville TN USA
| | - Joseph S Neimat
- Department of Neurosurgery University of Louisville Louisville KY USA
| | - Hakmook Kang
- Department of Biostatistics Vanderbilt University Nashville TN USA
| | - Peter Hedera
- Department of Neurology Vanderbilt University Nashville TN USA
| | - David Zald
- Department of Psychology Vanderbilt University Nashville TN USA
| | - Bennett Landman
- Department of Electrical Engineering Vanderbilt University Nashville TN USA
| | - Benoit Dawant
- Department of Electrical Engineering Vanderbilt University Nashville TN USA
| | - Swati Rane
- Vanderbilt University Institute of Imaging Science Nashville TN USA
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Cooper CA, Jain N, Gallagher MD, Weintraub D, Xie SX, Berlyand Y, Espay AJ, Quinn J, Edwards KL, Montine T, Van Deerlin VM, Trojanowski J, Zabetian CP, Chen-Plotkin AS. Common variant rs356182 near SNCA defines a Parkinson's disease endophenotype. Ann Clin Transl Neurol 2016; 4:15-25. [PMID: 28078311 PMCID: PMC5221454 DOI: 10.1002/acn3.371] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 01/11/2023] Open
Abstract
Objective Parkinson's disease (PD) presents clinically with several motor subtypes that exhibit variable treatment response and prognosis. Here, we investigated genetic variants for their potential association with PD motor phenotype and progression. Methods We screened 10 SNPs, previously associated with PD risk, for association with tremor‐dominant (TD) versus postural‐instability gait disorder (PIGD) motor subtypes. SNPs that correlated with the TD/PIGD ratio in a discovery cohort of 251 PD patients were then evaluated in a multi‐site replication cohort of 559 PD patients. SNPs associated with motor phenotype in both cross‐sectional cohorts were next evaluated for association with (1) rates of motor progression in a longitudinal subgroup of 230 PD patients and (2) brain alpha‐synuclein (SNCA) expression in the GTEx (Genotype‐Tissue Expression project) consortium database. Results Genotype at rs356182, near SNCA, correlated with the TD/PIGD ratio in both the discovery (Bonferroni‐corrected P = 0.04) and replication cohorts (P = 0.02). The rs356182 GG genotype was associated with a more tremor‐predominant phenotype and predicted a slower rate of motor progression (1‐point difference in annual rate of UPDRS‐III motor score change, P = 0.01). The rs356182 genotype was associated with SNCA expression in the cerebellum (P = 0.005). Interpretation Our study demonstrates that the GG genotype at rs356182 provides molecular definition for a clinically important endophenotype associated with (1) more tremor‐predominant motor phenomenology, (2) slower rates of motor progression, and (3) decreased brain expression of SNCA. Such molecularly defined endophenotyping in PD may benefit both clinical trial design and tailoring of clinical care as we enter the era of precision medicine.
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Affiliation(s)
- Christine A Cooper
- Department of Neurology Medical University of South Carolina Charleston South Carolina; Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Nimansha Jain
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Michael D Gallagher
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Daniel Weintraub
- Department of Psychiatry Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Yosef Berlyand
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania; Harvard Medical School Boston Massachusetts
| | - Alberto J Espay
- Department of Neurology University of Cincinnati Cincinnati Ohio
| | - Joseph Quinn
- Department of Neurology Oregon Health and Science University Portland Oregon
| | - Karen L Edwards
- Department of Epidemiology University of California Irvine Irvine California
| | - Thomas Montine
- Department of Pathology University of Washington Seattle Washington
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - John Trojanowski
- Department of Pathology and Laboratory Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Cyrus P Zabetian
- Department of Neurology VA Puget Sound Health Care System University of Washington Seattle Washington
| | - Alice S Chen-Plotkin
- Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
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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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Vervoort G, Leunissen I, Firbank M, Heremans E, Nackaerts E, Vandenberghe W, Nieuwboer A. Structural Brain Alterations in Motor Subtypes of Parkinson's Disease: Evidence from Probabilistic Tractography and Shape Analysis. PLoS One 2016; 11:e0157743. [PMID: 27314952 PMCID: PMC4912098 DOI: 10.1371/journal.pone.0157743] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The postural instability and gait disorder (PIGD) and tremor dominant (TD) subtypes of Parkinson's disease (PD) show different patterns of alterations in functional connectivity (FC) between specific brain regions. This study aimed to investigate the relation between symptomatic heterogeneity in PD and structural alterations underlying these FC changes. METHODS 68 PD patients classified as PIGD (n = 41) or TD (n = 19) and 19 age-matched controls underwent Magnetic Resonance Imaging (MRI). Diffusion-weighted images were used to assess fractional anisotropy (FA) and mean diffusivity (MD) at the whole-brain level using tract-based spatial statistics (TBSS). In addition, structural connectivity was assessed between regions that previously showed altered FC using probabilistic tractography. Anatomical images were used to determine shape and volume of the putamen, caudate and pallidum. RESULTS TBSS revealed widespread FA reductions in PIGD compared to controls involving the superior longitudinal fasciculi and corpus callosum. No such differences were found in TD. Both PD subgroups had increased MD compared to controls in tracts connecting the left caudate with the bilateral ventral putamen. TD patients additionally showed increased MD compared to PIGD and controls in tracts connecting the right inferior parietal lobule with the right premotor and primary motor cortex, which previously showed altered FC. We also found grey matter atrophy in the rostrodorsal head of the caudate in PIGD compared to controls. CONCLUSION Microstructural changes in white matter tracts, particularly in those connecting striatal sub-areas, partly underlie FC alterations in PD subtypes. Caudate shape alterations further implicate the striatum in PIGD pathophysiology.
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Affiliation(s)
- Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001, Leuven, Belgium
- * E-mail:
| | - Inge Leunissen
- KU Leuven, Department of Kinesiology, Tervuursevest 101/1501, 3001, Leuven, Belgium
| | - Michael Firbank
- Institute of Neuroscience and Newcastle University Institute for Ageing, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Elke Heremans
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001, Leuven, Belgium
| | - Evelien Nackaerts
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001, Leuven, Belgium
| | - Wim Vandenberghe
- University Hospitals Leuven, Department of Neurology, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Neurosciences, Herestraat 49, 3000, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001, Leuven, Belgium
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45
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Claassen DO, Dobolyi DG, Isaacs DA, Roman OC, Herb J, Wylie SA, Neimat JS, Donahue MJ, Hedera P, Zald DH, Landman BA, Bowman AB, Dawant BM, Rane S. Linear and Curvilinear Trajectories of Cortical Loss with Advancing Age and Disease Duration in Parkinson's Disease. Aging Dis 2016; 7:220-9. [PMID: 27330836 PMCID: PMC4898918 DOI: 10.14336/ad.2015.1110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 11/20/2022] Open
Abstract
Advancing age and disease duration both contribute to cortical thinning in Parkinson’s disease (PD), but the pathological interactions between them are poorly described. This study aims to distinguish patterns of cortical decline determined by advancing age and disease duration in PD. A convenience cohort of 177 consecutive PD patients, identified at the Vanderbilt University Movement Disorders Clinic as part of a clinical evaluation for Deep Brain Stimulation (age: M= 62.0, SD 9.3), completed a standardized clinical assessment, along with structural brain Magnetic Resonance Imaging scan. Age and gender matched controls (n=53) were obtained from the Alzheimer Disease Neuroimaging Initiative and Progressive Parkinson’s Marker Initiative (age: M= 63.4, SD 12.2). Estimated changes in cortical thickness were modeled with advancing age, disease duration, and their interaction. The best-fitting model, linear or curvilinear (2nd, or 3rd order natural spline), was defined using the minimum Akaike Information Criterion, and illustrated on a 3-dimensional brain. Three curvilinear patterns of cortical thinning were identified: early decline, late decline, and early-stable-late. In contrast to healthy controls, the best-fit model for age related changes in PD is curvilinear (early decline), particularly in frontal and precuneus regions. With advancing disease duration, a curvilinear model depicts accelerating decline in the occipital cortex. A significant interaction between advancing age and disease duration is evident in frontal, motor, and posterior parietal areas. Study results support the hypothesis that advancing age and disease duration differentially affect regional cortical thickness and display regional dependent linear and curvilinear patterns of thinning.
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Affiliation(s)
- Daniel O Claassen
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - David G Dobolyi
- 2McIntire School of Commerce, University of Virginia, Charlottesville, VA 22904, USA
| | - David A Isaacs
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - Olivia C Roman
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - Joshua Herb
- 3Department of Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Scott A Wylie
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - Joseph S Neimat
- 4Department of Neurosurgery, Vanderbilt University, Nashville, TN 37235, USA
| | - Manus J Donahue
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA; 5Department of Radiology, Vanderbilt University, Nashville, TN 37235, USA
| | - Peter Hedera
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - David H Zald
- 6Department of Psychology, Vanderbilt University, Nashville, TN 37235, USA
| | - Bennett A Landman
- 5Department of Radiology, Vanderbilt University, Nashville, TN 37235, USA; 7Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Aaron B Bowman
- 1Department of Neurology, Vanderbilt University, Nashville, TN 37235, USA
| | - Benoit M Dawant
- 7Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Swati Rane
- 5Department of Radiology, Vanderbilt University, Nashville, TN 37235, USA
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Heremans E, Nackaerts E, Broeder S, Vervoort G, Swinnen SP, Nieuwboer A. Handwriting Impairments in People With Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair 2016; 30:911-919. [PMID: 27094858 DOI: 10.1177/1545968316642743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies show that patients with Parkinson's disease (PD) and freezing of gait (FOG) experience motor problems outside their gait freezing episodes. Because handwriting is also a sequential movement, it may be affected in PD patients with FOG relative to those without. OBJECTIVE The current study aimed to assess the quality of writing in PD patients with and without FOG in comparison to healthy controls (CTs) during various writing tasks. METHODS Handwriting was assessed by the writing of cursive loops on a touch-sensitive writing tablet and by means of the Systematic Screening of Handwriting Difficulties (SOS) test in 30 PD patients with and without freezing and 15 healthy age-matched CTs. The tablet tests were performed at 2 different sizes, either continuously or alternatingly, as indicated by visual target lines. RESULTS Patients with freezing showed decreased writing amplitudes and increased variability compared with CTs and patients without freezing on the writing tablet tests. Writing problems were present during both tests but were more pronounced during writing at alternating compared with writing at continuous size. Patients with freezing also had a higher total score on the SOS test than patients without freezing and CTs, reflecting more extensive handwriting problems, particularly with writing fluency. CONCLUSIONS Writing is more severely affected in PD patients with FOG than in those without FOG. These results indicate that deficient movement sequencing and adaptation is a generic problem in patients with FOG.
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48
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Vervoort G, Alaerts K, Bengevoord A, Nackaerts E, Heremans E, Vandenberghe W, Nieuwboer A. Functional connectivity alterations in the motor and fronto-parietal network relate to behavioral heterogeneity in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:48-55. [PMID: 26924603 DOI: 10.1016/j.parkreldis.2016.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Insight into the neural mechanisms of postural instability and gait disorder (PIGD) and tremor dominant (TD) subtypes in Parkinson's disease (PD) is indispensable for generating pathophysiology hypotheses underlying this phenotyping. This cross-sectional study aimed to gain insight in specific and brain-wide functional connectivity (FC) and its correlation with motor deterioration and preservation in PD subtypes. METHODS 68 PD patients classified as PIGD (n = 41), TD (n = 19) or indeterminate (n = 8) and 19 age-matched controls underwent resting-state fMRI while 'off' medication to assess FC between regions of interest (ROIs) in the motor and fronto-parietal network and on a whole-brain level using a parcellated template. FC alterations were correlated with quantitative behavioral measures. RESULTS ROI-analyses showed decreased FC between the caudate and putamen in PIGD compared to TD. This hypo-connectivity was correlated with behavioral impairment. In contrast, TD-specific hyper-connectivity between motor cortical areas and the inferior parietal lobule correlated with less behavioral impairment, suggesting compensatory mechanisms. Both subgroups showed hyper-connectivity between the left supplementary motor area and pedunculopontine nucleus, whereas PIGD-specific right lateralized hyper-connectivity was shown between this nucleus and the premotor cortex. Whole-brain analyses revealed 65% hypo-connectivity and 35% hyper-connectivity in PIGD compared to TD. TD also revealed primarily hypo-connectivity compared to controls, but had more pronounced hyper-connectivity involving temporo-occipital areas. CONCLUSION This multilevel analysis showed differential connectivity alterations in large scale neural networks and between motor and cognitive control areas that related to behavioral heterogeneity in PD, underscoring the classic TD-PIGD phenotypical classification.
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Affiliation(s)
- Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Kaat Alaerts
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Aniek Bengevoord
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Evelien Nackaerts
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Elke Heremans
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Wim Vandenberghe
- University Hospitals Leuven, Department of Neurology, Herestraat 49, 3000 Leuven, Belgium.
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
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Deng X, Xiao B, Li HH, Lo YL, Chew LM, Prakash KM, Tan EK. Sexual dysfunction is associated with postural instability gait difficulty subtype of Parkinson's disease. J Neurol 2015. [PMID: 26210749 DOI: 10.1007/s00415-015-7855-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The pathophysiology of the postural instability gait difficulty (PIGD) subtype of Parkinson's disease (PD) is unclear. Information on the spectrum of non-motor symptoms (NMS) in PIGD phenotype is limited. Our objective is to compare the spectrum of NMS in PIGD subtype compared to non-PIGD subgroup in PD patients and to determine predictive factors that are associated with PIGD phenotype. A total of 432 PD patients comprising 158 PIGD and 274 non-PIGD patients were recruited. NMS burden (frequency and severity) was assessed using non-motor symptom scale (NMSS). In the univariable analysis, NMSS total score (P = 0.0132), NMSS domain 3 (mood/apathy) score (P = 0.0108), NMSS domain 5 (attention/memory) score (P = 0.0048) and NMSS domain 8 (sexual function) score (P = 0.0052) were significantly higher in the PIGD group than in the non-PIGD group. Using multivariable logistic regression, UPDRS tremor score, UPDRS PIGD score, H&Y staging score and NMSS domain 8 (sexual function) score were found to be significantly different in the PIGD group compared to the non-PIGD group. We disclosed for the first time that PIGD patients demonstrated a greater overall NMS burden and sexual dysfunction and was an independent predictor of PIGD phenotype. Early intervention of sexual dysfunction symptoms in PIGD patients may improve their clinical management.
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Affiliation(s)
- Xiao Deng
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, China
| | - Bin Xiao
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, China
| | - Hui-Hua Li
- Department of Clinical Research, Singapore General Hospital, Singapore, 169608, Singapore
| | - Yew-Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Lai-Mun Chew
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, 169608, Singapore. .,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore.
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50
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Freezing of gait and affective theory of mind in Parkinson disease. Parkinsonism Relat Disord 2015; 21:509-13. [DOI: 10.1016/j.parkreldis.2015.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/28/2015] [Accepted: 02/22/2015] [Indexed: 11/22/2022]
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